Man says world's first eye and face transplant has changed his life

Aaron James can't stop looking at himself in the mirror.

The 47-year-old U.S. Army veteran and power line worker was severely injured in a workplace accident in June 2021, damaging his left eye, chin, nose, lip and left arm, and leaving a large portion of his face severely disfigured by electrical burns.

A man from Hot Springs, Arkansas, said he felt like he wasn't himself for a long time afterward — he couldn't smell or taste anything, and people stared wherever he went.

But now, a year after undergoing what medical teams say is the world's first full eye and partial face transplant, he is finally getting used to seeing his face in the mirror again.

“I see myself,” James said. What actually happened “That's why I look at myself so much, because it still shocks me,” says host Nir Koksal.

Though James cannot yet see with his new eye, doctors say the fact that the eye appears healthy and well-integrated a year later is a major win for science and brings him one step closer to restoring his sight through transplant surgery.

A medical team from NYU Langone Health in New York City said face transplants are rare and James's entire eye transplant is the first of its kind in the world. Published in the medical journal JAMA.

“I don't know if it'll work.”

James said he had already booked surgery on his face when the medical team offered him an eye transplant — both face and eye would come from the same donor.

He underwent a 21-hour operation in May 2023, a feat made possible by the combined efforts of more than 140 medical professionals.

He says he knew it was risky and that it might not work: His body might reject the new eyes, and there was no guarantee then, and there is no guarantee now, that he would regain his lost vision.

But he also knew that whatever happened, the data his medical team collected would be invaluable to others in a similar situation, he said.

There are over 40 million people worldwide who are blind in both eyes. JAMA editorialVision can be lost due to illness or injury, and there is currently no way to restore lost vision.

James' surgery is a step towards changing that.

“From the beginning, they told me, 'This is unprecedented. We don't know if it's going to work,' but I trusted them,” he said.

Moreover, James figured he had nothing to lose and everything to gain.

“I will be taking immunosuppressants for the rest of my life. [and] I just didn't have any interest in it in the first place.”

Why is it so hard to replace eyes?

Doctors have long studied the possibility of eye transplants to treat vision problems, but the eye is a particularly difficult organ to transplant because of its complex interaction with the brain.

In previous animal studies, transplanted eyes have been rejected by the recipients and have shrunken and deteriorated over time, the study authors said.

But so far, that hasn't been the case with James.

“Even though Aaron can't see light when you shine it into his eyes, his eyes themselves are just incredibly beautiful,” said Dr. Vaidehi Dedania, an ophthalmologist at NYU Grossman School of Medicine who has monitored James' recovery and is a co-author of the study.

“The eyes are round and clean, not crinkled or shrunken. This indicates that the eyes have a sufficient blood supply to make their own fluids, just as our bodies can make blood from bone marrow. In other words, the eyes are sustaining themselves.”

Although the eye has not yet regained vision, tests have shown that the retina responds electrically to light, suggesting that the rod cells, encoding cells and light-sensitive nerve cells all survived the surgery intact.

This gives hope that future transplants may be able to restore vision, said Dr. Eduardo D. Rodriguez, the study's senior author and James' primary surgeon.

“I'm really amazed that Aaron recovered without any rejection.” He said in a New York University press release:.

He credited the team's “systematic approach to the matching process that enabled Aaron to be matched with the most favorable donor” and their unique rigorous immunosuppressive regimen.

“Our discoveries over the past year have shown promising early results and lay the foundation for further progress and continued research.”

Dr. Bohdan Pomahaci, a surgeon at Yale University School of Medicine who performed the first total face transplant in the United States in 2011, called the operation “technically a marvel of surgery.”

“The authors pushed the boundaries of innovation,” said Pomahatch, who is not involved in James' case. He told Nature magazine.

The key to restoring vision, the authors say, is finding a way to regenerate the optic nerve, which carries light signals from the retina to the visual centre in the brain.

“You just have to take it one step at a time,” Dedania said. “This at least gives us some time to prepare for the next step.”

Eating becomes fun again

The surgery has dramatically changed James' life: not only has the face transplant changed the way he sees himself and is perceived by others, it has also restored his sense of taste and smell.

He said he couldn't remember whether the first food he truly enjoyed after his surgery was applesauce or chocolate pudding, “but I just remember that it was delicious,” he said.

He said his wife and daughter have welcomed his recovery and that accidents like his have a ripple effect, affecting the lives of the victim's loved ones.

“My daughter was 16 when my accident happened, and 16-year-olds have enough issues trying to become adults. [and] “You throw this on top of that,” he said, “but she handled it well. She's strong. She graduated high school.” [and is] I'm currently attending college.”

But beyond the personal impact of the operation, James says he's proud to be part of medical history.

“Everybody wants to do their part to help,” he said. “Maybe this is my role.”