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人死后,假肢都去哪了?
What happens to prosthetics and implants after you die?

[ 2014-03-25 09:50] 來(lái)源:中國(guó)日?qǐng)?bào)網(wǎng)     字號(hào) [] [] []  
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人死后,假肢都去哪了?

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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.

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

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.

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?

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.

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.

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.

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.

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.

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.

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.

“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.”

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”.

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.

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?”

查看譯文

當(dāng)今社會(huì)假肢、隆胸和心臟起搏器的使用屢見(jiàn)不鮮。而當(dāng)這些假體的使用者死去或者不再需要它們時(shí),它們會(huì)面臨怎樣的命運(yùn)呢?弗蘭克?斯溫(Frank Swain)對(duì)此進(jìn)行了調(diào)查。

世界首例人工心臟移植手術(shù)曾在法國(guó)成功完成,患者如今已經(jīng)去世。

在戴維森郡拘留所(Metro Davidson County Detention Facility)獄警的監(jiān)督下,6名身穿藍(lán)色工作服的犯人正在忙碌地處理著那些假肢。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(kāi)來(lái)。這個(gè)監(jiān)獄車(chē)間是由監(jiān)獄與美國(guó)一家慈善機(jī)構(gòu)“與希望同立”(Standing With Hope)合作建立的,該機(jī)構(gòu)總部位于田納西州首府納什維爾(Nashville),專門(mén)回收多余的假肢,然后稍往發(fā)展中國(guó)家。被拆卸的假肢將被運(yùn)到加納(Ghana),在那里,接收過(guò)培訓(xùn)的本地醫(yī)生會(huì)重新組裝這些部件,做成適合病人的假肢。

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著不同的命運(yùn)。怎樣處理人體這些不再需要(通常是由于主人死亡)的多余部分,已經(jīng)成為了一個(gè)日益普遍的問(wèn)題。現(xiàn)代醫(yī)學(xué)提供了一連串的替換零件,從整個(gè)肢體到金屬臀部、肩膀以及關(guān)節(jié)等等。日常使用的增加物還包括心臟起搏器,內(nèi)部心臟除顫器(ICDs)以及更為常見(jiàn)的假牙和硅膠乳房植入物等。當(dāng)這些增加物的使用者死去后,它們的命運(yùn)會(huì)如何呢?

在人死后,乳房植入物,臀部替換物等惰性設(shè)備一般不會(huì)被移出體外,很大原因在于沒(méi)有硬性要求一定要移除這些增加物,而且它們對(duì)環(huán)境不會(huì)造成太大威脅。所以很有可能未來(lái)的考古學(xué)家會(huì)在幾千年前的墳?zāi)估锩嬗歇?dú)特的發(fā)現(xiàn):硅膠袋、假牙和雕刻過(guò)的金屬骨骼。

而火葬的話,情況則大不相同。在爐灶中,硅膠可能會(huì)被燒掉,但植入物中的金屬如鈦或鈷合金卻不會(huì)。通常這些金屬會(huì)從灰燼中分離出來(lái),單獨(dú)處理。用金屬探測(cè)儀在灰燼堆上方掃掃,即使是微量的貴重金屬,比如金制品原料,也能被探測(cè)到。

近年來(lái),一些企業(yè)已經(jīng)開(kāi)始回收這種材料。比如,荷蘭Orthometals公司每年從歐洲各地的數(shù)百個(gè)火葬場(chǎng)回收250噸金屬。然后運(yùn)往位于Steenbergen的基地,在那里融化分解這些金屬,然后賣(mài)給汽車(chē)和航空公司。美國(guó)也有一家類似的植入物回收公司(Implant Recycling),融化重塑金屬后,重新賣(mài)給醫(yī)藥行業(yè)。在你死后,你身上的某個(gè)部分可能有一天最后會(huì)用于飛機(jī),風(fēng)力渦輪機(jī),甚至出現(xiàn)在另外一個(gè)人身上。

