So I was privileged to train in transplantation under two great surgical pioneers: Thomas Starzl, who performed the world's first successful liver transplant in 1967, and Sir Roy Calne, who performed the first liver transplant in the U.K. in the following year. I returned to Singapore and, in 1990, performed Asia's first successful cadaveric liver transplant procedure, but against all odds. Now when I look back, the transplant was actually the easiest part. Next, raising the money to fund the procedure. But perhaps the most challenging part was to convince the regulators -- a matter which was debated in the parliament -- that a young female surgeon be allowed the opportunity to pioneer for her country. But 20 years on, my patient, Surinder, is Asia's longest surviving cadaveric liver transplant to date. (Applause) And perhaps more important, I am the proud godmother to her 14 year-old son.
能在兩位偉大的外科先驅者 手下學習移植手術,是我的榮幸。 一位是湯馬斯·史塔哲, 於1967年成為世界上第一個 成功完成肝臟移植手術的人﹐ 以及萊伊·卡恩爵士, 於一年後﹐成為在英國第一個 進行肝臟移植手術的人。 我回到新加坡﹐ 然後,於1990年 完成了亞洲首宗 屍肝移植手術, 儘管手術困難重重。 如今當我再檢討時﹐ 手術部分其實是最簡單的。 其次就是湊錢去籌備手術的經費。 但最具挑戰性的部分 就是要說服監管者 - 這件事曾於議會受爭議 - 去讓一位年輕女外科醫生 獲得能為自己國家 作出創舉的機會。 但20年過去了﹐ 而我的病人,薩倫德, 是到目前為止﹐於亞洲生存最長久的 屍肝移植手術的例子。 (掌聲) 但更重要的是, 我有幸成為她 14歲兒子的教母。
(Applause)
(掌聲)
But not all patients on the transplant wait list are so fortunate. The truth is, there are just simply not enough donor organs to go around. As the demand for donor organs continues to rise, in large part due to the aging population, the supply has remained relatively constant. In the United States alone, 100,000 men, women and children are on the waiting list for donor organs, and more than a dozen die each day because of a lack of donor organs. The transplant community has actively campaigned in organ donation. And the gift of life has been extended from brain-dead donors to living, related donors -- relatives who might donate an organ or a part of an organ, like a split liver graft, to a relative or loved one.
但並不是所有正在輪候移植手術的病人 都是如此幸運。 事實上﹐ 所捐獻的器官根本未能足夠 去被妥善配置。 每當對捐獻器官的需求 主要由於人口老化而 持續上升﹐ 供應量仍是相對的維持不變。 僅在美國, 已經有10萬人,包括男人﹑女人及小孩 正為得到捐助器官而輪候﹐ 而且每天有十幾人﹐ 正因缺乏捐獻的器官而死亡。 器官移植界 曾積極推廣器官捐獻的活動。 而饋贈生命的意念﹐ 已經 從腦死亡的捐獻者 被延續至還在世的﹑有血緣關係的捐獻者 - 包括會將整個器官﹑或器官的一部份 捐贈的親屬﹐ 例如將肝臟分割移植 到親屬或所愛的人身上。
But as there was still a dire shortage of donor organs, the gift of life was then extended from living, related donors to now living, unrelated donors. And this then has given rise to unprecedented and unexpected moral controversy. How can one distinguish a donation that is voluntary and altruistic from one that is forced or coerced from, for example, a submissive spouse, an in-law, a servant, a slave, an employee? Where and how can we draw the line? In my part of the world, too many people live below the poverty line. And in some areas, the commercial gifting of an organ in exchange for monetary reward has led to a flourishing trade in living, unrelated donors.
