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Groundbreaking face transplant: After a firefighter was injured on duty, a deceased 26-year-old cyclist gave him his life back

Patrick Hardison before the fire. (Photos courtesy NYU Langone)

Patrick Hardison was working as a volunteer firefighter in his hometown of Senatobia, 40 miles south of Memphis, when he got a desperate call. A house was in flames, with a woman trapped inside. Hardison arrived on the scene and raced inside, moments before the roof suddenly collapsed. His helmet was knocked off, and he felt his mask melting. He closed his eyes and jumped out the window.

Hardison lost his eyelids, ears, lips and most of his nose, as well as his hair, because of that fire. He also had disfiguring third-degree burns across his entire face, head, neck and upper torso. His skin was so badly damaged that he was not even able to close his eyes completely.

"From that day on, Sept. 5, 2001, there was no normal tissue left throughout his face," Eduardo D. Rodriguez, chair of plastic surgery at NYU Langone Medical Center, said in recounting the first responder's story.

Watch volunteer fire fighter Patrick Hardison before and after his 26-hour-long face transplant surgery in August. (Video: Ashleigh Joplin/NYU Langone Medical Center)

In a press conference on Monday, the medical center announced that Hardison, now 41 and a father of five, had undergone the world's most extensive face transplant to date. The donor was a young BMX cyclist from Ohio named David Rodebaugh, whose family donated his liver, kidneys, and both eyes to help other patients. A representative from LiveOnNY, which works to match donors with recipients in the New York metropolitan area, said his mother didn't hesitate when asked about the face transplant and called her son "a free spirit who loved life."

Rodebaugh died in July when he crashed and hit his head while riding in Brooklyn. He was 26 -- virtually the same age as Hardison was when he was injured.

The years following that accident were full of dark times for the young Mississippi firefighter.

He underwent more than 70 surgeries that involved multiple grafts from his leg to his face, but he was still very disfigured -- with "no semblance of normal anatomy," as Rodriguez put it -- and had to hide behind sunglasses and a baseball cap whenever he went out. Talking or eating caused tremendous pain.

A friend at Hardison's church heard about the work Rodriguez had done at the University of Maryland Medical Center for another man whose face had been damaged and contacted the surgeon on his behalf. Hardison became a patient of Rodriguez's while the doctor was at UMMC and continued to work with him after he was recruited to join NYU Langone.

The transplant operation, which took place Aug. 14, was funded by a grant from NYU Langone. The hospital estimates it cost between $850,000 and $1 million.

In the 26-hour surgery, Rodriguez and a team of more than 100 doctors, nurses and technical assistants were able to give Hardison a new face. Unlike previous face transplants, which involved delicately stitching parts of another person's skin, lips, bones, muscles and/or blood vessels onto a patient, this one involved a comprehensive graft of both the front and back of the head that was described as a kind of "hood." It included the scalp, ears and ear canals, parts of the bone from the chin and cheeks, and an entire nose. Surgeons were also able to replace Hardison's eyelids, including the muscles that control blinking.

The team worked in two groups, in two adjoining operating rooms. One was responsible for procuring the face from the donor along with other organs which were to help other patients and the second on Hardison.

Surgeons said encouraging signs were evident even as he was still in surgery: "Patrick’s new face, particularly his new lips and ears, were robust with color, indicating circulation had been restored." Soon the hair on his scalp and face began growing back. Within a week, he was able to sit up in a chair.

The hospital said that just three months after the surgery -- a critical period when most rejections occur -- Hardison is "doing well and is quickly returning to his daily routines."

“I am deeply grateful to my donor and his family,” Hardison said in a statement. “Even though I did not know who they would be, I prayed for them every day, knowing the difficult decision they would have to make in order to help me. I hope they see in me the goodness of their decision."

Rodriguez said that "when I met Patrick and heard his story, I knew that I had to do all I could to help him."

He said one of the most moving moments for him was when Hardison went out to Macy's in New York after his surgery to buy clothes. “For him it was so remarkable that no one stared at him. ... It was a very emotional exchange for us,” Rodriguez said.

The medical science behind transplants has been progressing at a rapid pace in recent years. Patients have seen miraculous results with womb transplants, penis transplants and hand transplants as well as tongue transplants.

The world's first partial face transplant was performed in 2005 in France on a woman who lost her lips, cheeks, chin and most of her nose after she was mauled by her dog. The first full face transplant took place in 2010 in Spain. The procedures set off a firestorm of ethical debate about whether such risky surgeries should be undertaken to improve someone's quality of life — rather than save it.

In 2012, the University of Maryland Medical Center announced that it had completed what was then the most comprehensive face transplant on 37-year-old Richard Lee Norris, who had been disfigured after a gun accident 15 years earlier. The 36-hour operation involved more than 150 doctors, nurses and staff members.

The Washington Post corresponded with Norris about his experience later that year:

“Everything from the scalp to the midline of my neck was replaced, including the jaw bones, teeth, part of my tongue, muscles, and nerves,” said Norris, who has retained his eyesight through the gun accident and the subsequent surgeries. The days immediately following the transplant were promising. Norris was taken off his postoperative ventilator, and within the first week he was able to shave his face and brush his teeth. When Norris saw his new face in a mirror for the first time, he wrote, “the only thing I could do was hug Dr. Rodriguez.”

[After full face transplant, Virginia man comes out of hiding]

In total, roughly 35 patients worldwide have had face transplants. The risk of complications, even death, are very high. Even if the initial surgery, which is enormously complicated and dangerous, goes well, face transplant patients — like those receiving donor organs like a heart or kidney — face the significant risk that their body will reject the foreign part. As a result, many doctors believe these patients will have to take immunosuppressant drugs their whole lives.

The U.S. military is funding a study that is attempting to wean one face transplant patient — Charla Nash — off such medications, which can make the patients more vulnerable to other illnesses. But its experiment is still in the early stages. Doctors hope that Nash, who was left without lips, eyes or eyelids after being attacked by an employer's pet chimpanzee in 2009 and received a face transplant in 2011, will be able to replace the immunosuppressant drugs with Interleukin-2. The latter can have less serious side effects and is usually used to treat cancers.

[The military has high hopes for face transplants]

Below is a look at other patients who have received face transplants in recent years.

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