Dr. Eduardo Rodriguez previously performed four face transplant surgeries but in transplanting an eye as well, this was "a first in the history of medicine"
NYU Langone Health surgeon Dr. Eduardo Rodriguez had already performed four face transplants and was a pioneer in the life-changing procedure when he met 46-year-old Aaron James in 2021.
James had lost half his face and his left eye when he was electrocuted on the job as an electrical lineman in June 2021.
But Dr. Rodriguez and the hospital's transplant team recognized the possibility of breaking through a new medical frontier by attempting the world’s first eye transplant with James.
“I told him it's never been performed,” Dr. Rodriguez tells PEOPLE. “It was unknown territory. I said, ‘I don't even know if we could do it. The transplant of the eye could complicate things. It may kill you.’ But the possibility of replacing a face with an eye was not too far out of reach.”
After months of living with his injuries, which left him breathing through a trach tube and only able to eat soup because all that was left of his mouth was a small hole, James and his wife said they were willing to try. “I had seen Dr. Rodriguez’s work and I knew his reputation and I was like, ‘This is the best guy to do it,’" James tells PEOPLE. Adds Meagan: “There was complete trust from the beginning.”
On May 27, a medical team of 140 from NYU Langone carried out a 21-hour surgery and successfully gave James a transplanted donor face and eye. James says he’s been “blown away” by the results. “It’s just amazing to me that they can do what they do,” he says. “When I look in the mirror, it almost doesn't even look like I've had a surgery.”
And while his new eye, donated by the same donor who gave him the face (a man in his 30s who saved three other lives by donating his kidneys, liver and pancreas), has not yet allowed James to see or perceive light, “the eyeball is alive,” says Dr. Rodriguez. “It’s making fluid. It’s vascularized — all the vessels light up. The brain is receiving messages from the eyeball, so the connection of the optic nerve to the brain, something’s happening. And that’s never been done before. It’s remarkably exciting.”
That means that there is at least potential for sight. “I am not going to say that he will see, but I will tell you, what we're seeing today, the quality of the eyeball, the messaging, it is far more promising that any of us ever expected. It opens up a world of possibilities to patients who lost a globe where they thought there’s nothing we can do,” Dr. Rodriguez says. “It’s a glimmer of hope.”
It’s been a long road to get to that point —and Rodriguez and the James family have traveled it together.
James connected with Dr. Rodriguez soon after his accident, but the surgeon first evaluated him as a potential transplant recipient in June 2022. “He was in pretty bad shape still,” says Dr. Rodriguez, who acts as chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health and Helen L. Kimmel, Professor of Reconstructive Plastic Surgery.
But, he says “he was an ideal candidate. He had a deformity that was unreconstructible." Areas like the eyelids and the mouth, which for James had sustained serious injury from the 7,000-plus jolt of electricity that hit him, are particularly difficult to reconstruct, he says: "We have ways of putting skin grafts and tissue, but those areas are so sensitive. To make them move like a normal eyelid or a lip, that's very hard. Once surgeons recognize that those anatomical boundaries are involved in an injury, they understand that it's going to have to go to the next level.”
Once Dr. Rodriguez realized he could help James, he took what might seem an unusually personal step for a surgeon: he visited James and his wife and their daughter, Allie, now 18, at home in Hot Springs Village, Ark., in October 2022. “It's kind of a psychosocial field assessment,” he says. “I look at their home, I look at the surroundings. What's their access to medical care if in trouble? I want to get a vibe of the place. And the family, I want them to understand what they are getting into.”
The surgeon also had a chance to see how challenging daily life was for Aaron. “It was not living. This guy basically lived on the couch and he a towel around him all day long because he was drooling,” he says “His wife was suffering. She had been through the whole thing and she was the stronghold, the pillar of strength. And he has a beautiful daughter, but everybody was suffering.”
After the visit, he recognized that the James family “was all in. They were behind him.”
James was officially listed as a potential transplant recipient in February 2023, which begins the search for a donor. With a face and eye transplant, the request to a donor family is all the more sensitive: “We ask the family if they would be willing to let us procure the face with the eyeball while the heart is still beating. In a brain-dead donor, a family consents to organ donation and the procurement of the face is considered a research donation.”
Meanwhile, Dr. Rodriguez and the transplant team began their preparation. “We did about 15 rehearsals,” he says.
Appropriately for James, who served in the Army National Guard, it was Memorial Day weekend when the team found “the perfect donor” and got to work. The operation lasted 21 hours (“no napping or pausing — we have a good nap afterwards but we just push through”), 15 hours shorter than Dr. Rodriguez’s first face transplant in 2012. “I’m getting better,” he says. And in this case, “everything went perfect.”
James remained in the ICU for 17 days, where the team monitored his recovery, taking special care with his transplanted eye. “Eyes can develop what's called sympathetic ophthalmia, a severe pain issue,” he says. And “a rejection in the eye could set off a pretty severe acute rejection in the face. I did express to the family, 'If we have a concern, if the eye is an issue, I will take out the eye in a heartbeat to save your life.'”
There was more swelling of the eyeball than expected — "the eyeball was basically sticking out of the eyelid and that was very concerning” — but eventually it went down and James’s eyelid was able to close and protect it. "But everything went great and this guy's recovery was impressive,” Rodriguez says.
James's recovery continues but “his face is starting to move,” Rodriguez says. “He’s started squinting. The eyelid's still down, so that may take a while, but you can see his muscles moving." And, look close and you can even see the faintest hint of a smile.
For James, it’s been a life-changing transformation personally — but it’s also been about taking a bold, new step for other patients. "When they approached me with the eye transplant and asked if I wanted to do it, I said, 'Of course.' You've got to start somewhere and hopefully, this will kick off something we can improve on for the next person,” he told reporters at a press conference Thursday. “Whether I can see or not.... hopefully this will help with future patients."
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