First face-eye combo transplant at NYU Langone makes history

Earlier this year, inside an operating room in New York City, a man’s life was transformed.

When a gruesome work accident occurred two years ago, electric lineman Aaron James received a deadly 7,200-volt shock as his face accidentally touched a live wire.

James, 46, suffered massive injuries, including the loss of his left eye, his dominant left arm from above the elbow, his entire nose and lips, his front teeth, his left cheek area and his chin down to the bone.

The outlook for James, a military veteran living in Arkansas, was decidedly grim.

But surgeons at NYU Langone Health made medical history in May with an unprecedented operation — the first whole-eye transplant in a human, and the only successful whole-eye and partial-face transplant ever performed.

The complex surgical procedure involved a team of more than 140 surgeons, nurses and other health care professionals led by Dr. Eduardo D. Rodriguez, director of the Face Transplant Program and chair of the Department of Plastic Surgery at NYU Langone.

“We couldn’t have asked for a more perfect patient,” said Rodriguez in a news release. “Aaron has been extremely motivated to regain the function and independence he lost after his injury.”

Weighing risks vs. rewards

James received early treatment at a Texas medical center, and the NYU Langone team was introduced to his case two months after his accident. Last year, James was evaluated for a face transplant.

But because of severe pain, Texas surgeons were forced to remove his injured left eye. Rodriguez recommended that the surgeons leave as much of the optic nerve as possible, in the hope of a transplant that might restore some level of vision.

That opened a discussion about the possibility of transplanting an eye with a face — something that had never before been attempted anywhere.

The unprecedented operation was fraught with risks, and beyond some cosmetic improvement for James, the outcome was uncertain.

But the James family and the surgical team at NYU Langone decided to forge ahead.

“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. Despite the eye being successfully transplanted, from a cosmetic standpoint, it would still be a remarkable achievement,” said Rodriguez.

‘Donor hero’ is found

A grand stroke of luck occurred when LiveOnNY, an organ procurement organization for the greater New York metropolitan area, quickly identified a potential donor 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 LiveOnNY.

“He 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,” Achan added.

Eye transplant challenges

The transplant of a human eye is a highly complex process because of the challenges associated with optic nerve regeneration, blood flow to the retina and the possibility that his immune system would reject any new organs or bodily tissues.

Rodriguez and the team at NYU Langone’s Transplantation and Cellular Therapy Center made the decision to combine the donor eye with donor-derived stem cells.

Transplanted stem cells can work as a natural “repair crew,” dividing again and again to create healthy cells that replace damaged or dysfunctional tissue.

“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.

A carefully rehearsed operation

The 21-hour surgery took place in NYU Langone’s Kimmel Pavilion, where two different surgical teams simultaneously operated in both the donor and recipient rooms.

Each team kept to a carefully planned timetable — which had been rehearsed several times over the past year — to integrate the donor’s face and eye onto James as quickly as possible.

The face transplant included the nose, left eyelids and eyebrow, lips and underlying skull, cheek, nasal and chin bone segments, plus the underlying muscles, blood vessels and nerves.

The concurrent eye transplant included the entire left eye and socket, plus the orbital bone and all surrounding tissue, including the optic nerve.

The transplanted left eye does not currently have any sight, but over the last six months, his eye has shown remarkable signs of health, including a robust flow of blood to the retina. If the organ stays healthy, there’s a chance it could restore some sight — but all they can do is hope.

Outcome ‘far exceeds our initial expectation’

The successful outcome of the complex surgical procedure has exceeded even the high hopes of the healthcare team.

“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,” said Dr. Bruce Gelb, a transplant surgeon at the NYU Langone Transplant Institute.

“This far exceeds our initial expectations, as going in our best hope was that the eye would survive at least 90 days,” Gelb added.

Rodriguez concurred: “Beyond the eye, the quality of Aaron’s results from the face transplant is special. You would never think he underwent such a procedure so recently. He looks great.”

One twist: The donor’s eye was brown, and James’ eye is blue, giving him heterochromia (different colored eyes in the same person). 

A ‘second chance at life’

Following the surgery, James spent only 17 days in the Intensive Care Unit at NYU Langone — one of the
shortest recoveries among Rodriguez’s face transplant recipients.

James is now back home in Arkansas, where he’s looking forward to spending Thanksgiving with his family and eating a holiday meal for the first time since his injury in 2021.

“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.

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