World’s first total eye and partial face transplant takes place in the United States

It was a moment Meagan James never expected to see. A surgical team from NYU Langone Health in New York successfully performed the world’s first whole eye transplant on a living person: her husband, Aaron James.

After a workplace accident led to the loss of his left eye and part of his face, Aaron received a new window into his soul, along with a partial face transplant.

When Meagan first looked at her husband’s new eye, she noticed post-operative swelling and found that the eye was brown. Aaron naturally has blue eyes. She also saw the new nose, lips and cheek, which already had a beard growing. She saw a face full of gratitude and that’s when the emotion took hold.

She was happy for her husband of 20 years. “It was a crazy, awesome, weird, happy, ecstatic feeling,” Meagan said. “I was very happy that he survived and everything was fine at that point.”

On that day in late May, a team of more than 140 surgeons from NYU Langone Health completed Aaron’s transplant procedure, which took approximately 21 hours. The operation included the transplantation of the entire left eye and parts of the face from a single donor. It was a medical novelty.

Aaron’s eye now shows “remarkable” signs of health, according to his medical team. Even though he can’t see with his eye, he remains hopeful that the vision could become a reality in time – and that his procedure, the first of its kind, could help advance transplant medicine.

“That’s really my biggest hope,” Aaron said. “If I can see it, great. But if it opens up a new path in the medical field, then I’m all for it.

A life-changing accident

Seeing Aaron’s new eye and face “wasn’t as big a shock” as seeing him the night of the accident, Meagan said. Aaron, a 46-year-old military veteran based in Arkansas, worked as a high-voltage electrician, and on that night in June 2021, he was working with his co-workers in Mississippi when his face accidentally touched a live wire.

The fatal 7,200-volt electric shock caused severe injuries to Aaron’s face: his left eye, his entire nose and lips, his left cheek and chin, and his left arm.

Aaron James and wife Meagan kiss for the first time after eye transplant and partial face transplant / NYU Langone Health

Back in Arkansas, Meagan and her daughter Allie, who was in high school, were walking home from the grocery store when Meagan’s phone rang. She didn’t recognize the number, but answered it anyway. She heard the words “Aaron,” “accident,” and “seriously.”

Meagan immediately packed a bag when she got home, then drove about four and a half hours to Mississippi, where Aaron was being treated at a local hospital. During the trip, his phone rang again. This time it was a doctor. The doctor described Aaron’s condition and explained that he had been electrocuted.

“Is he okay? Will he be okay?” Meagan asked. She remembers the doctor’s response: “The only thing I can promise is that he won’t die before you arrive.” »

Meagan remembers telling Aaron to “be careful” every morning before work. She still remembers the morning of the accident and wonders if she told him to “be careful” that day.

“Oh my God, his face is gone.”

Meagan stayed by Aaron’s side as he was transported to different medical centers for more intensive care, reconstructive surgeries and to have his left arm amputated.

After being taken to a burn unit in Dallas, Allie, who was then living with her grandmother, was able to visit her.

Surgeon Dr. Eduardo Rodriguez with Aaron James before his full eye and partial face transplant / NYU Langone Health

“When I saw him, his chin was exposed,” Allie said. “I could see his eye socket and everything. I was looking at his skull and I think that’s the part that seemed a little weird to me. I was like, ‘Oh my God, his face is gone,'” she said. “Most of my worries were about what he would be like when he was awake and conscious.”

Aaron said he doesn’t remember the accident. “I basically got up, went to work and woke up six weeks later in Dallas, Texas,” he said. “It’s a strange feeling when you suddenly wake up in a hospital.”

The first time Aaron saw himself after the accident was in his hospital bed in Dallas. He asked Meagan to take a photo, but she hesitated.

“She said, ‘Are you sure?’ I said, ‘Yeah, I’ll be fine,'” Aaron said. “She took a picture, turned her phone over, and I thought, ‘Oh my God, this is a bad deal here,’” he recalls. “I mean, I felt good, so I knew everything was going to be okay. We just had a long way to go.

Aaron’s medical team discussed the option of a face transplant with Meagan. When she talked to Aaron about it, he said he was all for it.

“As soon as we talked about face transplants, I was like, ‘Man, this is important,’ because they don’t do it every day,” he said.

In New York, Dr. Eduardo Rodriguez, director of the facial transplant program at NYU Langone Health – who has already performed four face transplants – and his colleagues were introduced to Aaron’s case by experts in Texas. After learning more about Aaron’s accident and resulting injuries, Rodriguez said it was “amazing” that Aaron survived.

“To see him walking after being completely discredited in the hospital – multiple organ failure, breathing tube, he will survive, he will have neurological damage – to see him without any of those aftereffects, is very impressive,” Rodriguez said.

