Brigham face transplant recipient goes home

5 min read

James Maki journeys to new life

James Maki, a 59-year-old who became the nation’s second face transplant recipient in April to repair injuries from a horrific subway accident, left Brigham and Women’s Hospital on Thursday (May 21), thankful for what he called a “new chance to build my life.”

Maki, whose April 9 surgery at the Harvard-affiliated hospital received wide news coverage, appeared in public for the first time Thursday morning at a Brigham news conference. With him was Susan Whitman-Helfgot, the wife of donor Joseph Helfgot, who died at age 60 during heart transplant surgery.

Maki expressed his gratitude to the Helfgot family and the doctors at the Brigham and said he hopes his story highlights the importance of organ donation. Maki, whose place of residence was kept confidential, asked for privacy as he continues his rehabilitation and takes steps to start his life again.

“They did not know me. Clearly it was a deeply held belief in helping others that led them to their decision,” Maki said of the Helfgots. “I will be forever grateful.”

Maki, a Vietnam veteran who moved to Amherst, Mass., from Seattle when he was in high school, was injured in 2005 during an accident at the Ruggles stop on Boston’s subway Orange Line. Maki fell onto the tracks and came in contact with the electrified third rail. The contact burned away much of the middle of Maki’s face, including his upper lip, hard palate that makes up the roof of the mouth, and his nose.

Reconstructive surgery after the accident left Maki able to survive, but with a hole in his face where his nose used to be and difficulty speaking and eating.

His partial face transplant gave him a new nose, hard palate, upper lip, nasal structure, facial skin and the muscles and nerves that move the skin and give it sensation.

He received the transplant during a marathon 17-hour procedure that involved 35 doctors, anesthesiologists, nurses, and other clinical personnel working in two operating rooms to harvest the tissue and transplant it.

Maki said the transplant is pain free and the first thing he thought when he looked at his new face was that his new nose looks like his old one.

Whitman-Helfgot also spoke Thursday, describing her husband as someone who grew up in poverty but sought out an education, earning a doctorate. He became a father and worked in Hollywood as a marketing adviser on such films as “Iron Man,” “X-Men,” and “Spider-Man.” She declined to share details of the family’s discussions as they weighed whether to permit the transplant, but urged everyone in the room to sign up to become organ donors, saying her husband’s heart transplant failed because he had to wait too long for a donor heart.

Seeing Maki, she said, helps take some of the sting out of losing her husband. She called Maki’s transformation “a miracle and a blessing.”

Also speaking Thursday were Elof Eriksson, chief of the Brigham’s Division of Plastic Surgery and Joseph E. Murray Professor of Plastic and Reconstructive Surgery at Harvard Medical School; Bohdan Pomahac, a plastic surgeon at the Brigham and assistant professor of surgery at Harvard Medical School; and Richard Luskin, president and chief executive officer of the New England Organ Bank.

Pomahac, who led the surgical team for Maki’s transplant, first met Maki the night of his injury, when he was the surgeon on call. The thought of doing a face transplant didn’t occur to Pomahac, since the first such operation, in France in 2005, hadn’t yet been conducted.

Maki faces a lifetime on antirejection drugs to ensure his body doesn’t reject the donor tissue as foreign. Because those drugs suppress his immune system, they could make Maki more susceptible to infection. He may also face additional surgery to trim excess skin, Pomahac said, though that hasn’t been determined yet. It will take months before the swelling goes down and enough nerve regrowth occurs to give Maki sensation in his new tissue. After that happens, further steps will be considered, Pomahac said.

“We will not let our guard down because we’re in uncharted water with [this] transplantation,” Pomahac said.

The operation was just the second of its kind to be conducted in the United States and among just a handful worldwide. Since the first partial face transplant in 2005, similar procedures have been performed in France, China, and at the Cleveland Clinic in Ohio.

The recipient of the world’s first face transplant, Isabelle Dinoire, a French woman who had been mauled by a dog, visited Maki at the hospital recently. Leaders of the Brigham team had met Dinoire before, when they traveled to France in preparation for Maki’s surgery.

Pomahac said it is likely that more such surgeries will be performed. He estimated there are several hundred people in the United States who could benefit — including more than 100 wounded soldiers. Face transplant surgery, he said, could become an infrequent but regular procedure performed in extraordinary cases.

“Right now I strongly believe this is a way to treat the worst facial deformities,” Pomahac said.

The Brigham has had a pioneering role in the history of transplantation. The first ever organ transplant was performed there in 1954 when Joseph Murray, today a professor of surgery emeritus at Harvard Medical School, transplanted a kidney from one brother to another. Murray won the 1990 Nobel Prize in medicine for his work on organ transplantation. In 2006 alone, more than 100 kidney transplants and 30 lung transplants were performed there.