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From left, BWH surgery resident Evan Matros and surgeons Elof Eriksson, Bohdan Pomahac and Julian Pribaz during New England’s first-ever partial face transplant operation.
In 2006, Bohdan Pomahac, MD, medical director of the Burn Center, began developing a protocol so BWH could perform a partial face transplant for patients with the severest facial injuries. Last Thursday, a multidisciplinary team of more than 35 staff completed this historic 17-hour transplant procedure—the first partial face transplant in New England and only the second in the country and seventh in the world.
Five days later, the patient—whose identity remains confidential and guarded—and his family saw his new face for the first time following the transplant of the bony structures of the middle face, nose, nasal canal, hard palate, upper lip and muscle and tissue.
“He recognized himself, and he really was very pleased,” Pomahac said. “Both he and his family said his nose resembles his old nose.”
Julian Pribaz, left, and Bohdan Pomahac, operate.
Pomahac and Elof Eriksson, MD, PhD, chief of Plastic Surgery, were joined by Kevin O’Connor, senior vice president of the New England Organ Bank, and dozens of team members in announcing the completion of the procedure during a news conference last Friday in Carrie Hall, which was packed with print and television journalists. Pomahac, Eriksson and O’Connor thanked BWH leaders for supporting this effort, praised the many team members who contributed to this complex procedure and expressed gratitude for the donor family’s courageous decision.
“It takes a special family to participate in something so new, so visionary and so life-fulfilling,” O’Connor said.
The donor family released a statement at the April 10 press conference: “To go from being a recipient family to a donor family so suddenly has given us the opportunity to fully understand the power of organ transplants to give and transform lives.”
A member of the donor family publicly affirmed the decision this week in an interview with the Boston Globe. In addition to a section of his face, the donor’s liver, kidneys and heart were transplanted into other recipients.
“It’s important to pause and remember the compassion and gifts that the donor and donor’s family gave to other human beings,” Eriksson said.
Eriksson and Pomahac spoke in detail about the sizable team involved in planning and preparing for the transplant surgery and mobilizing the team once the donor was identified. Staff and residents from Transplant Surgery, Nursing, Anesthesiology, Medicine, Psychiatry, Infectious Diseases, Tissue Typing, Pathology, Pharmacy, Social Work, Chaplaincy and others came together to care for the patient before and after.
“It truly is a team effort,” Pomahac said.
Team members applaud as Bohdan Pomahac, MD, details the procedure during an April 10 press conference in Carrie Hall.
Pomahac and plastic surgeon Julian Pribaz, MD, traveled to France to train with Dr. Jean-Michel Dubernard, the surgeon who led the first facial transplant in 2005. They met with that patient and even practiced the procedure in a French laboratory.
BWH’s IRB approved Pomahac’s protocol in 2007, initially limiting potential recipients to patients already taking immuno-suppression drugs. The protocol was expanded last year to pave the way for a recipient whose facial deformity involves 25 percent or more of his or her face.
Planning for the face transplant had begun in 2007, also involving anesthesiologist Thomas Edrich, MD, to establish a perioperative protocol. This included planning for anesthesia techniques to allow the surgeons to identify nerve structures as well as intraoperative immunosuppression and antibiotics. As a result of advance planning, an unanticipated allergy against a vital medication was picked up and alternative plans were made rapidly with consultation from the hematology service.
“I applaud Dr. Pomahac for taking a team approach early on to ensure the safety of the patient and smooth communications,” Edrich said.
The OR nursing staff and surgical technologists were involved in planning, training and education sessions over the two years leading to the April 9 procedure, especially the core Plastic Surgery nurses and technologists, said Susan Lovell, RN, CNOR, an OR nurse in-charge. “We thoroughly reviewed expectations and questions,” she said. “It went exactly as the team drew it up, like clock-work.”
The first incision came at 1:15 a.m., when teams began procurement from the donor in one OR while preparing the recipient in an OR across the hall. The transplanted section of the face was detached at 9 a.m. and perfusion, or blood flow, began in the recipient’s face 45 minutes later.
“The most fascinating moment was the gradual return of color to the face as blood flowed from the left side to the right side,” Pomahac said.
BWH has made a life-long commitment to the patient, as the hospital does with all organ transplant recipients. “Both physical and psychological healing have just begun,” said Pomahac, who refers to this surgery not as life saving, but life giving.
See a photo gallery, video of the press conference and details on the team.