相反,人死后,心臟起搏器和內(nèi)部心臟除顫器都會(huì)被移出體外,而且?guī)缀醵际窃诨鹪崆埃驗(yàn)檫@些儀器內(nèi)部的電池在加熱時(shí)可能會(huì)爆炸。這同樣適用于治療疼痛的脊髓刺激器和某些類型的用來(lái)施用藥物的內(nèi)部泵,這些儀器也都含有電池。

這些植入物一旦被移出體外,基本上都會(huì)被丟棄-歐盟和美國(guó)都規(guī)定禁止再利用這些被植入過(guò)的醫(yī)療器械。然而在發(fā)展中國(guó)家,再利用這些使用過(guò)的醫(yī)療器械的趨勢(shì)在日益增長(zhǎng)。

一個(gè)心臟起搏器可以賣(mài)4000美元,一個(gè)內(nèi)部心臟除顫器2萬(wàn)美元,因此二手植入物是許多人唯一能夠負(fù)擔(dān)得起的救生設(shè)備。英國(guó)一家慈善機(jī)構(gòu)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(nèi)科醫(yī)學(xué)年鑒雜志(Annals of Internal Medicine)最近發(fā)表了美國(guó)某項(xiàng)目“心心相印”(My heart Your Heart)的研究結(jié)果,該研究表明,75名使用二手的內(nèi)部心臟除顫器的患者并沒(méi)有出現(xiàn)感染或功能失常的癥狀。該研究小組目前正在申請(qǐng)食品藥物管理局(FDA)批準(zhǔn)將這些回收的心臟裝置運(yùn)往海外。

在納什維爾,“與希望同立”慈善機(jī)構(gòu)也是采取了類似的方法,將假肢運(yùn)往加納。格雷西?羅森伯格(Gracie Rosenberger)是該慈善機(jī)構(gòu)的聯(lián)合創(chuàng)始人,她17歲時(shí)在一次交通事故中嚴(yán)重受傷,并失去了雙腿。和許多截肢者一樣,這么多年來(lái)格雷西儲(chǔ)存了許多假肢。于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(lái)后就被放在柜櫥后面,沾滿灰塵。截肢者去世后,家里往往會(huì)剩下許多還能用的假肢,但沒(méi)人會(huì)去用它們。

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

現(xiàn)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(jī)構(gòu)。該慈善機(jī)構(gòu)在請(qǐng)求捐贈(zèng)時(shí),就在網(wǎng)上寫(xiě)到:“我們的要求并不多,只是一條你不再需要了的義腿而已。”

我們的目標(biāo)是超過(guò)去年運(yùn)送到加納的500個(gè)假肢。“去年,我有個(gè)計(jì)劃,我取名為‘渾身是勁’計(jì)劃,我總是在我的廣播節(jié)目里演奏《渾身是勁》(Footloose)的主題曲,然后唱到‘讓我們渾身是勁地拆開(kāi)假肢,把你循環(huán)利用吧’”,彼得笑道。

那些捐贈(zèng)醫(yī)療植入物的人和器官捐贈(zèng)者一樣,可以在告別世界的同時(shí),給一個(gè)陌生人帶來(lái)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(jìn)行髖關(guān)節(jié)置換的美國(guó)女人,也可能是一個(gè)截肢的加納孩子。在這個(gè)過(guò)程中,不僅僅是捐贈(zèng)者和受贈(zèng)者有所收獲。開(kāi)車(chē)從戴維森郡拘留所到彼得家只需要幾分鐘,因此他經(jīng)常去看望在肢體拆卸車(chē)間工作的犯人們。他們聊天的時(shí)候,一名犯人告訴彼得,“與希望同立”慈善機(jī)構(gòu)對(duì)自己意義重大。“他熱淚盈眶地對(duì)我說(shuō),‘我第一次用自己的雙手做了些有意義的事情。我之前從來(lái)沒(méi)有做過(guò)任何有意義的事’ ”,彼得回憶道,“這多么值得啊!”

(譯者 dreamcatcher888 編輯 丹妮)

 
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