Face, hands transplants work

Joe DiMeo, a 22-year-old man from New Jersey, has become the first person to successfully undergo a transplant of his face and two hands from a single donor.

Dr Edurardo Rodriguez, director of the face-transplant program at NYU Langone Health in New York City, led a team of more than 140 healthcare professionals, including surgeons, nurses and other staff, to operate on DiMeo for about 23 hours in two operating rooms in August 2020.

DiMeo suffered 80 percent third-degree burns in a car accident in July 2018. After going through 20 reconstructive surgeries, DiMeo still had extensive problems, including amputated fingertips, severe facial scarring and no lips or eyelids.

Those issues 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," Rodriguez said in a news release from Langone. It was the fourth face transplant and the first hand transplant performed by the doctor.

Worldwide, surgeons have completed at least 18 face transplants and 35 hand transplants, according to the United Network for Organ Sharing, which oversees the US transplant system.

There had been only two other simultaneous face and hand transplant attempts in the past, in Paris in 2009 and in Boston in 2011. The patient in Paris died about a month later from infection complications. Boston doctors tried it again on a woman who was mauled by a chimpanzee, but ultimately had to remove the transplanted hands days after they failed to thrive.

The search for a donor was challenging, as organ donations plummeted in New York City amid the pandemic. Members of the transplant unit were reassigned to work in COVID-19 wards.

Despite the obstacles, the core surgical team continued to perform monthly rehearsals to ensure a seamless operation when the time came, according to NYU.

Due to multiple lifesaving blood transfusions and skin grafts that he received after the accident, DiMeo's immune system was highly sensitized; doctors estimated that he had just a 6 percent chance of finding a compatible donor with his immune system.

They also wanted to find someone with the same gender, skin tone and hand dominance. He was listed for 10 months before a donor was identified.

"Finding Joe the perfect donor was like finding a needle in a haystack," Rodriguez said.

In early August, the team finally identified a donor in Delaware and completed the 23-hour procedure a few days later.

They amputated DiMeo's hands, replacing them mid-forearm and connecting nerves, blood vessels and 21 tendons with hair-thin sutures. They also transplanted a full face, including the forehead, eyebrows, nose, eyelids, lips, both ears and underlying facial bones.

The presurgical planning and the surgery itself were guided by state-of-the-art technology. The use of 3D computer surgical planning and 3D-printed patient-specific cutting guides ensured that bones were aligned perfectly and that implantable plates and screws were in the best position to anchor the grafted face and hands to DiMeo.

"We practiced the surgery nearly a dozen times over the course of a year, and in the operating rooms, we had teams ensuring everyone followed the steps exactly, so we didn't skip a beat or get out of sequence. Ultimately, it went better than I ever expected," said Rodriguez.

DiMeo spent several weeks in recovery at NYU Langone after the surgery and was discharged in November.

"The rehabilitation demands on Joe are greater than any of our previous face-transplant patients," said Rodriguez. "With the added element of his hand therapy, Joe has performed up to five hours of rehabilitation daily and he is constantly pushing for more. He's completely focused on his goal of gaining greater independence and freedom."

"When I saw my face for the first time, it still didn't actually, it didn't hit me 'cause, it just didn't seem real at first," DiMeo said during an interview on ABC-TV's Good Morning America.

"The swelling comes down a lot more every day. I could see a lot coming back now, especially like, my cheekbones," he said.

DiMeo said he is very grateful to the family that donated the face and hands and wrote a letter to them. The donor family doesn't want to be revealed, and he has no direct contact with them.

Almost six months after the transplant, DiMeo, who lives with his parents, can hold a slice of pizza and a hamburger. He can swipe on his smartphone, lift weights, plays pool and does pushups from a bench, according to USA Today.

Sensations are slowly returning, and he can tell when his hands are cold.

"I knew it would be baby steps all the way," DiMeo told The Associated Press recently. "You've got to have a lot of motivation, a lot of patience. And you've got to stay strong through everything.

"You got a new chance at life. You really can't give up,'' he said.

DiMeo has two more goals: "To drive again and get back to work."