但由於所捐贈器官仍是嚴重短缺, 捐贈範圍再次被擴大﹐ 由還在世的﹑有血緣關係的捐獻者﹐ 伸延至還在世的﹑非血緣關係的捐獻者。 因此就引發了一場 前所未有﹐以及意料之外的 道德上的爭議。 我們如何才能辨別 一位出於自願和無私的捐獻者﹐ 以及一位被迫或受強制的捐獻者﹖ 例如﹐ 一個唯命是從的配偶﹑一個媳婿﹑ 一個僕人﹑一個奴隸, 或者一位僱員? 我們應該於那裡﹑以及怎樣劃清這條界線呢﹖ 於我的日常生活的四週﹐ 太多人活在貧困線之下。 而在一些地區, 由非血緣關係者 去透過活體器官捐贈 而換取金錢上的報酬﹐ 已經是非常盛行的一種商業交易。
Shortly after I performed the first liver transplant, I received my next assignment, and that was to go to the prisons to harvest organs from executed prisoners. I was also pregnant at the time. Pregnancies are meant to be happy and fulfilling moments in any woman's life. But my joyful period was marred by solemn and morbid thoughts -- thoughts of walking through the prison's high-security death row, as this was the only route to take me to the makeshift operating room. And at each time, I would feel the chilling stares of condemned prisoners' eyes follow me. And for two years, I struggled with the dilemma of waking up at 4:30 am on a Friday morning, driving to the prison, getting down, gloved and scrubbed, ready to receive the body of an executed prisoner, remove the organs and then transport these organs to the recipient hospital and then graft the gift of life to a recipient the same afternoon. No doubt, I was informed, the consent had been obtained.
在完成首宗肝臟移植后不久, 我接到的下一個工作 便是到監獄裡面﹐ 從被處決的死囚身上 獲取器官。 那時我還正懷了孕。 懷孕﹐ 對任何一位女人而言﹐是一段 讓人快樂及感到充實的時光。 但我這段本應是喜悅的時期﹐ 卻被一陣陣幽暗的﹑帶著死亡氣息的思想沾污 - 回想著我曾步過 監獄裡最高嚴密的死囚區, 因為那是到達臨時手術室的 唯一的一條路。 而每當那時, 我就能感受到那些 用令人毛骨悚然的目光﹐跟隨著我的死囚的眼睛。 接下來的兩年, 我都於這困境中掙扎﹐ 每個周五早上 於凌晨四點半起床, 開車去到監獄﹐ 到地庫﹑戴上手套﹑消毒﹐ 準備接收一具 被處決的死囚的屍體﹐ 從之切出器官﹐ 再將這些器官帶回 接受移植者的醫院﹐ 然後再於同一天下午﹐ 給接受者移植器官﹐從而贈予新生命。 當然﹐他們都說 器官捐贈是獲得當事人同意。
But, in my life, the one fulfilling skill that I had was now invoking feelings of conflict -- conflict ranging from extreme sorrow and doubt at dawn to celebratory joy at engrafting the gift of life at dusk. In my team, the lives of one or two of my colleagues were tainted by this experience. Some of us may have been sublimated, but really none of us remained the same. I was troubled that the retrieval of organs from executed prisoners was at least as morally controversial as the harvesting of stem cells from human embryos. And in my mind, I realized as a surgical pioneer that the purpose of my position of influence was surely to speak up for those who have no influence. It made me wonder if there could be a better way -- a way to circumvent death and yet deliver the gift of life that might exponentially impact millions of patients worldwide.
但於我生命中﹐ 我所唯一擁有的﹑令我滿足的技能﹐ 現今竟然產生了情感上的衝突 - 這種衝突包括 從清晨時的極度悲傷和疑慮﹐至到 黃昏時慶祝 因器官移植而給予病人重生的喜悅。 於我的團隊中, 有一兩位同事的一生 也就因這樣的經歷而矇上污點。 我們當中的一些人可能已經麻木了﹐ 但實際上沒有人不受到感染。 我很困擾﹐ 這種從死囚上取得器官的做法﹐ 至少在道德上是與 從人類胚胎中抓取幹細胞一樣 受到同等程度上的爭議。 而且我認為, 身為一位外科手術的先鋒者﹐ 擁有具影響力的地位的存在意義﹐ 就是在於可以替那些 沒有影響力的人發言。 這令我自問 究竟有沒有更好的方法 -- 一個可迴避牽涉死亡的﹑ 而又同時可贈予新生命的方法。 這樣就能為全世界成千上萬的病人﹐ 帶來指數級的影響力。
Now just about that time, the practice of surgery evolved from big to small, from wide open incisions to keyhole procedures, tiny incisions. And in transplantation, concepts shifted from whole organs to cells. In 1988, at the University of Minnesota, I participated in a small series of whole organ pancreas transplants. I witnessed the technical difficulty. And this inspired in my mind a shift from transplanting whole organs to perhaps transplanting cells. I thought to myself, why not take the individual cells out of the pancreas -- the cells that secrete insulin to cure diabetes -- and transplant these cells? -- technically a much simpler procedure than having to grapple with the complexities of transplanting a whole organ.
