Aaron James, the world’s first patient to undergo a whole eye and partial face transplant, is healthy and thriving more than a year later. In a paper published Monday, James’ doctors at NYU Langone Health detail how he and his new eye have progressed since the historic procedure in May 2023. While James may never regain sight in the donated eye, the researchers say his experience has taught them important lessons about how to better perform these transplants in the future.
James is a 46-year-old military veteran who suffered a high-voltage electrical accident at work that injured much of the left side of his body and face, including his eye. The doctors originally intended to only perform a partial face transplant. But they eventually opted to try grafting a donated eyeball as well, believing that such a feat was now technologically feasible, even if it was unlikely to return James’ vision.
“People have been talking about doing eye transplantation for a long time now, but it’s very complex, and the blood vessels and nerves that you’re dealing with are very small,” Daniel Ceradini, one of James’ surgeons and the director of research at NYU Langone Health’s Hansjörg Wyss Department of Plastic Surgery, told Gizmodo. “So it was always an issue of trying to be able to restore blood flow to the eye.”
Ceradini and his team announced the transplant last November, six months after the procedure. In a new paper published in JAMA, they outline exactly how they were able to perform it and how James has fared since. The surgery took about 21 hours to complete, though the doctors were able to practice virtually beforehand. To boost the odds of success, they injected stem cells harvested from the donor into James’ optic nerve at the same time. So far, things have continued to go smoothly.
“He still does not have sight in the eye, which we reported in the paper. But there is electrical activity in the retina. And it’s very well perfused, which is a huge milestone for eye transplantation. No one really ever knew if this was possible in the way that we did it,” Ceradini said. “Aesthetically, Aaron’s doing great. His aesthetic outcome is incredible, and that can’t really be overlooked in how it’s impacted his quality of life and his reintegration into society and doing things that he used to like to do, pre-injury.”
As historic as this transplant is, the ongoing drug regimen used to keep James’ immune system from rejecting the donated eye isn’t any different from the care used to keep other donated organs working. To date, the donated eye hasn’t significantly shrunk or lost pressure, which were potential risks. Not all of the eye’s cells survived the journey, however, which will be a key area of improvement for future transplants, the doctors say. While James might receive small cosmetic revisions to his face in the future, there’s nothing else major planned for him.
His doctors hope that this procedure will only be the first of many for others in a similar situation—and that a complete restoration of sight will indeed someday happen.
“I think it’s promising. This was a big hurdle that needed to be overcome in order to get the medical fields moving again towards this goal of restoring vision. So I’m hopeful that it will happen in the near future,” Ceradini said. “It will take a multidisciplinary approach, though. In this case, you have ophthalmologists, you have transplant surgeons, you have plastic surgeons, you know, everybody getting together and coming up with a plan and rehearsing the plan well ahead of time. I think that is the key for success.”
As for James, he’s returning to his usual routine, even having recently received a new ID card from the DMV with his current face. “I’m pretty much back to being a normal guy, doing normal things,” said James in a statement released by NYU Langone Health. “All in all, though, this has been the most transformative year of my life. I’ve been given the gift of a second chance, and I don’t take a single moment for granted.”
