The extremely complex facial procedure was performed in New York. The eye tissue functions properly, but it wasn’t possible to regenerate the optic nerve and restore the patient’s vision. However, the operation provided an opportunity to trial a series of surgical techniques that may be very useful in eye transplants further down the line.
Aaron James, aged 47, lives in Hot Springs, Arkansas. He’s the first human to have received a face transplant that includes half the face and a whole eye.
His case was reported in the journal JAMA and covered by numerous other scientific publications, including Nature. This operation features several innovative aspects and raises hopes of successfully transplanting a functioning eye in the future, even if that is not the case for James.
In 2021, James was electrocuted while working on a high-voltage line. He lost his dominant (left) hand, his chin, nose and left eye. For two years after that, he could only eat liquid food, he had no sense of smell and speaking or laughing were incredibly difficult. He wore a kind of mask and covered his lost eye with a patch whenever he went out.
Then, in May 2023, he was operated on at New York University (NYU) Langone Health in New York City. Now, one year later, he’s doing well and his sense of smell is back. He can’t see out of the transplanted eye, but he can feel that it’s there. And he hasn’t lost hope of being able to regain at least a little vision in time.
An almost day-long face transplant
The 21-hour procedure was a real marathon, but it had been prepared for months by practising on about 15 cadavers. When the half-face became available for the transplant, the surgeons carried out a series of CT scans of both the donor and James, to make sure that the face parts fitted together perfectly, like the pieces of a jigsaw puzzle. What’s more, to ensure the donated eye didn’t lose blood flow for too long, the surgeons used a special technique: they connected the artery that supplied the donor’s eye to a branch of the external carotid artery, a large vessel that starts near the neck. As reported by Nature, “the whole assembly was then transplanted into James, a procedure that has never been achieved in humans”. This approach was successful, guaranteeing perfect blood flow.
James received the left eye and the socket around it, the nose, part of the chin and the associated muscles, nerves and blood vessels. There isn’t any hope of him seeing out of it, at least for the time being. Light impulses are in fact transmitted to the brain by the optic nerve, which carries them from the retina to the brain. But it wasn’t possible to regenerate James’s optic nerve.
Future advances in eye transplants
This currently insurmountable hurdle could perhaps be overcome in the future. And if and when that time comes, the novel technique tested on James will form the basis of new procedures. What really impressed the doctors, however, was the generally good condition of the eye, and the fact that the transplanted retina responds to stimuli, even if it can’t transmit them anywhere.
When James agreed to the procedure, he was aware of the risks and that he’d have to take anti-rejection medicines. But he gained something, in terms of his self-image and appearance. He no longer wears a mask or eye patch when he goes out, and his new face is a whole lot better than the one disfigured by the high-voltage electric shock. James was also aware of the importance of volunteering his own face to test novel surgical techniques that may help many other people.