也就是在同一時間, 外科手術的技巧﹐進展到 從大到小, 從寬大的切口 到鎖孔式的 微創技術。 而且移植手術的概念﹐已從整個器官 移轉到細胞移植。 1988年,在明尼蘇達大學, 我參與了一系列小规模的 整個胰臟移植手術。 我親眼見證了此項技術的難度。 同時這啟發了我 去考慮將移植整個器官﹐ 轉移到細胞移植。 我在想, 何不考慮去將胰臟裡 個別的細胞提取 -- 即那些能分泌出胰島素而治愈糖尿病的細胞 -- 再將這些細胞移植呢?-- 技術上而言﹐這類程序﹐ 相比起要因進行整個器官移植﹐而要應付繁複的事項﹐ 來得簡單得多。
And at that time, stem cell research had gained momentum, following the isolation of the world's first human embryonic stem cells in the 1990s. The observation that stem cells, as master cells, could give rise to a whole variety of different cell types -- heart cells, liver cells, pancreatic islet cells -- captured the attention of the media and the imagination of the public. I too was fascinated by this new and disruptive cell technology, and this inspired a shift in my mindset, from transplanting whole organs to transplanting cells. And I focused my research on stem cells as a possible source for cell transplants.
同時間﹐ 幹細胞研究方面﹐ 亦繼於90年代時期﹐ 世上首次成功將 人類胚胎幹細胞分離以後﹐ 獲得了新的進展。 能將幹細胞用作母細胞 去發育成 一系列林林總總的細胞種類 -- 心肌細胞﹑肝細胞﹑ 胰島細胞 -- 這項發現﹐廣泛受到媒體關注﹐ 也激發了廣大市民的想象力。 我也因這種全新的﹑ 具影響力的細胞技術而著迷﹐ 思維亦被激發﹑而引起了轉變, 從將整個器官移植﹐ 轉移到細胞移植。 我把研究焦點﹐放在 利用幹細胞 作為細胞移植來源之中。
Today we realize that there are many different types of stem cells. Embryonic stem cells have occupied center stage, chiefly because of their pluripotency -- that is their ease in differentiating into a variety of different cell types. But the moral controversy surrounding embryonic stem cells -- the fact that these cells are derived from five-day old human embryos -- has encouraged research into other types of stem cells.
今日﹐我們了解到 有很多不同類型的幹細胞。 其中,胚胎幹細胞 已占據了中心地位, 主要是因為它的多能性-- 即是它們能輕鬆的分化成 一系列林林總總的細胞種類。 但是之所以胚胎幹細胞的範疇 在道德上備受爭議 -- 是因為這些細胞來源於 5天大的人類胚胎。 而正因為這種爭議﹐才更激勵人們去研究 其他類型的幹細胞。
Now to the ridicule of my colleagues, I inspired my lab to focus on what I thought was the most non-controversial source of stem cells, adipose tissue, or fat, yes fat -- nowadays available in abundant supply -- you and I, I think, would be very happy to get rid of anyway. Fat-derived stem cells are adult stem cells. And adult stem cells are found in you and me -- in our blood, in our bone marrow, in our fat, our skin and other organs. And as it turns out, fat is one of the best sources of adult stem cells. But adult stem cells are not embryonic stem cells. And here is the limitation: adult stem cells are mature cells, and, like mature human beings, these cells are more restricted in their thought and more restricted in their behavior and are unable to give rise to the wide variety of specialized cell types, as embryonic stem cells [can].
