(CNN) â It was a moment Meagan James never expected to witness.
A surgical team at NYU Langone Health in New York had performed the worldâs first successful whole-eye transplant in a living person: her husband, Aaron James.
After an accident at work led to the loss of his left eye and part of his face, Aaron was given a new window to his soul, as well as a partial face transplant.
When Meagan peered into her husbandâs new eye for the first time, she noticed the post-surgery swelling and saw that the eye was brown. Aaron naturally has ocean-blue eyes.
She also saw his new nose, lips and cheek, which already had some beard stubble growing. She saw a face filled with gratitude, and thatâs when the emotion set in.
She was happy for her husband of 20 years.
âIt was a crazy, great, weird, strange, ecstatic, happy feeling,â Meagan said. âI was just happy he made it through, and everything was good in the moment.â
On that day in late May, a team of more than 140 surgeons at NYU Langone Health completed Aaronâs transplantation procedure, which lasted about 21 hours. The surgery included transplanting the entire left eye and parts of the face from a single donor. It was a medical first.
Aaronâs eye is now showing âremarkableâ signs of health, according to his medical team. Although he canât see out of the eye, he remains hopeful that vision might come with time â and that his first-of-its-kind procedure may help advance transplant medicine.
âThatâs really my biggest hope,â Aaron said. âIf I can see out of it, thatâs great. But if itâll kick-start the next path in the medical field, then Iâm all for it.â
A life-changing accident
Seeing Aaronâs new eye and face âwasnât as big of a shockâ as seeing him the night of his accident, Meagan said.
Aaron, a 46-year-old military veteran based in Arkansas, worked as a high-voltage power lineman, and that night in June 2021, he was working with his colleagues in Mississippi when his face accidentally touched a live wire.
The deadly 7,200-volt electric shock caused extensive injuries to Aaronâs face: his left eye, his entire nose and lips, his left cheek area and chin, as well as his left arm.
Back in Arkansas, Meagan and their daughter, Allie, who was in high school, were driving home from the grocery store when Meaganâs phone rang. She didnât recognize the number, but she still answered. She heard the words âAaron,â âaccidentâ and âserious.â
Meagan immediately packed a bag when she got home and then drove about four and a half hours to Mississippi, where Aaron was being cared for at a local hospital. During the drive, her phone rang again. This time, it was a doctor. The doctor described Aaronâs condition and explained that he had been electrocuted.
âIs he OK? Is he going to be OK?â Meagan asked. She recalls the doctor responding, âThe only thing that I can promise you is that he wonât die before you get here.â
Meagan remembers that she would tell Aaron to âbe carefulâ every morning before work. She still thinks back to the morning of his accident and wonders whether she told him to âbe carefulâ that day.
âOh, my goodness, his face is goneâ
Meagan remained by Aaronâs side as he was transported to different medical centers for more intensive care, for reconstructive surgeries and to have his left arm amputated.
After he was flown to a burn unit in Dallas, Allie, who was staying with her grandmother at the time, was able to visit him.
âWhen I saw him, his chinbone was exposed,â Allie said.
âI could see his eye socket and everything. I was seeing his skull, and I think thatâs the part that was kind of freaky for me. I was like âOh, my goodness, his face is gone,ââ she said. âMost of my worries was just how he was going to be when he was awake and aware.â
Aaron said he doesnât remember the accident at all.
âBasically, I got up, went to work and woke up six weeks later in Dallas, Texas,â he said. âItâs a weird feeling when you just all of a sudden wake up in a hospital.â
The first time Aaron saw himself after the accident was from his hospital bed in Dallas. He asked Meagan to take a photo, but she hesitated.
âShe said, âAre you sure?â I said, âYeah, itâll be fine,ââ Aaron said.
âShe took a picture, and she spun the phone around, and I was just like, âOh, my goodness, this is a bad deal right here,ââ he recalled. âI mean, I felt OK, so I knew I was going to be OK. We were just going to have a long road ahead of us.â
Aaronâs medical care team had mentioned the option of a face transplant to Meagan. When she then brought it up to Aaron, he said he was âall for it.â
âAs soon as the face transplant got talked about, thatâs when I thought, âMan, this is a big deal,â because they just donât do those every day,â he said.
In New York, Dr. Eduardo Rodriguez, director of the Face Transplant Program at NYU Langone Health â who had performed four face transplants before â and his colleagues were introduced to Aaronâs case by specialists in Texas.
After learning more about Aaronâs accident and subsequent injuries, Rodriguez said that it was âremarkableâ that Aaron had survived.
âTo see him walking when he was completely down for the count in the hospital â multiorgan system failure, breathing tube, is he going to make it, is he going to have neurological injury â to see him without any of those sequelae, itâs very impressive,â Rodriguez said.
