under two great surgical pioneers:

能在兩位偉大的外科先驅者

Thomas Starzl,

手下學習移植手術，是我的榮幸。

who performed the world's first successful liver transplant

一位是湯馬斯·史塔哲，

in 1967,

於1967年成為世界上第一個

and Sir Roy Calne,

成功完成肝臟移植手術的人﹐

who performed the first liver transplant in the U.K.

以及萊伊·卡恩爵士，

in the following year.

於一年後﹐成為在英國第一個

I returned to Singapore

進行肝臟移植手術的人。

and, in 1990,

我回到新加坡﹐

performed Asia's first successful

然後，於1990年

cadaveric liver transplant procedure,

完成了亞洲首宗

but against all odds.

屍肝移植手術，

Now when I look back,

儘管手術困難重重。

the transplant was actually the easiest part.

如今當我再檢討時﹐

Next, raising the money to fund the procedure.

手術部分其實是最簡單的。

But perhaps the most challenging part

其次就是湊錢去籌備手術的經費。

was to convince the regulators --

但最具挑戰性的部分

a matter which was debated in the parliament --

就是要說服監管者 －

that a young female surgeon

這件事曾於議會受爭議　－

be allowed the opportunity

去讓一位年輕女外科醫生

to pioneer for her country.

獲得能為自己國家

But 20 years on,

作出創舉的機會。

my patient, Surinder,

但20年過去了﹐

is Asia's longest surviving

而我的病人，薩倫德，

cadaveric liver transplant to date.

是到目前為止﹐於亞洲生存最長久的

(Applause)

屍肝移植手術的例子。

And perhaps more important,

（掌聲）

I am the proud godmother

但更重要的是，

to her 14 year-old son.

我有幸成為她

(Applause)

14歲兒子的教母。

But not all patients on the transplant wait list

（掌聲）

are so fortunate.

但並不是所有正在輪候移植手術的病人

The truth is,

都是如此幸運。

there are just simply not enough donor organs

事實上﹐

to go around.

所捐獻的器官根本未能足夠

As the demand for donor organs

去被妥善配置。

continues to rise,

每當對捐獻器官的需求

in large part due to the aging population,

主要由於人口老化而

the supply has remained relatively constant.

持續上升﹐

In the United States alone,

供應量仍是相對的維持不變。

100,000 men, women and children

僅在美國，

are on the waiting list for donor organs,

已經有10萬人，包括男人﹑女人及小孩

and more than a dozen die each day

正為得到捐助器官而輪候﹐

because of a lack of donor organs.

而且每天有十幾人﹐

The transplant community

正因缺乏捐獻的器官而死亡。

has actively campaigned in organ donation.

器官移植界

And the gift of life

曾積極推廣器官捐獻的活動。

has been extended

而饋贈生命的意念﹐

from brain-dead donors

已經

to living, related donors --

從腦死亡的捐獻者

relatives who might donate an organ

被延續至還在世的﹑有血緣關係的捐獻者　－

or a part of an organ,

包括會將整個器官﹑或器官的一部份

like a split liver graft,

捐贈的親屬﹐

to a relative or loved one.

例如將肝臟分割移植

But as there was still a dire shortage of donor organs,

到親屬或所愛的人身上。

the gift of life was then extended

但由於所捐贈器官仍是嚴重短缺，

from living, related donors

捐贈範圍再次被擴大﹐

to now living, unrelated donors.

由還在世的﹑有血緣關係的捐獻者﹐

And this then has given rise

伸延至還在世的﹑非血緣關係的捐獻者。

to unprecedented and unexpected

因此就引發了一場

moral controversy.

前所未有﹐以及意料之外的

How can one distinguish

道德上的爭議。

a donation that is voluntary and altruistic

我們如何才能辨別

from one that is forced or coerced

一位出於自願和無私的捐獻者﹐

from, for example,

以及一位被迫或受強制的捐獻者﹖

a submissive spouse, an in-law,

例如﹐

a servant, a slave,

一個唯命是從的配偶﹑一個媳婿﹑

an employee?

一個僕人﹑一個奴隸，

Where and how can we draw the line?

或者一位僱員？

In my part of the world,

我們應該於那裡﹑以及怎樣劃清這條界線呢﹖

too many people live below the poverty line.