我在同事的嘲諷聲中, 將實驗焦點 放於我認為 最沒有爭議價值的幹細胞資源 -- 脂肪組織﹐即是脂肪﹐對﹐是脂肪 -- 現今可垂手可得的 -- 至少﹐我想像你和我一樣﹐都很樂意將它擺脫。 脂肪源幹細胞 是一種成體幹細胞。 而成體幹細胞是在 你和我身體內都能找到 -- 於我們的血液中﹑骨髓中﹑ 脂肪中﹑皮膚中﹐以及其他器官中。 而事實證明, 脂肪是成體幹細胞的 最佳來源之一。 但是成體幹細胞 並不是胚胎幹細胞。 它具有本身的限制﹕ 成體幹細胞是成熟的細胞, 而就像成年人一樣, 這些細胞﹐於思維上較為受到局限﹐ 於行為上亦較為受到局限﹐ 因此它們也無法像 胚胎幹細胞一般﹐可以分化成 多種具特定功能的細胞。
But in 2007, two remarkable individuals, Shinya Yamanaka of Japan and Jamie Thomson of the United States, made an astounding discovery. They discovered that adult cells, taken from you and me, could be reprogrammed back into embryonic-like cells, which they termed IPS cells, or induced pluripotent stem cells. And so guess what, scientists around the world and in the labs are racing to convert aging adult cells -- aging adult cells from you and me -- they are racing to reprogram these cells back into more useful IPS cells. And in our lab, we are focused on taking fat and reprogramming mounds of fat into fountains of youthful cells -- cells that we may use to then form other, more specialized, cells, which one day may be used as cell transplants. If this research is successful, it may then reduce the need to research and sacrifice human embryos.
但在2007年, 有兩位傑出人士 -- 日本的山中伸彌﹐ 以及美國的占美·湯臣 -- 作出了驚人的發現。 他們發現 那些取自你我身上的成體細胞﹐ 可以重組還原成 類似胚胎的細胞。 他們將之命名為IPS細胞, 或稱誘導培養多潛能幹細胞。 於是如你我所料﹐ 世界各地的﹑以及在實驗室中的科學家﹐ 都爭先恐後的 去將正在老化的成體細胞轉化 -- 那些取自你我身上的﹑正在老化的成體細胞 -- 他們都想搶先將這些細胞重組 成為更有用的IPS細胞。 而在實驗室裡, 我們專注于提取脂肪 以及將一堆堆的脂肪﹐ 重編成 如泉噴湧的幼年細胞 -- 那些可用作 轉化為其他 更為特定的細胞, 以便日後可用作細胞移植的用途。 如果這項研究成功的話, 它就能減少 要研究和犧牲 人類胚胎的需求。
Indeed, there is a lot of hype, but also hope that the promise of stem cells will one day provide cures for a whole range of conditions. Heart disease, stroke, diabetes, spinal cord injury, muscular dystrophy, retinal eye diseases -- are any of these conditions relevant, personally, to you?
事實上,當中有很多炒作,但亦同時存在 有朝一日可以利用幹細胞 去治療 一系列的病症的希望。 心臟病﹑中風﹑糖尿病﹑ 脊髓損傷﹑肌肉萎縮﹑ 視網膜疾病 -- 以上病症之中﹐ 有任何病症與您有切身的關係嗎﹖
In May 2006, something horrible happened to me. I was about to start a robotic operation, but stepping out of the elevator into the bright and glaring lights of the operating room, I realized that my left visual field was fast collapsing into darkness. Earlier that week, I had taken a rather hard knock during late spring skiing -- yes, I fell. And I started to see floaters and stars, which I casually dismissed as too much high-altitude sun exposure. What happened to me might have been catastrophic, if not for the fact that I was in reach of good surgical access. And I had my vision restored, but not before a prolonged period of convalescence -- three months -- in a head down position. This experience taught me to empathize more with my patients, and especially those with retinal diseases.
2006年5月, 有件可怕的事發生於我身上。 我正準備進行機械人手術﹐ 但當走出電梯 來到手術室的明亮炫目的手術燈下的一剎那, 我感覺到 左邊視野 突然陷入一片黑暗。 那週的早些時候, 我在春末滑雪時 受到了蠻重的一擊 -- 是的,我摔倒了。 接着我開始看到漂浮物和星星﹐ 當時我以為﹐那只是高海拔之下 過份曝晒於陽光下的緣故﹐並很快將事情拋諸腦後。 事件發生以後, 假如我當時沒有 機會接受優質的手術治療的話﹐ 可能就會引致一場大災難。 而我的視力恢復了﹐ 但亦要經過一段被預期中更長的康復期 -- 3個月 -- 當中一直要保持著頭向下的狀態。 這次經歷 教懂我更加體諒我的病人, 特別是那些有視網膜疾病的。
37 million people worldwide are blind, and 127 million more suffer from impaired vision. Stem cell-derived retinal transplants, now in a research phase, may one day restore vision, or part vision, to millions of patients with retinal diseases worldwide. Indeed, we live in both challenging as well as exciting times. As the world population ages, scientists are racing to discover new ways to enhance the power of the body to heal itself through stem cells.