“It’s a testament to modern medicine,” he said. “It’s a testament to this patient and his family. And it is also proof that in these cases, there is a certain heavenly involvement where it was not the time for him to go.

“We must have patient zero”

Discussions about the possibility of a transplant continued even after Aaron’s medical team in Texas removed his left eye due to severe pain. Rodriguez and his colleagues in New York asked the Texas team to preserve as much of the optic nerve as possible in hopes of an eventual eye transplant.

As Rodriguez spoke to Aaron about the possibility of undergoing not only a partial face transplant, but also a full eye transplant, he warned that the donor eye might not restore vision. For vision to occur, some communication will be necessary between the transplanted eye and the brain.

“But I said ‘even if it doesn’t work, I’ll have an eye and it will at least look normal, and then you can all learn from it,'” Aaron said. “You must have patient zero.”

Aaron was listed as a potential recipient in February 2023. The opportunity to perform a full eye transplant and partial face transplant presented itself a few months later in May. It was a “risky” operation for Rodriguez and his colleagues. No medical team in the world has yet successfully performed a human eye transplant on a living patient.

“It’s completely uncharted territory,” Rodriguez said.

Eduardo Rodriguez, director of the facial transplant program at NYU Langone Health, performs a face and eye transplant / NYU Langone Health

The operation involved two operating rooms. Aaron was in a room where surgeons removed parts of his face that would be replaced with donated tissue. Rodriguez was in the other room, dissecting the donor’s face and eyeball.

“This part of the operation lasted about 12 hours,” Rodriguez said. “Now I have to make sure Aaron’s room is ready for the facial,” he said. “We cut the blood vessels, disconnect them from the donor and the race begins. At this stage, the face and eyes receive no blood supply.

Rodriguez and his colleagues then began connecting the donor’s face and eyeball to Aaron. For the eye transplant, the team combined the donor eye with adult stem cells derived from the donor’s bone marrow, injecting the adult stem cells into the optic nerve during the transplant. These stem cells can help improve nerve regeneration.

“We were able to define a specific cell, a CD34, which is an adult stem cell that has some potential benefits – not only in terms of immune modulation, because it is a transplant – but also in terms of neuroregeneration,” Rodriguez said. “At the optic nerve connection from the donor to the recipient, right there, we inject these CD34 stem cells.”

A key step in the whole eye transplant was reconnecting Aaron’s optic nerve to the donor eye, said Dr. José-Alain Sahel, clinical spokesperson for the American Academy of Ophthalmology. He was not involved in the procedure, but is chairman of the Department of Ophthalmology at the University of Pittsburgh School of Medicine and has participated in related experimental research.

“It was very smart not to cut the optic nerve too far from the eyeball when the eye was removed from the recipient,” said Sahel, who followed the team’s work at NYU Langone Health.

Aaron James sees his new face for the first time with Dr. Eduardo Rodriguez, his wife Meagan and his daughter Allie / NYU Langone Health

“I think what remains to be done – which is a very important task – will be how to regrow the optic nerve, guide its fibers or axons to the appropriate targets, as well as ensure that the corneal nerves are well preserved,” did he declare. .he. “What we learned from this is that surgery can potentially work, and so we should promote more research, more investment in research into corneal and optic nerve regeneration. »

When the surgery was completed and Aaron looked at his new face in the mirror for the first time, he was thrilled, Rodriguez said. Aaron continues to be closely monitored and must continue to take medication to reduce the risk of his body rejecting the transplant. His medical team notes that the eye is showing signs of health, such as direct blood flow to the retina, the layer of tissue at the back of the eyeball associated with visual processing.

Looking ahead, Aaron, Meagan and their daughter Allie, a recent high school graduate, are preparing to celebrate Thanksgiving together in a few weeks. Aaron can now smell and taste – and looks forward to his meal. He also holds out hope that one miraculous day he will be able to see through the donor’s eye.

“Whether he sees it or not is the unanswered question,” Rodriguez said. “A transplant like this has never been done, and transplants have a unique way of working, and even with face transplants, things have happened that we wouldn’t have imagined,” he said. he declares. “So I’m hopeful.”

The procedure marks an important advance in the field of transplantation medicine, said Dr. Oren Tepper, a plastic and reconstructive surgeon and director of the craniofacial surgery program at Montefiore Health System.

“This highly technical and complex surgery represents a significant advance in the field of facial transplantation,” wrote Tepper, who was not involved in Aaron’s care.

“Ultimately, if an eye transplant is successful in restoring any form of nerve function or visual signs, it would be a significant advance in medicine for patients who have suffered eye loss due to trauma or cancer.”