於我的日常生活的四週﹐

And in some areas,

太多人活在貧困線之下。

the commercial gifting of an organ

而在一些地區，

in exchange for monetary reward

由非血緣關係者

has led to a flourishing trade

去透過活體器官捐贈

in living, unrelated donors.

而換取金錢上的報酬﹐

Shortly after I performed the first liver transplant,

已經是非常盛行的一種商業交易。

I received my next assignment,

在完成首宗肝臟移植后不久，

and that was to go to the prisons

我接到的下一個工作

to harvest organs

便是到監獄裡面﹐

from executed prisoners.

從被處決的死囚身上

I was also pregnant at the time.

獲取器官。

Pregnancies are meant

那時我還正懷了孕。

to be happy and fulfilling moments

懷孕﹐

in any woman's life.

對任何一位女人而言﹐是一段

But my joyful period

讓人快樂及感到充實的時光。

was marred by solemn and morbid thoughts --

但我這段本應是喜悅的時期﹐

thoughts of walking through

卻被一陣陣幽暗的﹑帶著死亡氣息的思想沾污　－

the prison's high-security death row,

回想著我曾步過

as this was the only route

監獄裡最高嚴密的死囚區，

to take me to the makeshift operating room.

因為那是到達臨時手術室的

And at each time,

唯一的一條路。

I would feel the chilling stares

而每當那時，

of condemned prisoners' eyes follow me.

我就能感受到那些

And for two years,

用令人毛骨悚然的目光﹐跟隨著我的死囚的眼睛。

I struggled with the dilemma

接下來的兩年，

of waking up at 4:30 am

我都於這困境中掙扎﹐

on a Friday morning,

每個周五早上

driving to the prison,

於凌晨四點半起床，

getting down, gloved and scrubbed,

開車去到監獄﹐

ready to receive the body

到地庫﹑戴上手套﹑消毒﹐

of an executed prisoner,

準備接收一具

remove the organs

被處決的死囚的屍體﹐

and then transport these organs

從之切出器官﹐

to the recipient hospital

再將這些器官帶回

and then graft the gift of life

接受移植者的醫院﹐

to a recipient the same afternoon.

然後再於同一天下午﹐

No doubt, I was informed,

給接受者移植器官﹐從而贈予新生命。

the consent had been obtained.

當然﹐他們都說

But, in my life,

器官捐贈是獲得當事人同意。

the one fulfilling skill that I had

但於我生命中﹐

was now invoking feelings of conflict --

我所唯一擁有的﹑令我滿足的技能﹐

conflict ranging

現今竟然產生了情感上的衝突　－

from extreme sorrow and doubt at dawn

這種衝突包括

to celebratory joy

從清晨時的極度悲傷和疑慮﹐至到

at engrafting the gift of life at dusk.

黃昏時慶祝

In my team,

因器官移植而給予病人重生的喜悅。

the lives of one or two of my colleagues

於我的團隊中，

were tainted by this experience.

有一兩位同事的一生

Some of us may have been sublimated,

也就因這樣的經歷而矇上污點。

but really none of us remained the same.

我們當中的一些人可能已經麻木了﹐

I was troubled

但實際上沒有人不受到感染。

that the retrieval of organs from executed prisoners

我很困擾﹐

was at least as morally controversial

這種從死囚上取得器官的做法﹐

as the harvesting of stem cells

至少在道德上是與

from human embryos.

從人類胚胎中抓取幹細胞一樣

And in my mind,

受到同等程度上的爭議。

I realized as a surgical pioneer

而且我認為，

that the purpose of my position of influence

身為一位外科手術的先鋒者﹐

was surely to speak up

擁有具影響力的地位的存在意義﹐

for those who have no influence.

就是在於可以替那些

It made me wonder

沒有影響力的人發言。

if there could be a better way --

這令我自問

a way to circumvent death

究竟有沒有更好的方法 --

and yet deliver the gift of life

一個可迴避牽涉死亡的﹑

that might exponentially impact

而又同時可贈予新生命的方法。

millions of patients worldwide.

這樣就能為全世界成千上萬的病人﹐

Now just about that time,

帶來指數級的影響力。

the practice of surgery evolved

也就是在同一時間，

from big to small,

外科手術的技巧﹐進展到

from wide open incisions

從大到小，

to keyhole procedures,

從寬大的切口

tiny incisions.

