Doctor Who Performed World's 1st Successful Face, Double Hand Transplant Discusses Rare Surgery
Joe DiMeo, a 22-year-old from New Jersey, was severely disfigured in a horrific car accident two and a half years ago.
In July of 2018, he was driving home from working the night shift when he fell asleep behind the wheel on a busy highway. A bystander ran across the median to pull DiMeo out from underneath his rolled over vehicle before it exploded.
But the damage was already inflicted: DiMeo sustained third-degree burns on about 80% of his body. He was transported to an acute burn center where he underwent multiple procedures while in a medically induced coma for several months.
But now, thanks to the groundbreaking work performed by Dr. Eduardo Rodriguez and a surgical team at NYU Langone Health, DiMeo successfully underwent a full face and double hand transplant — the first successful transplant surgery of its kind in the world.
When Rodriguez first met DiMeo in March of 2019, the patient’s eyelids and lips were melted together, his nose was almost completely gone, his ears were burnt off, and his hands “were like mittens” from thick scarring, rendering them almost completely useless, Rodriguez says.
Rodriguez knew he could treat DiMeo’s face, but paused when examining the burnt hands.
The two previous attempts — one transplant unfortunately turned fatal in France, and another in Boston missed the mark when the face worked but the hands did not — surfaced in the back of Rodriguez’s mind.
“When I thought about combining the face and the hands, looking back at the history, there had been two attempts in the world,” the doctor recalls. “And I know that both of them were unsuccessful.”
During initial conversations, DiMeo was focused on regaining hand mobility so he could get back to work and gain independence again, Rodriguez says. But the doctor pointed out that without working eyelids, returning to his normal job would be impossible.
That’s when Rodriguez proposed doing both a double hand and face transplant. He assembled a team of face and hand surgeons, discussed their options, then began to rehearse the operation in a simulation lab, he says.
Rodriguez has experience operating on three previous face transplants, so he knew the operation setting and understood the extreme time sensitivity of a transplant.
“In a transplant, it’s a totally different set of rules because when you have a donor, time is of the essence,” he says.
DiMeo is right-hand dominant, so Rodriguez set his team’s sights on first replacing his damaged right hand with the new donor hand. The plan was that if the right hand transplant — which includes amputating the existing hand — was successful, then they would immediately get to work attaching the new donor left hand.
“And if that was moving along well, then we would remove his existing scarred face and replace it with a new face,” he says. “So all of that had to occur perfectly, well orchestrated, without missing a beat.”
To get the routine down without any errors, his team rehearsed and studied “a great deal,” he says.
The new hands and face were from the same donor, an advantage for putting together a “very selective immunosuppressive medication regimen” that includes anti-rejection medication DiMeo will have to take for the rest of his life, Rodriguez says.
Chances of rejection exist after any transplant surgery, which is why tissues from the one donor can help doctors with any potential hurdles down the road, he explains.
“If we see any changes in the antibody profile over time, we can actually treat it before it actually becomes a full-blown rejection,” he says.
It’s only been six months since the historic surgery, and DiMeo has already been hitting the gym. He’s able to lift weights and has a strong grip.
Rodriguez says DiMeo’s “impressive” transformation is in part due to the patient’s strong spirit and perseverance.
“Every day he gains more and more intrinsic hand function. Intrinsic hand function gives you the ability to spread your fingers in your hand, bring them together, move around independently, and that continues to improve as the nerves continue to regenerate,” Rodriguez says.
For many, face transplants can seem almost beyond human comprehension. Receiving a new face may seem jarring and emotionally challenging, but Rodriguez says most patients actually experience an identity crisis when looking at their own face’s deformities.
“I’ve seen that when we give these patients a new face of normal anatomic features — in other words, normal eyelids and normal nose, cheeks, lips, ears — and they look in the mirror and that face begins to adapt to their underlying skeleton, they will all tell you unanimously that that face is them,” he says. “When they look in the mirror, they see themselves.”
The success of the complicated and risky transplant is extraordinary for DiMeo, for medicine and for the NYU Langone Health team who made it happen.
Throughout the world, there have been more than 100 successful hand transplants and nearly 50 face transplants, he says, so the “breakthrough” with DiMeo proves that both can be done at the same time.
“If we could procure tissues from one donor and perform these transplants, that just offers patients a tremendous amount of hope, and it gives us more opportunities to help people,” he says.
Rodriguez describes DiMeo as an “ideal candidate” who was dedicated throughout the surgery and rehabilitation. When the two first met, the doctor learned the young man was nicknamed “Joey Whispers” after his quiet demeanor. But Rodriguez came to learn DiMeo is a confident, funny and healthy guy who loves being with friends.
Now, Rodriguez says the two joke that DiMeo is “Joey Hollywood.”
“He feels great. You know that this was the right operation for him, and it kind of resets the clock for him,” he says. “I’m so glad that he’s doing so well.”
This article was originally published on WBUR.org.
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