驚悚科學:人死後假肢都去哪了

Millions of prosthetics, breast implants, and pacemakers now exist – so what happens to all these augmentations when their owners die or no longer need them? Frank Swain investigates.

當今社會假肢、隆胸和心臟起搏器的使用屢見不鮮。而當這些假體的使用者死去或者不再需要它們時，它們會面臨怎樣的命運呢？弗蘭克?斯溫（Frank Swain）對此進行了調查。

The first patient to be fitted with a pioneering artificial heart in France has died

世界首例人工心臟移植手術曾在法國成功完成，患者如今已經去世。

Under the watchful eye of the prison guards at Metro Davidson County Detention Facility, half a dozen inmates in blue overalls are wrestling with prosthetic legs. They strip each one down into a collection of screws, bolts, connectors, feet and other components. The prison workshop is home to a collaboration with Standing With Hope, a US charity based in Nashville, Tennessee that recycles unwanted prosthetic limbs for the developing world. The disassembled legs will be shipped to Ghana, where locally trained clinicians will rebuild them to fit patients there.

在戴維森郡拘留所（Metro Davidson County Detention Facility）獄警的監督下，6名身穿藍色工作服的犯人正在忙碌地處理着那些假肢。他們要把每條假肢的螺釘、螺栓、連接器、腳和其他零件都拆分開來。這個監獄車間是由監獄與美國一家慈善機構“與希望同立”（Standing With Hope）合作建立的，該機構總部位於田納西州首府納什維爾（Nashville)，專門回收多餘的假肢，然後稍往發展中國家。被拆卸的假肢將被運到加納（Ghana），在那裏，接收過培訓的本地醫生會重新組裝這些部件，做成適合病人的假肢。

These legs will get a second life, but other types of prosthetics and implants usually face a different destiny. What to do with augmented human parts when they are no longer needed – often due to the owner’s death – is an increasingly common issue. Modern medicine offers a litany of replacement parts, from whole limbs to metal hips, shoulders and joints. Then there are pacemakers and internal cardiac defibrillators (ICDs), as well as more common augmentations like dentures and silicone breast implants. What happens to these augmentations when someone dies?

這些假肢將得到“二次生命”，但是其他類型的假肢或植入物通常面臨着不同的命運。怎樣處理人體這些不再需要（通常是由於主人死亡）的多餘部分，已經成爲了一個日益普遍的問題。現代醫學提供了一連串的替換零件，從整個肢體到金屬臀部、肩膀以及關節等等。日常使用的增加物還包括心臟起搏器，內部心臟除顫器（ICDs）以及更爲常見的假牙和硅膠乳房植入物等。當這些增加物的使用者死去後，它們的命運會如何呢？

Inert devices such as breast implants and replacement hips tend not to be removed after death, largely because there’s no compelling reason to do so, and they pose little threat to the environment. So it’s likely that the archaeologists of future centuries will uncover peculiar objects in the graves of the millennial dead: silicone bags, plastic teeth and sculpted metal bones.

在人死後，乳房植入物，臀部替換物等惰性設備一般不會被移出體外，很大原因在於沒有硬性要求一定要移除這些增加物，而且它們對環境不會造成太大威脅。所以很有可能未來的考古學家會在幾千年前的墳墓裏面有獨特的發現：硅膠袋、假牙和雕刻過的金屬骨骼。

It’s a different story for cremation. In a furnace, silicone may burn up, but not the metal in implants – such as titanium or cobalt alloy. It is often separated from the ash and disposed of separately. Even tiny amounts of precious metals such as gold fillings can be discovered by waving a metal-detector over the ashes.

而火葬的話，情況則大不相同。在爐竈中，硅膠可能會被燒掉，但植入物中的金屬如鈦或鈷合金卻不會。通常這些金屬會從灰燼中分離出來，單獨處理。用金屬探測儀在灰燼堆上方掃掃，即使是微量的貴重金屬，比如金製品原料，也能被探測到。

In recent years, enterprising organisations have stepped in to recycle this material. Dutch company Orthometals, for example, collects 250 tonnes of metal every year from hundreds of crematoriums around Europe. At their facility in Steenbergen, it is sorted and melted down into ingots before being sold to the automobile and aeronautical industries. A similar US company, Implant Recycling, sells the melted and recast metals back into the medical industry. After you die, a little piece of you may one day end up in an aeroplane, a wind turbine, or even another person.

近年來，一些企業已經開始回收這種材料。比如，荷蘭Orthometals公司每年從歐洲各地的數百個火葬場回收250噸金屬。然後運往位於Steenbergen的基地，在那裏融化分解這些金屬，然後賣給汽車和航空公司。美國也有一家類似的植入物回收公司（Implant Recycling），融化重塑金屬後，重新賣給醫藥行業。在你死後，你身上的某個部分可能有一天最後會用於飛機，風力渦輪機，甚至出現在另外一個人身上。

Pacemakers and ICDs, by contrast, are often taken out of the body after death – and almost always before cremation, because the batteries can explode when heated. The same goes for spinal cord stimulators that treat pain and some types of internal pumps for administering drugs, since they contain electronics too.

相反，人死後，心臟起搏器和內部心臟除顫器都會被移出體外，而且幾乎都是在火葬前，因爲這些儀器內部的電池在加熱時可能會爆炸。這同樣適用於治療疼痛的脊髓刺激器和某些類型的用來施用藥物的內部泵，這些儀器也都含有電池。

Once removed, implants are typically discarded – both the European Union and the US, among others, have rules that forbid the reuse of implanted medical devices. However, there is a growing trend to recover them for use in the developing world.

