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

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

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

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

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

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

Aaron’s eye is now showing “remarkable” signs of health, according to his medical team. Although he can’t see out of his eye, he remains hopeful that vision may come 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 kickstarts the next 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 it 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 colleagues in Mississippi when his face accidentally touched a live wire.

The deadly 7,200-volt electrical shock caused serious injuries to Aaron’s face: his left eye, his entire nose and lips, his left cheek area and chin, as well as his left arm.

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 anyway. She heard the words “Aaron,” “accident,” and “seriously.”

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

“Is he ok? 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 get here.”

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

After he was taken to a burn unit in Dallas, Allie, who was staying with her grandmother at the time, was able to visit him.

“When I saw him, his chin bone 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 was kind of weird to me. I was like, ‘Oh, my God, his face is gone,’” she said. “Most of my concerns were 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, it’s going to be okay,’” Aaron said. “She took a picture, turned her phone around, and I thought, ‘Oh, my God, this is a bad deal here,’” he recalled. “I mean, I felt good, so I knew I would be fine. We just had a long way to go.”

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

“As soon as there was talk of face transplantation, I thought, ‘Man, this is important,’ because they just 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 performed four face transplants before – and his colleagues were introduced to Aaron’s case by experts in Texas. After learning more about Aaron’s accident and subsequent injuries, Rodriguez said it was “amazing” that Aaron survived.

“Seeing him walking after being completely discredited in the hospital – multiple organ failure, breathing tube, he will survive, he will have neurological damage – seeing him without any of these sequelae, is very impressive,” said Rodriguez.

“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 some celestial involvement where it was not his time to go.”

“You have to have a 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 a potential eye transplant.

As Rodriguez talked to Aaron about the possibility of having not just a partial face transplant, but 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 one eye and it will at least look normal, and then you can all learn something from it,’” Aaron said. “You have to have patient zero.”

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

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

The operation involved two operating rooms. Aaron was in a room, where surgeons removed the 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 face,” he said. “We cut the blood vessels, disconnect them from the donor and the race begins. At this point, the face and eyes are not receiving any 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 just in immune modulation, because it is a transplant – but also in neuroregeneration,” said Rodriguez. “At the connection of the optic nerve from the donor to the recipient, right in that location, we inject those CD34 stem cells.”

A key step in the whole-eye transplant surgery was reconnecting Aaron’s optic nerve to the donor eye, said Dr. José-Alain Sahel, clinical spokesman 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 that they didn’t cut the optic nerve too far from the eyeball when the eye was removed from the recipient,” said Sahel, who has been following the work of the NYU Langone Health team.

“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,” he said. he. “What we learned from this is that potentially surgery can work, and so we should promote more research, more investment in research into corneal and optic nerve regeneration.”

When the surgery was complete 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 taking 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, who recently graduated from high school, are preparing to celebrate Thanksgiving together in a few weeks. Aaron can now smell and taste – and is looking forward to his meal. He also remains hopeful that one miraculous day, he will be able to see through the donor’s eye.

“Whether he will see it or not is the question that remains unanswered,” 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. “So I’m hopeful.”

The procedure marks an important step forward for the field of transplant medicine, said Dr. Oren Tepper, plastic and reconstructive surgeon and director of the Craniofacial Surgery Program at Montefiore Health System.

“This highly technical and complex surgery represents a significant advancement 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 tremendous advance in medicine for patients who have suffered eye loss due to trauma or cancer.”