âItâs a testament to modern medicine,â he said. âItâs a testament to this patient and his family. And itâs also a testament that, in these cases, thereâs some celestial involvement where it wasnât his time to go.â
âYou have to have a patient zeroâ
Discussions around the possibility of a transplant continued even after Aaronâs medical team in Texas had removed his left eye due to severe pain. Rodriguez and his colleagues in New York asked the Texas team to preserve as much of the optic nerve as possible in hopes of a potential eye transplant.
As Rodriguez talked with Aaron about the possibility of doing not just a partial face transplant but a whole-eye transplant, he warned that the donor eye might not restore vision. For there to be sight, there will have to be some communication between the transplanted eye and the brain.
âBut I said âeven if it donât work, Iâll have an eye, and it will be at least normal-looking, and then you all could learn something off of this,â â Aaron said. âYou have to have a patient zero.â
Aaron was listed as a potential recipient in February 2023. The opportunity to perform the whole-eye and partial facial transplant came just a few months later, in May.
It was a âriskyâ operation for Rodriguez and his colleagues. No medical team in the world had previously performed a successful human eye transplant in a living patient.
âItâs completely uncharted territory,â Rodriguez said.
The surgery involved two operating rooms. Aaron was in one room, where surgeons removed the parts of his face that would be replaced with donor tissue. Rodriguez was in the other room, dissecting the donor face and eyeball.
âThat part of the operation took about 12 hours,â Rodriguez said.
âNow I have to ensure that Aaronâs room is ready to receive the face,â he said. âWe cut the blood vessels, we disconnect it from the donor, and the race begins. At this point, the face and the eye are not receiving any blood supply.â
Rodriguez and his colleagues then began connecting the donor face and eyeball to Aaron. For the eye transplant, the team combined the donor eye with adult stem cells derived from the donorâs bone marrow by injecting the adult stem cells into the optic nerve during the transplant. Those stem cells may help enhance nerve regeneration.
âWe were able to define a specific cell, a CD34, which is an adult stem cell that has some potential benefits â not only in immune modulation, because it is a transplant â but also neuro regeneration,â Rodriguez said. âAt the connection of the optic nerve from the donor to the recipient, right at that site, we injected those CD34 stem cells.â
A key step in the whole-eye transplant surgery was reconnecting Aaronâs optic nerve to the donor eye, said Dr.Â JosĂ©-AlainÂ Sahel, clinical spokesperson for the American Academy of Ophthalmology. He was not involved in the procedure but is chair of the Department of Ophthalmology at the University of Pittsburgh School of Medicine and has been involved in related experimental research.
âIt was very smart that they didnât cut the optic nerve too far from theÂ eyeball when the eye was removed in the recipient,â said Sahel, who has been following the NYU Langone Health teamâs work.
âI think what remains to be done â which is a major, major undertaking â will be how to regrow the optic nerve, guide its fibers or axons to the appropriate targets, as well asÂ making sure that theÂ corneal nerves areÂ well-preserved,â he said. âWhat we learn from this is that potentially the surgery can work, and then we should promote more research, more investment into research onÂ corneal and optic nerve regeneration.â
When the surgery was complete and Aaron looked at his new face in a mirror for the first time, he was thrilled, Rodriguez said. Aaron continues to be closely monitored and must continue taking medications to reduce the risk of his body rejecting the transplant. His medical team notes that the eye has shown signs of health, such as having direct blood flow to the retina, the layer of tissue at the back of the eyeball associated with visual processing.
Looking ahead, Aaron, Meagan and their daughter, Allie, who recently graduated from high school, are preparing to celebrate Thanksgiving together in a couple of weeks. Aaron can now smell and taste â and looks forward to the Turkey Day meal. He also remains hopeful that on one miraculous day, he may be able to see out of his donor eye.
âAs far as whether he will see or not, thatâs the question that remains unanswered,â Rodriguez said.
âA transplant of this kind has never been done, and transplants have a unique way to work, and even in face transplants, things have occurred that we would not have imagined,â he said. âSo, Iâm hopeful.â
The procedure marks a major step for the field of transplant medicine, Dr. Oren Tepper, plastic and reconstructive surgeon and director of the Craniofacial Surgery Program at Montefiore Health System, said in an email.
âThis highly technical and complex surgery represents a significant advancement in the field of face transplantation,â wrote Tepper, who was not involved in Aaronâs care.
âUltimately, if transplanting an eye proves to be successful at restoring any form of nerve function or visual signals, this would be a tremendous breakthrough in medicine for patients who have suffered loss of the eye due to trauma or cancer.â
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