這些植入物一旦被移出體外，基本上都會被丟棄－歐盟和美國都規定禁止再利用這些被植入過的醫療器械。然而在發展中國家，再利用這些使用過的醫療器械的趨勢在日益增長。

At $4,000 for a pacemaker and $20,000 for an ICD, a second-hand implant is the only way that millions of people will be able to afford this life-saving equipment. In the UK, charity Pace4Life collects functioning pacemakers from funeral parlours for use in India. In a similar effort, the journal Annals of Internal Medicine recently published the results of a US programme called Project My Heart Your Heart, which found that 75 patients who received second-hand ICDs showed no evidence of infection or malfunction. The group are now applying for FDA approval to send recycled heart devices overseas.

一個心臟起搏器可以賣4000美元，一個內部心臟除顫器2萬美元，因此二手植入物是許多人唯一能夠負擔得起的救生設備。英國一家慈善機構Pace4Life從殯儀館回收功能正常的心臟起搏器，供印度人民使用。同樣，內科醫學年鑑雜誌（Annals of Internal Medicine）最近發表了美國某項目“心心相印”（My heart Your Heart）的研究結果，該研究表明，75名使用二手的內部心臟除顫器的患者並沒有出現感染或功能失常的症狀。該研究小組目前正在申請食品藥物管理局（FDA）批准將這些回收的心臟裝置運往海外。

Back in Nashville, Standing With Hope has adopted a similar approach by shipping prosthetic limbs to Ghana. The charity’s co-founder, Gracie Rosenberger, was badly injured in a traffic accident at 17, an incident which cost her both legs. Like many amputees, Gracie acquired a stockpile of prosthetics over the years, which made her wonder whether they could be put to better use. As limbs are replaced or outgrown, the old ones gather dust in the backs of closets. When an amputee passes away, the family are often left with a cache of working limbs but no one to take them.

在納什維爾，“與希望同立”慈善機構也是採取了類似的方法，將假肢運往加納。格雷西?羅森伯格（Gracie Rosenberger）是該慈善機構的聯合創始人，她17歲時在一次交通事故中嚴重受傷，並失去了雙腿。和許多截肢者一樣，這麼多年來格雷西儲存了許多假肢。於是她就想是否可以更好地利用這些假肢。舊的假肢被替換下來後就被放在櫃櫥後面，沾滿灰塵。截肢者去世後，家裏往往會剩下許多還能用的假肢，但沒人會去用它們。

“The private insurers do not want it back, I don’t even think Medicare wants it back,” explains Rosenberger’s husband Peter, who is president of Standing With Hope. “There are all kinds of liabilities. So a lot of this stuff is discarded, unfortunately.”

羅森伯格的丈夫彼得（Peter）是該慈善機構的董事長，他解釋道：“私人保險公司不想收回這些假肢，甚至是醫療機構也不想這樣做。這些機構負債太多，很多這種東西都不得不丟棄。”

Now amputees and their families can send old limbs in the mail to the Rosenbergers. When asking for donations, Standing With Hope’s website reads: “We’re not asking for an arm and a leg... just a leg”.

現在截肢者和他們的家人可以把不用的假肢郵寄給羅森伯格所在的這家機構。該慈善機構在請求捐贈時，就在網上寫到：“我們的要求並不多，只是一條你不再需要了的義腿而已。”

The goal is to beat last year’s total of 500 replacement limbs delivered to Ghana. “Last year I had a thing I called Operation Footloose, and on my radio show I would play the theme from Footloose and say ‘turn that foot loose so we can recycle it’,” Peter laughs.

我們的目標是超過去年運送到加納的500個假肢。“去年，我有個計劃，我取名爲‘渾身是勁’計劃，我總是在我的廣播節目裏演奏《渾身是勁》（Footloose）的主題曲，然後唱到‘讓我們渾身是勁地拆開假肢，把你循環利用吧’”，彼得笑道。

Just like organ donors, those that bequeath their medical implants can bid farewell to the world with the knowledge they offer a stranger a second chance at life, be it a man with a heart defect in India, a woman undergoing a hip replacement in America, or a child with a missing limb in Ghana. And it’s not just donors and recipients that have something to gain from the process. The Metro Davidson County Detention Facility is just a few minutes’ drive from Peter’s home, and every so often he visits the inmates working in the limb disassembly workshop. As they chatted, one prisoner told Peter what the Standing With Hope project meant to him. “He had tears in his eyes and said to me: ‘I get to do something positive for the first time with my hands. I’ve never done anything positive with my hands’,” Peter recalls. “How rewarding is that?”

那些捐贈醫療植入物的人和器官捐贈者一樣，可以在告別世界的同時，給一個陌生人帶來第二次生命，可能是一名有心臟缺陷的印度男子，可能是一位進行髖關節置換的美國女人，也可能是一個截肢的加納孩子。在這個過程中，不僅僅是捐贈者和受贈者有所收穫。開車從戴維森郡拘留所到彼得家只需要幾分鐘，因此他經常去看望在肢體拆卸車間工作的犯人們。他們聊天的時候，一名犯人告訴彼得，“與希望同立”慈善機構對自己意義重大。“他熱淚盈眶地對我說，‘我第一次用自己的雙手做了些有意義的事情。我之前從來沒有做過任何有意義的事’ ”，彼得回憶道，“這多麼值得啊！”