Firefighter receives most extensive face transplant ever performed

On September 5, 2001, volunteer firefighter Patrick Hardison, 41, of Senatobia, MS, ran into a burning house on a rescue mission when the roof collapsed on him. He survived by jumping out of a window, but was left with third-degree burns across his entire face, head, neck, and upper body. He lost his eyelids, ears, lips, and most of his nose, as well as his hair and eyebrows.

After 14 years and more than 70 surgeries in Mississippi and elsewhere, Patrick was still in tremendous pain, his face covered in scar tissue and skin grafts, and unable to return to a normal life.

A fellow firefighter and member of Patrick’s church learned of the pioneering work in transplant surgery performed by Eduardo D. Rodriguez, MD, DDS, and wrote to the surgeon describing Patrick’s situation.

“We immediately got together and put together a core group of surgeons to be able to take on this task,” said Dr. Rodriguez, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery and chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Medical Center, in New York, NY.

In total, a team of more than 100 physicians, nurses, and technical and support staff worked together to perform this historic operation—the most extensive face transplant ever performed and the first face transplant in New York State.

“We began to schedule and organize a specific procedure that would fit Patrick’s restoration,” Dr. Rodriguez said. The team started with carefully timed rehearsals on cadavers, planning to the minute how the procedure would take place between two operating rooms—one for Patrick and one for the donor.

Donor difficulty

But finding a donor was not easy, and it took longer than anticipated, said Helen Irving, MBA, President and Chief Executive Officer of LiveOnNY, the organ recovery organization tasked to recruit a suitable donor.

“For Patrick, we needed to find the perfect match—not only blood type, height, weight, and age, but light skin color (the type of skin that sunburns easily), fair hair, similar bone structure, no facial hair or tattoos and, most importantly, no antibodies that would cause Patrick to regret his donor,” Ms. Irving said. “The potential donors to meet these criteria were very few.”

On August 12, 2015, a potential donor presented in David P. Rodebaugh, 26, an Ohio-born Brooklyn artist and bicycling enthusiast, who tragically died from injuries sustained in an accident. David’s mother gave permission for her son to be Patrick’s donor. “He cared more for…life and others than about himself,” Ms. Irving said, quoting David’s mother.

The 26-hour operation

On the morning of August 14, the transplantation group jumped into action. Two surgical teams worked simultaneously in adjoining operating rooms.

In one room, the team first analyzed the donor bone, skin, and vascular tissue to ensure these were in ideal condition. Next, they removed the donor’s entire face, eyelids, nose, lips, scalp, ears, and the skin surrounding the neck. This also included sections of bone—from the chin, cheeks, and nose—to anchor the skin onto the Patrick’s face. The donor’s other organs and tissue—including heart, kidneys, liver, eyes, skin, and bone—were also harvested for other recipients and for research.

In the other room, the recipient team removed scar tissue down to virgin healthy tissue from Patrick’s face and scalp. They also excised sections of bone that were to be precisely replaced by the donor bone sections. (An animated videoof the procedure shows the steps involved.)

The entire procedure took 26 hours. “Procurement of the face took approximately 12 hours, while the preparation of Patrick’s face took approximately 8 hours,” Dr. Rodriguez said. The remaining 10 hours, concluding on August 15, took place in the recipient room, where the combined team attached the donor face and scalp—along with connecting sections of bone, blood vessels, and nerves—onto Patrick’s head.

Within the final hours of surgery, the operation already showed signs of success. Patrick’s new face, particularly his lips and ears, were a healthy color, indicating circulation had been restored.

By the third day post-op, the swelling had begun to diminish and Patrick was able to blink his new eyelids. Within a week, he was sitting up in a chair. The hair on his scalp and face had already begun to grow.

A new beginning

Now, at 3 months after the surgery, the swelling has largely subsided. “Commonly in [transplant] patients, we expect them to experience some form of acute rejection within 90 days,” Dr. Rodriguez said. “Patrick is now out of the hospital and we have yet to see an acute episode.”

He will continue to be on immune suppressants for life. Also, he’ll return monthly to NYU Langone for routine follow-up visits, in addition to local treatment and care in Mississippi. After about 6 months, he should be ready for additional procedures to “tailor” and reduce the surplus tissue around his eyes and mouth, Dr. Rodriguez said.

In the meantime, Patrick will continue to work with physical, speech, and occupational therapists to acclimate to his new face and re-educate himself on activities of daily living. He will also participate in psychological counseling to become adjusted to his new image after 14 years of seeing a scarred and deformed version of his face in the mirror.

“Now that Patrick has a new face, you can see that he’s happy with it. It’s his face, as he says,” Dr. Rodriguez noted. “With this new face, we are now giving Patrick a chance for a new beginning. We have yet to see [all of] his story and we hope it will unfold exactly as he expected it to be.”