到鎖孔式的

And in transplantation, concepts shifted

微創技術。

from whole organs to cells.

而且移植手術的概念﹐已從整個器官

In 1988, at the University of Minnesota,

移轉到細胞移植。

I participated in a small series

1988年，在明尼蘇達大學，

of whole organ pancreas transplants.

我參與了一系列小规模的

I witnessed the technical difficulty.

整個胰臟移植手術。

And this inspired in my mind

我親眼見證了此項技術的難度。

a shift from transplanting whole organs

同時這啟發了我

to perhaps transplanting cells.

去考慮將移植整個器官﹐

I thought to myself,

轉移到細胞移植。

why not take the individual cells

我在想，

out of the pancreas --

何不考慮去將胰臟裡

the cells that secrete insulin to cure diabetes --

個別的細胞提取 --

and transplant these cells? --

即那些能分泌出胰島素而治愈糖尿病的細胞 --

technically a much simpler procedure

再將這些細胞移植呢？--

than having to grapple with the complexities

技術上而言﹐這類程序﹐

of transplanting a whole organ.

相比起要因進行整個器官移植﹐而要應付繁複的事項﹐

And at that time,

來得簡單得多。

stem cell research

同時間﹐

had gained momentum,

幹細胞研究方面﹐

following the isolation of the world's first

亦繼於90年代時期﹐

human embryonic stem cells

世上首次成功將

in the 1990s.

人類胚胎幹細胞分離以後﹐

The observation that stem cells, as master cells,

獲得了新的進展。

could give rise

能將幹細胞用作母細胞

to a whole variety of different cell types --

去發育成

heart cells, liver cells,

一系列林林總總的細胞種類 --

pancreatic islet cells --

心肌細胞﹑肝細胞﹑

captured the attention of the media

胰島細胞 --

and the imagination of the public.

這項發現﹐廣泛受到媒體關注﹐

I too was fascinated

也激發了廣大市民的想象力。

by this new and disruptive cell technology,

我也因這種全新的﹑

and this inspired a shift in my mindset,

具影響力的細胞技術而著迷﹐

from transplanting whole organs

思維亦被激發﹑而引起了轉變，

to transplanting cells.

從將整個器官移植﹐

And I focused my research on stem cells

轉移到細胞移植。

as a possible source

我把研究焦點﹐放在

for cell transplants.

利用幹細胞

Today we realize

作為細胞移植來源之中。

that there are many different types of stem cells.

今日﹐我們了解到

Embryonic stem cells

有很多不同類型的幹細胞。

have occupied center stage,

其中，胚胎幹細胞

chiefly because of their pluripotency --

已占據了中心地位，

that is their ease in differentiating

主要是因為它的多能性--

into a variety of different cell types.

即是它們能輕鬆的分化成

But the moral controversy

一系列林林總總的細胞種類。

surrounding embryonic stem cells --

但是之所以胚胎幹細胞的範疇

the fact that these cells are derived

在道德上備受爭議 --

from five-day old human embryos --

是因為這些細胞來源於

has encouraged research

5天大的人類胚胎。

into other types of stem cells.

而正因為這種爭議﹐才更激勵人們去研究

Now to the ridicule of my colleagues,

其他類型的幹細胞。

I inspired my lab

我在同事的嘲諷聲中，

to focus on what I thought

將實驗焦點

was the most non-controversial source of stem cells,

放於我認為

adipose tissue, or fat, yes fat --

最沒有爭議價值的幹細胞資源 --

nowadays available in abundant supply --

脂肪組織﹐即是脂肪﹐對﹐是脂肪 --

you and I, I think, would be very happy to get rid of anyway.

現今可垂手可得的 --

Fat-derived stem cells

至少﹐我想像你和我一樣﹐都很樂意將它擺脫。

are adult stem cells.

脂肪源幹細胞

And adult stem cells

是一種成體幹細胞。

are found in you and me --

而成體幹細胞是在

in our blood, in our bone marrow,

你和我身體內都能找到 --

in our fat, our skin and other organs.

