人死后，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.

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?”

查看译文

当今社会假肢、隆胸和心脏起搏器的使用屡见不鲜。而当这些假体的使用者死去或者不再需要它们时，它们会面临怎样的命运呢？弗兰克•斯温

世界首例人工心脏移植手术曾在法国成功完成，患者如今已经去世。

在戴维森郡拘留所

这些假肢将得到“二次生命”，但是其他类型的假肢或植入物通常面临着不同的命运。怎样处理人体这些不再需要

在人死后，乳房植入物，臀部替换物等惰性设备一般不会被移出体外，很大原因在于没有硬性要求一定要移除这些增加物，而且它们对环境不会造成太大威胁。所以很有可能未来的考古学家会在几千年前的坟墓里面有独特的发现：硅胶袋、假牙和雕刻过的金属骨骼。

而火葬的话，情况则大不相同。在炉灶中，硅胶可能会被烧掉，但植入物中的金属如钛或钴合金却不会。通常这些金属会从灰烬中分离出来，单独处理。用金属探测仪在灰烬堆上方扫扫，即使是微量的贵重金属，比如金制品原料，也能被探测到。

近年来，一些企业已经开始回收这种材料。比如，荷兰Orthometals公司每年从欧洲各地的数百个火葬场回收250吨金属。然后运往位于Steenbergen的基地，在那里融化分解这些金属，然后卖给汽车和航空公司。美国也有一家类似的植入物回收公司

相反，人死后，心脏起搏器和内部心脏除颤器都会被移出体外，而且几乎都是在火葬前，因为这些仪器内部的电池在加热时可能会爆炸。这同样适用于治疗疼痛的脊髓刺激器和某些类型的用来施用药物的内部泵，这些仪器也都含有电池。

这些植入物一旦被移出体外，基本上都会被丢弃－欧盟和美国都规定禁止再利用这些被植入过的医疗器械。然而在发展中国家，再利用这些使用过的医疗器械的趋势在日益增长。

一个心脏起搏器可以卖4000美元，一个内部心脏除颤器2万美元，因此二手植入物是许多人唯一能够负担得起的救生设备。英国一家慈善机构Pace4Life从殡仪馆回收功能正常的心脏起搏器，供印度人民使用。同样，内科医学年鉴杂志

在纳什维尔，“与希望同立”慈善机构也是采取了类似的方法，将假肢运往加纳。格雷西•罗森伯格

罗森伯格的丈夫彼得

现在截肢者和他们的家人可以把不用的假肢邮寄给罗森伯格所在的这家机构。该慈善机构在请求捐赠时，就在网上写到：“我们的要求并不多，只是一条你不再需要了的义腿而已。”

我们的目标是超过去年运送到加纳的500个假肢。“去年，我有个计划，我取名为‘浑身是劲’计划，我总是在我的广播节目里演奏《浑身是劲》

那些捐赠医疗植入物的人和器官捐赠者一样，可以在告别世界的同时，给一个陌生人带来第二次生命，可能是一名有心脏缺陷的印度男子，可能是一位进行髋关节置换的美国女人，也可能是一个截肢的加纳孩子。在这个过程中，不仅仅是捐赠者和受赠者有所收获。开车从戴维森郡拘留所到彼得家只需要几分钟，因此他经常去看望在肢体拆卸车间工作的犯人们。他们聊天的时候，一名犯人告诉彼得，“与希望同立”慈善机构对自己意义重大。“他热泪盈眶地对我说，‘我第一次用自己的双手做了些有意义的事情。我之前从来没有做过任何有意义的事’ ”，彼得回忆道，“这多么值得啊！”