In Their Own Words | Postbac Premed Program Alumnus Describes Filming the First Successful Face and Bilateral Hand Transplant

By
Ivan Dominuez
June 03, 2021

In August of 2020, a few other camera operators and I filmed the world's first successful face and bilateral hand transplant. Having previously filmed two face transplants, one in 2015 and a second in 2018, I came into the situation with quite a bit of prior experience. Unlike the previous two surgeries, where I was only really present for the surgery and some follow-up filming, I would come to get an inside view of this patient's journey for a year and a half. 

Currently, face transplantation is not a common practice and falls under the purview of research. Perhaps in the future, it may be as common as heart or liver transplantation are today, but faces are considered purely aesthetic. While this is not necessarily true, this kind of surgery is elective and carries an immense risk. I detail this because it helps explain why I ended up traveling with Dr. Rodriguez to help film and document the patient's support network. This kind of extensive surgery requires 100% dedication not just by the patient but also by their friends and family. That is why it was imperative that everything checks out. 

I cannot express enough how much this kind of surgery is the product of excellent teamwork, start to finish. This became clear to me when I filmed the meeting where Joe's entire care team came together to discuss any potential issues or pitfalls that would be expected before finally approving to move the patient to the transplant list. Previous patients who underwent face transplants had the use of their hands. This patient was going to have brand new hands and be entirely dependent on others in a way that previous patients hadn't. 

Joe recovers in the ICU

The patient Joe Dimeo received extensive burn injuries after being involved in an auto accident while driving home from working a night shift. He survived because a good samaritan pulled him from the burning wreckage. The resulting injuries caused a near-complete fusion of his eyelids and functional loss of his hands. He went from being completely independent to relying on other people to bathe, feed, and dress. The biggest issue in Joe's mind was that the loss of hands meant he could no longer work or be independent. 

As part of the assessment, the team I work on went to Joe's place of work, his church, his parents' house, and the crash site. For the most part, people think of photographers or videographers as a fly on the wall, but I can tell you, there's no way to be out of the way when you're handling cameras and sound equipment. You end up interacting and being part of the situation. Seeing Joe with his coworkers, talk to his priest, and going to his parents' house helped paint a more complete picture of what Joe's life was like. I kind of think of it as an extended patient history. Usually, that kind of thing happens in 15 minutes on a typical doctor's visit. We spent a whole day embedded in his support network. 

We ended the day with a last supper of sorts. Joe was finally going to get listed for transplant, and Dr. Rodriguez wanted to make sure, in no uncertain terms, that all the important people in his life could come together and fully understand the risks and potential benefits. Joe would undergo a surgery that had never been successfully done in the history of modern medical science. But the historic nature of what was to come was not on my mind. It was the fact that the risk for such an extensive surgery is death. Tissue rejection or even surgical complications could leave Joe in an even worse state than he was currently living in. Joe was 19 at the time of his injury and was 20 when I met him. Dr. Rodriguez did not mince his words at that dinner when he said to the whole room, "The risk is death." 

Joe and his family visit

I wish I could explain the feeling I had that night, having dinner with Joe's friends and family in New Jersey. It was complex because I knew we had the best surgical team to make good on the proposed surgery, but I also knew that nothing is ever certain, and the risks were high.

A few months later (pre-pandemic), I was in one of the (multiple) surgical dry runs. It became clear the difficulties were logistical as much as technical. With the addition of hand transplantation, the surgery would require 6 simultaneous teams, acting in tandem. One for each hand, and one for the face, both in the donor room and the recipient room. I was surprised that the dry runs could be completed in 6-10 hours on cadavers, as usually a face transplant traditionally takes around 24 hours. The dry runs go much faster because there are no complications revolving around bleeding. 

Fast forward to August of 2020, mid pandemic. I don't remember when I got the call that the surgery was a go, but I do remember going home to try to get whatever excited sleep I could to prepare for the next day. Sometimes all you can do is lie in bed and close your eyes, even if you don't sleep so much. 

The months leading up to the surgery had been hell on earth for everyone, so I was pretty amazed that the surgery happened at all. Just the 4 months previous had been the height of the COVID wave in NYC, and here we were setting up to document what was to become the world's first successful face and bilateral hand transplant. History in the middle of history. During that time, I was also in the middle of studying to re-take the MCAT and had already submitted my AMCAS. So on top of everything, I was re-applying to medical school. When it rains, it pours.

To be quite honest, only a few moments from the surgery stood out to me as much of it now is a blur. Despite the fact that I was around for 16 hours of the surgery, it might as well have been only an hour-long in my own memory. When I looked back at the footage later, it was like it happened to someone else. I had been in the room, present, awake, attentive, and time slipped on by. 

The operating rooms we were in were large by any standard, and it felt absolutely tiny with the number of people present. Each surgical team was at least three people, with their own surgical techs on standby. That means at least 12 people were necessary for each room before counting anesthesia or any other required personnel. The difficulty of the surgery was logistical as much as technical. How do you coordinate 9 teams and mitigate potential errors? The answer is, of course, practice. The smoothness of the operation was due in large part to the dry runs where the surgeons had rehearsed ad nauseam. 

Doctors work in an operating room

The surgery was completed in under 24 hours, which considering that it was a gigantic undertaking relative to the previous face transplant surgeries, was astounding. It was like seeing someone complete a record-winning mile time with weights strapped to their feet. Simply astounding. Little did I know that there would be more surprises in store. 

I had never seen a hand transplant before, and I tried to go online to get a sense of what that entailed. Unfortunately, I didn't find many good videos, and it was hard to get a sense of how quickly this patient would recover. Six weeks after surgery, we documented Joe seeing his face for the first time in a mirror. What I didn't realize is that we would also see him holding up the mirror with his new hand. In talking with the physical therapist later, I would come to find out Joe was blowing away all the benchmarks for his recovery by a long shot. Not only was he doing well, he was doing better than anyone could have hoped for. 

Joe recovers in the ICU.

Around Thanksgiving, I documented Joe being discharged from the hospital after what amounted to a 3-month in-patient recovery, as he was transitioning to an out-patient setting. It was not the last time we were going to interact, but it seemed fitting that I got to be a fly on the wall for the trajectory of this patient's treatment.

Joe steps out after recovering from his surgery

While I can't say that he knows my name, for I was one of the hundreds of people involved in Joe's care, I can say that the course of his treatment left an impact on me and my thoughts about what it means to offer compassionate care. After his accident, he was completely reliant on others and was not living a life he considered meaningful. I thought back to when I first met him and the dinner where Dr. Rodriguez's words still rang in my ears. In that context, seeing him leave the hospital and pet his dog with new hands, with dreams of driving and returning to a life of independence, was eye-opening. Despite the enormous amount of effort and risk, his life was better. He had hope for the future.

Organ transplantation didn't just keep him alive; it saved his life. 


Dominguez completed the Postbac Premed Program in 2021 and will be attending New York Medical College in the fall.