A surgical team from New York University (NYU) Langone Health has performed the world’s first whole-eye and partial face transplant for a 46-year-old military veteran from Arkansas who survived a work-related high-voltage electrical accident. The surgery included transplanting the entire left eye and a portion of the face from a single donor, making this the first-ever human whole-eye transplant in medical history and the only successful combined transplant case of its kind.

The May 27 surgery lasted approximately 21 hours and included a team of more than 140 surgeons, nurses and other healthcare professionals, led by Eduardo D. Rodriguez, MD, DDS, director of the Face Transplant Program, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, and chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone.

The recipient, Aaron James of Hot Springs, Ark., survived a deadly 7,200-volt electric shock while working as a high-voltage lineman in June 2021, when his face accidentally touched a live wire. Despite multiple reconstructive surgeries, James had extensive injuries—including the loss of his left eye, his dominant left arm from above the elbow, his entire nose and lips, front teeth, left cheek area, and chin down to the bone.

“Aaron has been extremely motivated to regain the function and independence he lost after his injury. We couldn’t have asked for a more perfect patient,” says Rodriguez. “We owe much of our success in this monumental endeavor to the exceptional institutional support we receive at NYU Langone and the unwavering dedication of our world-class team in delivering the highest level of care to our patient. This achievement demonstrates our capacity to embrace the most difficult challenges and drive continuous advancements in the field of transplantation and beyond.”

The NYU Langone team was introduced to James’ case just two months after his injury, allowing guidance during the early-phase reconstructions with specialists at a Texas medical center where he was receiving care. The possibility of a face transplant was discussed over the next year, and an initial evaluation for the transplant took place one year following the initial injury in June 2022.

When Texas surgeons were forced to remove James’ left eye after injury due to severe pain, Rodriguez and his team recommended that the optic nerve be cut as close to the eyeball as possible, to preserve as much nerve length to maximize reconstructive options, including the hope of a potential transplant later. This began the discussion on the possibility of including an eye with the face, something that has never been attempted before.

NYU Langone’s multidisciplinary team, Rodriguez, and the James family collectively made the decision to move ahead with a whole-eye transplant in combination with the face—understanding that at best it may only provide cosmetic benefits but leave many unknowns. “Given James needed a face transplant and will be taking immunosuppressive drugs regardless, the risk versus reward ratio of transplanting the eye was very low. Despite the eye being successfully transplanted, from a cosmetic standpoint, it would still be a remarkable achievement,” says Rodriguez.

This is the fifth face transplant performed under the leadership of Dr. Rodriguez and the first known whole-eye transplant in existence. “The mere fact that we’ve accomplished the first successful whole-eye transplant with a face is a tremendous feat many have long thought was not possible,” adds Rodriguez. “We’ve made one major step forward and have paved the way for the next chapter to restore vision.”

Featured image: After receiving a whole-eye and partial face transplant—the first-ever case of its kind in the world—Aaron James is getting a second chance at life after a severe high-voltage electrical accident. He joins plastic surgeon Eduardo D. Rodriguez, MD, DDS, just five months after his procedure.