The story of Mayo Clinic’s second face transplant, a decade in the making – Twin Cities

ROCHESTER, Minn. – Ten years ago, while Derek Pfaff was on life support for a self-inflicted gunshot wound, his family was preparing to donate his organs in the event of his death.

Now 30, Pfaff is participating in the organ and tissue donation process — earlier this year, a man from Harbor Beach, Michigan, underwent a face transplant at the Mayo Clinic in Rochester.

“We are very grateful,” said Jerry Pfaff, Derek’s father.

Two and a half years of preparation took place for the 50-hour procedure, which began on February 4, 2024. The surgery was the second of its kind at the Mayo Clinic and places Derek Pfaff among only a few dozen people in the world who have undergone the surgery. received a face transplant.

“You have to connect with the patient, and in a face transplant, that’s the highest level where you have to work with them through good times and bad,” said Dr. Samir Mardini, a facial plastic surgeon and chair of Mayo Clinic’s division of plastic and reconstructive surgery.

Scary night

Derek Pfaff doesn’t remember what happened the night he tried to take his own life. His mother, Lisa Pfaff, said it was spring break and Derek had returned home from college, where “we knew he was putting a lot of pressure on himself.” On Tuesday evening, Derek Pfaff had just returned from a ski trip and was hanging out with friends at his parents’ house.

At 1:30, when Jerry got up for work, Lisa said she went to Derek’s room to check on him. He wasn’t there, and Jerry hadn’t seen him anywhere else in the house.

“(Jerry) noticed the gun cabinet was open and went outside,” Lisa Pfaff said. “And then I heard him screaming and screaming, ‘No, Derek, no, why?’ “

Derek shot himself. After the family arrived at the nearest trauma hospital, doctors told Derek’s parents that his chances of survival were not good. Two of his four siblings came to the hospital to say goodbye.

Derek was then airlifted to another hospital where he underwent surgery. It was the first of almost 60 surgeries preceding the face transplant.

“We were prepared to discuss organ donation, and they said, ‘There is brain activity,’” Lisa Pfaff said. “We don’t know what Derek’s quality of life will be, but there is hope.”

The facial injuries were extensive – he was missing his upper and lower jaws, many teeth, the hard palate at the top of his mouth, his nose and one eye. When Derek managed to get his life support removed two weeks after the incident, he couldn’t speak or see.

“But he could write in a notebook and that’s how we communicated with each other,” Lisa Pfaff said.

When Lisa told Derek that he had been in an accident, Derek initially assumed it was a car accident and asked if anyone else was hurt.

“And I told him that wasn’t the case,” Lisa Pfaff added. “I told him what he did and he wrote back: ‘Are you sure? I would never do this to myself. “

So many surgeries

Over the next few years, Derek gradually recovered, going under the knife time and time again to reconstruct parts of his face and try to regain some functions. But until his face transplant, Derek had trouble breathing and speaking, couldn’t wear glasses and couldn’t eat solid food – he had to use a feeding tube for feeding. He kept his spirits up.

“Keep up the good work,” Derek Pfaff said. “One surgery down. “Okay, what’s next?” Keep doing it.

In 2021, Derek’s doctors in Michigan reached the point where nothing could be done other than a face transplant.

“If that was what he wanted, we would support him and make it happen,” Lisa said. “And he said to me, ‘Mom, I’ve had 58 surgeries. Why don’t I finish now? “

That’s when the Pfaff family contacted Mayo Clinic and Dr. Mardini, who led the team behind Mayo Clinic’s first face transplant in 2016.

“I met an amazing guy who had been fighting adversity for years,” Mardini said. “He was able to get through it all and come back to life, and Derek and his family were looking for him to get his life back.”

The journey to transplant

From that moment on, the 2.5-year journey to transplant began. For Derek, this meant scans, scans, blood tests, exercises to build strength for surgery, and meetings with mental health professionals to make sure he understood what would happen and how to stay resilient during the recovery process.

As for Mardini, he and his colleagues spent thousands of hours studying Derek’s facial anatomy and practicing the procedure more than 35 times on cadavers.

“Our goal was not to simply transplant a face,” Mardini said. “Our goal was to achieve the goals he had set and… restore the functions he was missing, and that meant making sure the surgery was performed as best as possible.”

On February 1, 2024, the Pfaff family received a life-changing phone call. Earlier in the day, Lisa had spoken to Dr. Mardini.

“Dr. Mardini has a special ringtone on my phone,” Lisa said. “The first words he said to me were, ‘Hi, I bet you don’t think you’re going to talk to me twice today?’ “

Then the news: Mardini had a potential donor for Derek.

“I was in my room… playing on my phone,” Derek said, “and suddenly the door just opened. My mom told me we had a potential donor.

Once the Pfaffs boarded the plane to Minnesota, Mardini and his colleagues began preparing for the marathon operation: arranging schedules, deploying personnel, and putting together all the pieces of the logistical puzzle.

“One of the first calls is to our anesthesia team – our anesthesiology team has to provide incredible support,” Mardini said. “We had to hire a team of nurses to cover all the shifts in two rooms for about 20 hours and then the rest of Derek’s surgery.”

Over the course of 50 hours, more than 80 medical workers – nurses, surgeons, anesthesiologists, technicians and more – participated in Derek’s face transplant. Mardini and five other surgeons used microsurgical techniques to connect nerves, blood vessels and tissues using microscopes and stitched sutures the width of a human hair.

“Facial transplantation is a combination of many other surgeries we perform every day,” Mardini said.

The team replaced about 85% of Derek’s face, grafting donor skin on his face and neck, eyelids, jaws, teeth, nose, hard palate, part of the soft palate, and fat surrounding and supporting his eyes. They even transplanted the donor’s tear drainage system, which now allows Derek’s tears to flow down his nose.

A new beginning

When Derek woke up in the intensive care unit, he couldn’t see his face at first. When Derek recovered, he was sedated for two weeks. He had the opportunity to see his new face on March 5, exactly 10 years after the injury.

“Then we were moved to a regular floor, and then we stayed there for a month,” Lisa said. “He did so well that they brought him an exercise bike so he could continue exercising in his room while we were in Mayo. He bounced back very quickly.”

Everything went well, Derek said, and the recovery wasn’t too painful. Now, after a few months off, Derek said he feels great.

“My face doesn’t hurt. I have a nose. I can wear glasses now,” Derek said. “I can speak in public, people won’t point at me or talk under their breath. I look like a normal person.”

Derek’s future includes further surgery to improve the function of his eyelids and tongue. He will still be able to enjoy his hobby.

Derek and Lisa have already begun their mission to speak to large groups about mental health and suicide awareness.

“I want to help others in any way I can,” Derek said.

Suicide prevention information

• • If you need help: If you find yourself in a crisis, call 988 or text “Home” to 741741 for free help 24/7 Crisis text line. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
  • If you want to help: Five steps to help others and yourself Take5tosavelives.org.
  • Please stay: Read survivors’ stories on the website livethroughthis.org: “Our stories can save lives. You are not alone. Please stay.”
  • Local resources: More local resources can be found on the Suicide Awareness Voices of Education (SAVE) website at Save.org.