世界上有3700萬人 患有失明﹐ 另外更有1億2700萬人 正承受著患有視力障礙的痛苦。 利用幹細胞源視網膜進行的移植手術﹐ 目前正處於研究階段, 它可能有天會幫助成千上萬 視網膜疾病患者﹐ 去恢復部分或全部視力。 事實上,我們生活於 一個富有挑戰﹑ 亦同時間令人刺激的時代。 隨著世界人口老化, 科學家們會不斷去搶先 尋求新的方法﹐ 去透過幹細胞提高人體機能﹐ 從而讓它自我復原。
It is a fact that when our organs or tissues are injured, our bone marrow releases stem cells into our circulation. And these stem cells then float in the bloodstream and hone in to damaged organs to release growth factors to repair the damaged tissue. Stem cells may be used as building blocks to repair damaged scaffolds within our body, or to provide new liver cells to repair damaged liver. As we speak, there are 117 or so clinical trials researching the use of stem cells for liver diseases.
事實上, 當器官或組織受損時, 我們的骨髓 會將幹細胞﹐釋放到 血液循環系統之中。 而這些幹細胞 會然後漂浮於血液中﹐ 再導向到受損的器官處﹐ 去釋放生長因子 來修復受損組織。 幹細胞可以像砌牆用的磚塊一般﹐ 用作修復身體中受損的支架, 或用作為新的肝細胞 來修復受損的肝臟。 就在這一刻﹐大約共有117個 研究利用幹細胞去治療肝臟疾病 的臨床實驗正在進行中。
What lies ahead? Heart disease is the leading cause of death worldwide. 1.1 million Americans suffer heart attacks yearly. 4.8 million suffer cardiac failure. Stem cells may be used to deliver growth factors to repair damaged heart muscle or be differentiated into heart muscle cells to restore heart function. There are 170 clinical trials investigating the role of stem cells in heart disease. While still in a research phase, stem cells may one day herald a quantum leap in the field of cardiology.
那麼﹐前景怎樣﹖ 心臟病 是世界上死亡的首要原因。 每年有110萬名美國人 心臟病發作。 有480萬人 患有心臟衰竭。 幹細胞可用作 供應生長因子 以至受損的心肌得到修復 也可以分化成 心肌細胞 去幫助回復心臟機能。 有170個臨床實驗 正在研究幹細胞在心臟疾病中﹐所扮演的角色。 雖然仍處於研究階段, 但幹細胞可能有朝一日 會預示心臟病學界的一個巨大的突破。
Stem cells provide hope for new beginnings -- small, incremental steps, cells rather than organs, repair rather than replacement. Stem cell therapies may one day reduce the need for donor organs. Powerful new technologies always present enigmas. As we speak, the world's first human embryonic stem cell trial for spinal cord injury is currently underway following the USFDA approval. And in the U.K., neural stem cells to treat stroke are being investigated in a phase one trial.
幹細胞帶來可獲得新開始的希望 -- 步伐是細小及漸進的﹐ 是用細胞﹑而不是用器官﹐ 是透過修復﹑而不是將之取替。 幹細胞療法 也許有一天會減少對於捐獻器官的需求。 有影響力的新科技 總是存有它的奧秘。 就在這一刻﹐ 世界上首次用人類胚胎幹細胞﹐治療脊髓受損的臨床實驗 在美國食品藥物管理局批准下 正在進行中。 同時在英國, 用神經幹細胞去治療中風的研究 亦正處於臨床實驗的初步階段。
The research success that we celebrate today has been made possible by the curiosity and contribution and commitment of individual scientists and medical pioneers. Each one has his story. My story has been about my journey from organs to cells -- a journey through controversy, inspired by hope -- hope that, as we age, you and I may one day celebrate longevity with an improved quality of life.
我們今天所慶賀的這些研究成果 是有賴 各位科學家及醫學界先鋒 於他們的探索精神驅使下﹐ 所作出的奉獻以及承諾。 每個人都有屬於自己的故事。 而我的故事就是我從器官移植 走到細胞移植的一段旅程 -- 一段歷盡爭議﹑ 卻憑著盼望作為動力的旅程 -- 盼望隨著我們年長時﹐ 可有朝一日﹐於更好的生活水平之下 去歡欣地安享晚年。
Thank you.
多謝。