NYU Langone Health Performs World’s First Successful Face and Double Hand Transplant
A surgical team from NYU Langone Health performed a face and double hand transplant for a 22-year-old New Jersey resident severely burned in a high-speed car crash. The surgery included transplanting both hands and the full face of a single donor. It marked the first successful combination transplant case of its kind in the world.
The surgery, which began the morning of Wednesday, August 12, took approximately 23 hours—a total surgery time shorter than NYU Langone’s most recent face-only transplant for Cameron Underwood performed in 2018. A team of more than 140 health care professionals, including surgeons, nurses, and other staff, was once again led by Eduardo D. Rodriguez, MD, DDS, director of the Face Transplant Program, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, and chair of the Hansjörg Wyss Department of Plastic Surgeryat NYU Langone.
The recipient in this recent case is Joe DiMeoof Clark, NJ, who suffered third-degree burns over 80 percent of his body from a car accident in July 2018. Despite undergoing approximately 20 reconstructive surgeries, DiMeo had extensive injuries—including amputated fingertips, severe facial scarring, and no lips or eyelids—that affected his vision and daily activities, and severely limited his ability to live a functional and independent life.
“Joe was an ideal candidate for this procedure; he’s extremely motivated and dedicated to recovering the independence he lost after his accident,” says Rodriguez. “Thanks to the institutional support we received here at NYU Langone and a world-class team committed to providing the best care for our patient, we’ve succeeded in a tremendous undertaking that shows we can continue to take on new challenges and advance the field of transplantation.”
A New Chapter for a Pioneering Program
This is the fourth face transplant performed under the leadership of Rodriguez and the first hand transplant under his direction. While two other simultaneous face and hand transplant attempts are known to have been performed, in each case there was an adverse outcome: One patient ultimately died due to infectious complications, and another required removal of the hands after they failed to thrive.
“Fundamentally, I viewed this as the same type of surgical exercise as our previous successful face transplants,” Rodriguez says. “I saw no reason why we couldn’t achieve this outcome to help improve Joe’s function and quality of life.”
As they do in all transplant operations, the surgeons sought to complete the procedure as quickly as possible to limit the ischemia time, or the amount of time the donated tissue is not receiving a blood supply. The surgery was precisely orchestrated to connect the tissues quickly in order to ensure the optimal outcome for the recipient as well as for the other lifesaving organs made available by the donor.
Navigating the COVID-19 Pandemic
Just three months after DiMeo was listed for organ donation with the United Network for Organ Sharing (UNOS) in October 2019, the first coronavirus case was identified in the United States. In March, elective surgeries were halted in New York. Medical professionals in New York City, including members of NYU Langone’s face and hand transplant team, were reassigned to work in COVID-19 units as the number of positive cases surged.
Despite the additional demands during this time, the core surgical team continued to safely perform monthly rehearsals to ensure a seamless operation when the time came. DiMeo was listed for just 10 months before a donor was identified; his total time from injury to transplantat was 2 years.
A Needle in a Haystack
Due to the multiple life-saving blood transfusions and skin grafts DiMeo received after the initial accident, his immune system was highly sensitized. His panel reactive antibody (PRA), which reveals the percentage of donors the recipient would reject, was 94 percent—meaning he had just a 6 percent chance of finding a compatible donor. Adding in other factors such as bone structure and skin tone matching meant that “finding Joe the perfect donor was like finding a needle in a haystack,” says Rodriguez.
Locally, the effort to find a donor for DiMeo was led by LiveOnNY, the organ recovery organization for the greater New York metropolitan area and a member of UNOS. To expand the pool of potential donors, NYU Langone broadened the donor search to organ procurement agencies across the country. An exact match for DiMeo was ultimately identified by Gift of Life, the regional organ donor program serving Southern New Jersey, Pennsylvania, and Delaware. After Rodriguez traveled to Delaware to perform a series of evaluations, the donor’s body was brought to NYU Langone for the transplant surgery.
“Gift of Life Donor Program is proud to have collaborated with such a distinctive team of medical professionals on the first face and bilateral hand transplant in U.S. history. We congratulate our colleagues at NYU Langone Health on this pioneering medical milestone and are thrilled to hear that the patient is doing so well,” says Richard D. Hasz Jr., MFS, CPTC, vice president of clinical services, Gift of Life Donor Program. “This transplant was possible because a selfless family said yes to this unique donation. The donor’s mother shares that she is proud and comforted that her son was able to help another young man while also saving and healing others through organ and tissue donation. She says her son will always be her angel. Gift of Life salutes the donor family’s enduring generosity and pays tribute to the heroic donor. It was an honor to coordinate the donation on their behalf and to contribute our national leadership and expertise in organ procurement and the coordination of these rare and complex donations to help heal and transform a young man’s life. Our thoughts are with the donor family and the recipient that they find the healing and hope donation makes possible.”
“Dr. Rodriguez and the NYU Langone transplantation team continue to show that organ donation and transplantation is an ever-expanding field that continues to help people in new and exciting ways,” says Helen Irving, president and chief executive officer of LiveOnNY. “It is important to remember that none of this would be possible without the selfless organ donor who chose to give the gift of life. This is groundbreaking work that will continue to save lives as more New Yorkers sign up on the New York State Donate Life Registry.”