How the first human eye transplant was performed

For two years, Aaron James He avoided doing something that might be common for people: looking in the mirror.

The U.S. Army veteran was also unable to perform other daily activities, such as eating solid foods, tasting or smelling.

In June 2021, while working as a power line technician, his face touched a live wire. The powerful electric shock of more than 7,000 volts caused him to lose his left arm and large parts of his face, including his left eye, nose, lips and chin.

But in May 2023, James underwent a procedure that made medical history. A medical team from NYU Langone Health in New York, successfully performed the world’s first complete human eye transplant, in addition to a partial face transplant.

A year after the operation, James, 47, has made notable progress in his recovery and has even been able to resume his normal life in Arkansas. says a study recently published in the journal Journal of the American Medical Association (JAMA) .

The new study, led by Dr. Eduardo Rodriguez, director of the facial transplant program at NYU Langone Health states that after James’ accident, initial treatment focused on performing “conventional reconstruction,” which included a skin graft, excision of the burn and enucleation of the left eye.

In May 2023, it was identified that there was a suitable donor for the American veteran. He was a 30-year-old man who was brain dead and had no signs of head trauma, hemorrhage or damage to his left eye.

That same month, the surgery took place, which lasted about 21 hours and involved a team of more than 140 medical professionals. The goal was to transplant James’ entire left eye, the bony orbit surrounding it, his nose, part of his chin and other areas of his face.

For this, innovative microsurgical techniques and customized surgical devices were used. Doctors have also attempted for the first time to inject stem cells into a human optic nerve during a transplant, in order to promote nerve regeneration.

Daniel Ceradini, a surgeon at NYU Langone Health and one of the study’s authors, told the magazine: Nature that the medical team did not expect James to regain vision in his left eye, given that there is no scientific evidence that the donor optic nerve can connect to the patient’s brain.

The optic nerve is the set of nerve fibers responsible for transmitting visual information from the retina to the brain. The regeneration process remains a mystery to science, but researchers suggest that this intervention is a small step forward so that in the future, new eye transplants will be accompanied by vision recovery.

James’ operation was not without its challenges. One of them was the surgical dissection of the eye, for which they had to practice on at least 15 cadavers, according to Nature.

Then they had to worry that the eye would not go long without blood flow. Faced with this, the team connected the artery that supplied blood to the donor’s eye to a branch of the external carotid artery. Then everything was transferred to James.

The professionals were also responsible for creating 3D printed surgical guides, in order to take the appropriate amount of bone from the donor to bring it to the patient’s face. For this, it was essential to have CT scans of both faces.

Once the operation was over, Rodriguez and his colleagues had no idea how James’ transplant would go. Until now, no medical team had managed to successfully perform a human eye transplant on a living patient.

Once he woke up after undergoing surgery, James immediately realized that he had recovered something precious: the pleasure of feeling.

A few days later, he decided to see what his new face looked like. As soon as he saw himself in the mirror, he was enchanted. Over the months, he also managed to eat solid food again, which he had also lost after this devastating accident.

“I’m a normal person again, I do normal things” James said in a statement. “Overall, this has been the most transformative year of my life. I have been given the gift of a second chance and I don’t take any moment for granted,” he added.

In its report, the NYU Langone Health research team said clinical tests on James’ transplanted eye showed favorable results. Among them, the eye maintained normal pressure and blood flow during those months.

Added to this is the fact that it managed to maintain its size, unlike what had been identified in the eyes of donated animals, which usually shrink after transplantation.

The study authors also suggest that a clinical test measuring the retina’s electrical response to light, called electroretinography, identified that the rods and cones in the donated eye, in addition to light-sensitive nerve cells, were able to survive the transplant.

In addition, the feeling of deep itching in the orbit and tenderness in the eye area were some of the effects reported by the patient.

Rodriguez, who has already performed four face transplants, stressed that these results “mark promising first results” that could pave the way for new research on this type of transplant.

“We are truly amazed at Aaron’s recovery, with no episodes of rejection. Our methodical approach to the matching process, ensuring Aaron receives the most favorable donor, along with our unique immunosuppression regimen, has set the standard for eliminating and avoiding early rejection episodes,” he added.

For Ceradini, it is also necessary to highlight “the aesthetic results and the quality of life” that this intervention brought to James. . “He’s regained a lot of the life he lost after the injury in 2021, and that’s our ultimate goal,” he said.

Today, James is focused on his daughter Alice’s college education and continuing his appointments at NYU Langone Health. “I felt honored to be patient zero. Even though I can’t see with my new eye, I have regained my quality of life and I know this is a step forward on the path to helping future patients,” he says.