於我們的血液中﹑骨髓中﹑

And as it turns out,

脂肪中﹑皮膚中﹐以及其他器官中。

fat is one of the best sources

而事實證明，

of adult stem cells.

脂肪是成體幹細胞的

But adult stem cells

最佳來源之一。

are not embryonic stem cells.

但是成體幹細胞

And here is the limitation:

並不是胚胎幹細胞。

adult stem cells are mature cells,

它具有本身的限制﹕

and, like mature human beings,

成體幹細胞是成熟的細胞，

these cells are more restricted in their thought

而就像成年人一樣，

and more restricted in their behavior

這些細胞﹐於思維上較為受到局限﹐

and are unable to give rise

於行為上亦較為受到局限﹐

to the wide variety of specialized cell types,

因此它們也無法像

as embryonic stem cells [can].

胚胎幹細胞一般﹐可以分化成

But in 2007,

多種具特定功能的細胞。

two remarkable individuals,

但在2007年，

Shinya Yamanaka of Japan

有兩位傑出人士 --

and Jamie Thomson of the United States,

日本的山中伸彌﹐

made an astounding discovery.

以及美國的占美·湯臣 --

They discovered

作出了驚人的發現。

that adult cells, taken from you and me,

他們發現

could be reprogrammed

那些取自你我身上的成體細胞﹐

back into embryonic-like cells,

可以重組還原成

which they termed IPS cells,

類似胚胎的細胞。

or induced pluripotent stem cells.

他們將之命名為IPS細胞，

And so guess what,

或稱誘導培養多潛能幹細胞。

scientists around the world and in the labs

於是如你我所料﹐

are racing

世界各地的﹑以及在實驗室中的科學家﹐

to convert aging adult cells --

都爭先恐後的

aging adult cells from you and me --

去將正在老化的成體細胞轉化 --

they are racing to reprogram these cells

那些取自你我身上的﹑正在老化的成體細胞 --

back into more useful IPS cells.

他們都想搶先將這些細胞重組

And in our lab,

成為更有用的IPS細胞。

we are focused on taking fat

而在實驗室裡，

and reprogramming

我們專注于提取脂肪

mounds of fat

以及將一堆堆的脂肪﹐

into fountains of youthful cells --

重編成

cells that we may use

如泉噴湧的幼年細胞 --

to then form other,

那些可用作

more specialized, cells,

轉化為其他

which one day may be used as cell transplants.

更為特定的細胞，

If this research is successful,

以便日後可用作細胞移植的用途。

it may then reduce the need

如果這項研究成功的話，

to research and sacrifice

它就能減少

human embryos.

要研究和犧牲

Indeed, there is a lot of hype, but also hope

人類胚胎的需求。

that the promise of stem cells

事實上，當中有很多炒作，但亦同時存在

will one day provide cures

有朝一日可以利用幹細胞

for a whole range of conditions.

去治療

Heart disease, stroke, diabetes,

一系列的病症的希望。

spinal cord injury, muscular dystrophy,

心臟病﹑中風﹑糖尿病﹑

retinal eye diseases --

脊髓損傷﹑肌肉萎縮﹑

are any of these conditions

視網膜疾病 --

relevant, personally, to you?

以上病症之中﹐

In May 2006,

有任何病症與您有切身的關係嗎﹖

something horrible happened to me.

2006年5月，

I was about to start a robotic operation,

有件可怕的事發生於我身上。

but stepping out of the elevator

我正準備進行機械人手術﹐

into the bright and glaring lights of the operating room,

但當走出電梯

I realized

來到手術室的明亮炫目的手術燈下的一剎那，

that my left visual field

我感覺到

was fast collapsing into darkness.

左邊視野

Earlier that week,

突然陷入一片黑暗。

I had taken a rather hard knock

那週的早些時候，

during late spring skiing -- yes, I fell.

我在春末滑雪時

And I started to see floaters and stars,

受到了蠻重的一擊 -- 是的，我摔倒了。

which I casually dismissed

接着我開始看到漂浮物和星星﹐

as too much high-altitude sun exposure.

當時我以為﹐那只是高海拔之下

What happened to me

過份曝晒於陽光下的緣故﹐並很快將事情拋諸腦後。

might have been catastrophic,

事件發生以後，

if not for the fact

假如我當時沒有