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April 20, 2016

Firefighter receives full face transplant

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Ninety-three days after transplant, surgeons say Patrick Hardison, a retired fireman injured when a burning roof collapsed on him, is making a full recovery
Surgeons in New York have declared the most extensive face transplant ever a success, saying the procedure to give a firefighter the face of a brain-dead man stands as a “historic” achievement.
In August surgeons at New York University’s Langone Medical Center performed the transplant for 41-year-old Patrick Hardison, a retired fireman from Mississippiwho suffered disfiguring injuries when a burning roof collapsed on him, melting his mask, in 2001.
Ninety-three days after the transplant, which had more than 100 people working in two teams for 26 hours, lead surgeon Eduardo Rodriguez said that Hardison’s body had not rejected the face, making him confident that the dangerous procedure could be called a success.
Medical school dean Robert Grossman called the transplant, the most extensive ever, “a major milestone and [a] critically important contribution to the advancement of science and medicine”.
Rodriguez had told Hardison he had a 50/50 chance at surviving the transplant, which involved the meticulous closure and reconnection of blood vessels and nerves, cutting away Hardison’s scarred face, refitting facial bone and “re-draping” skin across his face.
Hardison received the face of David Rodebaugh, a 26-year-old bike mechanic from Brooklyn who was left in a vegetative state by a cycling accident. Hellen Irving, the head of a organ procurement organization, relayed a message from Rodebaugh’s mother, who said that her son was “born a miracle” and now “the miracle of David will live on”.
Rodebaugh’s heart, kidney, liver and eyes were also donated to patients waiting for eligible transplants.
Irving said that finding a match for Hardison was particularly difficult. The team needed to find a matching blood type, height, weight, skin tone, hair color and, “most importantly, no antibodies that would cause Patrick to reject his donor”, she said.
Because the skin is the body’s largest organ and its main defense – and thus its first and strongest guard against disease and infection – Hardison will have to take pills to suppress his immune system for the rest of his life, Rodriguez said.

Face transplant donor David Rodebaugh.

Between three and five of the other patients who have received facial transplants around the world died after the new tissue was rejected, he said, and physicians generally expect to see some kind of rejection episode within 90 days of surgery.
But after three months Hardison is doing “very well”, Rodriguez added. “He just had a gyro at one of the sub shops.” He said that in six months Hardison would not only be able to eat normal food but his speech would improve and the intense swelling should diminish dramatically.
Next year doctors will also cut down the tissue of Hardison’s new face to better tailor it to how he would like to appear.
Hardison also faces a long road of emotional and psychological recovery, Rodriguez said. “There’s a lot of scars that we still have to deal with. There’s a lot of anguish.”
When people with serious disfigurements “look in the mirror and try not to look in the mirror, they don’t seem themselves as normal”, Rodriguez said. In 2001, for instance, Hardison did not look in the mirror for the 63 days after the fire before he made it home to his family.
In the 14 years before the transplant, Hardison endured 71 operations on his face, which was only preserved at all thanks to skin grafts but was left without eyelids, ears or a scalp. Two of his five children never knew his face before the fire, and he became addicted to the painkillers meant to help him cope with the agony of moving any part of his scarred face. For years, he wore a baseball cap, sunglasses and prosthetic ears in public. Therapy and counseling are part of his course with the NYU medical center.
“Now that he has a new face you can see that he’s happy with it,” Rodriguez said. “It’s his face, as he said it.”

A 1999 family photo of Patrick Hardison with his two daughters.

Physicians accompanied Hardison into the outside world, he added, finding themselves moved by the former firefighter’s experience. “We took him to Macy’s to buy clothes and for him it was so remarkable that no one stared at him, no one looked him,” Rodriguez said. “It was a very emotional exchange for us.”
The procedure and the stories of Hardison and Rodebaugh’s lives were extensively detailed in a piece written for New York magazine by Steve Fishman and published on Sunday.
Of his appearance before the transplant, Hardison told Fishman: “Kids ran screaming and crying when they saw me. There are things worse than dying.”
Rodebaugh’s face was the third offered to Hardison, who met the pioneering Dr Rodriguez in 2012. The first was from a Hispanic man, whose family withdrew consent. The second was from a woman, which Hardison declined. Rodebaugh’s face was offered through LiveOnNY, the New York organ donor network.
The successful transplant nearly coincides with the 10th anniversary of the first partial facial transplant, for a 38-year-old French woman named Isabelle Dinoirre, who was bitten by a dog.
In the US, a Cleveland woman named Connie Club, who was shot by her husband in the face, underwent the first transplant in 2008.
The first full facial transplant was given in 2010 to a Spanish man who accidentally shot himself in the face, and in 2011 a 25-year-old Texan received a new lips, skin, muscle, nerves and a nose in a procedure paid for by the US military, which wanted to use what was learned to help soldiers with severe facial wounds.
Hardison’s procedure, preparation and rehabilitation cost between $850,000 and $1m, Rodriguez said, about the same as a liver transplant. It was paid for by a university grant.
He added that the transplant’s success bodes well for a future program meant first to help veterans and first-responders who have suffered major injuries.
Hardison will return to New York from his home in Senatobia, Mississippi, for regular appointments throughout his recovery.

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