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• Posted November 9, 2023

Man Maimed by Electric Shock Receives First-Ever Face Transplant That Includes New Eye

An Arkansas man maimed by a massive electrical shock to his face has successfully received the world's first whole-eye and partial face transplant.

In a 21-hour surgery performed in May, a NYU Langone Health surgical team transplanted an entire left eye and the portion of a face from a single donor onto Aaron James, a 46-year-old military veteran from Arkansas who survived a work-related, high-voltage accident.

"I'm grateful beyond words for the donor and his family, who have given me a second chance at life during their own time of great difficulty,"James said in an NYU Langone news release. "I hope the family finds solace in knowing that part of the donor lives on with me."

"Our hope is that my story can serve as inspiration for those facing severe facial and ocular injuries,"James added.

It's still unknown if James will regain sight in the left eye, but in the months following surgery it has shown remarkable signs of health, doctors say.

This includes restored blood flow to the retina, the area at the back of the eye that receives light and forwards images to the brain.

"The mere fact that we've accomplished the first successful whole-eye transplant with a face is a tremendous feat many have long thought was not possible," said Dr. Eduardo Rodriguez, director of the Face Transplant Program at NYU Langone. "We've made one major step forward and have paved the way for the next chapter to restore vision."

This is the fifth face transplant performed under Rodriguez and the first known whole-eye transplant ever done, doctors said.

James survived a deadly 7,200-volt electrical shock in June 2021 when his face accidentally touched a live wire while working as a high-voltage lineman. He lives in Hot Springs, Ark.

He underwent multiple reconstructive surgeries but still had extensive injuries, including the loss of his left eye, entire nose and lips, front teeth, and chin down to the bone.

NYU Langone doctors provided some guidance on James' case two months after his injury, consulting with specialists at a Texas medical center during early-phase reconstructions.

For example, when Texas surgeons had to remove James' left eye due to severe pain, the NYU surgeons recommended that the optic nerve be cut as close to the eyeball as possible. That would preserve additional nerve length and maximize future reconstructive options.

They discussed the possibility of a face transplant with James over the next year, and performed an initial evaluation for the transplant in June 2022.

James and his doctors decided to go ahead with a whole-eye transplant along with the face transplant, even though it might not restore his sight.

"Given James needed a face transplant and will be taking immunosuppressive drugs regardless, the risk versus reward ratio of transplanting the eye was very low,"Rodriguez noted.

James was officially listed as a recipient in February with the United Network for Organ Sharing, a private nonprofit that manages the U.S. organ transplant system.

Three months later, in May, a potential donor was identified at another hospital in New York City.

"The donor hero was a young man in his 30s who came from a family that strongly supports organ donation,"said Leonard Achan, president and CEO of New York organ procurement organization LiveOnNY. "He, in support by his family, generously donated tissues leading to this successful face and eye transplant, but also saved three other individuals between the ages of 20 and 70, donating his kidneys, liver and pancreas."

The May 27 transplant surgery included a team of more than 140 surgeons, nurses and other health care professionals, NYU Langone says. Two highly skilled teams simultaneously operated on both the donor and patient, adhering to a carefully planned timetable.

It's common to replace a cornea in the human eye, but whole-eye transplants to restore vision have remained elusive due to the complex nature of the eye.

For an eye transplant to be successful, the eye's connection to the brain via the optic nerve must be successfully regenerated, blood flow must be restored to the retina and the recipient's body has to be immune-suppressed to avoid rejection.

Rodriguez and his team decided to combine the donor eye with donor stem cells derived from his bone marrow, to hopefully enhance nerve regeneration. The stem cells were injected into James' optic nerve during the transplant procedure.

"This is the first attempt of injecting adult stem cells into a human optic nerve during a transplant in the hopes of enhancing nerve regeneration," said Dr. Samer Al-Homsi, executive director of the Transplantation and Cellular Therapy Center at NYU Langone.

"We have now demonstrated that the procedure is safe and potentially efficacious, but we need time to determine if this step plays a role in enhancing the chance of sight restoration, and if there's anything further that can be done in the future to optimize the procedure," added Al-Homsi.

The team also transplanted the left eye socket, including the orbital bones.

In addition to the revolutionary eye transplant, surgeons also transplanted the nose, left upper and lower eyelids, left eyebrow, upper and lower lips, and underlying skull, cheek, nasal and chin bone segments.

"The progress we've seen with the eye is exceptional, especially considering that we have a viable cornea paired with a retina showing great blood flow five months after the procedure. This far exceeds our initial expectations, given our initial hope was that the eye would survive at least 90 days," said Dr. Bruce Gelb, a transplant surgeon at the NYU Langone Transplant Institute. "We will continue to monitor, and I am excited to see what else we may learn over time."

James spent just 17 days in an NYU Langone ICU following the surgery, one of the shortest recoveries among Rodriguez's face transplant recipients.

James has since entered physical and occupational rehabilitation and speech therapy. He also has undergone follow-up surgery to tweak the transplant, and will have dental treatment in the coming months.

"Beyond the eye, the quality of Aaron's results from the face transplant is special,"Rodriguez said. "You would never think he underwent such a procedure so recently. He looks great."

James returned to Arkansas with his wife and daughter in September, and has regained the ability to taste, smell and eat solid foods. He returns to New York City monthly for follow-ups.

James said he's looking forward to enjoying a Thanksgiving meal for the first time since his injury.

"I will also forever be thankful to Dr. Rodriguez and his team for changing my life,"James said. "My family and I wouldn't have been able to navigate this difficult journey without their expertise and support."

More information

Cleveland Clinic has more about face transplant surgery.

SOURCE: NYU Langone Health, news release, Nov. 9, 2023

WHAT THIS MEANS FOR YOU:

This whole-eye transplant surgery could provide clues for more successful ocular transplants in the future.