More than a year of preparation came down to one day for one patient and the surgical team that was about to change his life. Joseph DiMeo, a 22-year-old man from New Jersey, had been severely injured in a motor vehicle accident, and in an effort to regain his independence, he turned to NYU Langone Health to perform the world’s first-ever successful face and double hand transplant.
Over the 23-hour operation last August, Zoe Berman, MD ’17, stood alongside the surgeons, confirming each critical step as the hands and face were detached from both the donor and Mr. DiMeo, and then the donor hands and face were carefully affixed to the recipient. For Dr. Berman, a reconstructive plastic surgery research fellow under world-renowned doctor Eduardo D. Rodriguez at NYU, the “groundbreaking” operation was a culmination of in-depth research and planning that she and her colleagues had contributed to in order to ensure its success.
After finishing up her fellowship at NYU, Dr. Berman will return to Maimonides Medical Center to complete a surgery residency this July, not without an experience she deemed “life-changing” just as it was for the patient. She shared what it was like to participate in the planning and execution of such an intricate procedure.
St. George’s University: How unique of an undertaking was this for Dr. Rodriguez and his team?
Dr. Berman: This was the first-ever hand transplant to be performed at NYU. There have been two face transplants done at the institution—one in 2015 and another in 2018—but NYU physicians had never done a hand transplant. Only 150 or so have been performed worldwide, and the combined face and double hand transplant procedure had never been done before successfully.
SGU: What was your role prior to and during the operation?
Dr. Berman: I was a part of the four-person research team that helped procured the necessary information to build the foundation for this procedure to happen. We started with a review of the peer-reviewed literature on hand transplant and other combined transplants, where we evaluated more than 1,800 articles and ended up critically appraising 93 of those articles to see how we could use that information to inform what our procedural steps were going to be, and how to execute the surgery safely and successfully. We were looking for what elements contributed to the successes of past surgeries, and perhaps even more importantly so, where the unsuccessful operations fell short—whether they were too ambitious in terms of the amount of skin that they took, the blood supply wasn’t adequate, or the patient simply wasn’t the best candidate. We then centralized all of this information and presented it to the surgical team.
Our research team also worked with the surgeons over a series of monthly rehearsals to develop the procedural steps for the hand transplant element. We created a surgical checklist to ensure adherence to every single agreed-upon step of the donor procurement, the recipient operation, and the re-attachment of the hands. Each operative sequence had between 30 and 50 steps and it took all the guesswork out of it.
SGU: Describe what it was like the day of the operation.
Dr. Berman: We had two adjacent operating rooms functioning simultaneously. Our team physically stood alongside the surgeons during all the cadaver rehearsals as well as the actual transplant to ensure that everyone was adhering to the procedural steps. When you’re talking about connecting multiple blood vessels, tendons, bones, and lot of different structures that meld together, it can make it a very complicated procedure.
SGU: How has Mr. DiMeo fared since the procedure?
Dr. Berman: Joe is a very motivated young man. It was important to him to get back to work, get back to the gym, to be independent, and to really get back to the life that he was living before his accident. I think it’s the most remarkable thing about him and part of the reason why Dr. Rodriguez and the team thought he was an exceptional candidate for this surgery.
Since the operation, he’s done very well with his rehabilitation and continues to improve functionally every day. He has been monitored very closely for any signs of rejection and he continues to heal and to accept all three of his allografts (face and both hands).
SGU: What prompted you to pursue this fellowship at NYU?
Dr. Berman: My father is a head and neck surgeon, so I think I’ve always had that influence me to a degree. There’s something about the symmetry and the intricacies of that part of the body that I find extremely fascinating. I’ve always had an appreciation for the face and what it represents for a human being in terms of providing a sense of identity and an outlet to communicate verbally and emotionally. To help restore that identity is very meaningful in somebody’s life. When I learned about the remarkable things Dr. Rodriguez and his team were doing at NYU, I jumped at the opportunity to be a part of it. Face transplant is the ultimate reconstructive surgery.
SGU: How has being part of this procedure changed your life?
Dr. Berman: It has been an extremely unique, once-in-a-lifetime opportunity. I feel so fortunate to be able to partake in this incredible experience that has truly pushed the field of reconstructive surgery forward. To be a part of this patient’s journey, to see him continue to be so motivated and so beautifully supported by his parents has really been a privilege.
More so than anything, I’ve been so fortunate to have had the mentorship of Dr. Rodriguez, who is a real visionary. He put trust in me to be a part of this, and to be able to contribute to changing somebody’s life—that’s why I went into medicine in the first place—to give someone the opportunity to live a better life, a more fulfilling life, and to have a second chance.
SGU: Why did you choose to go to SGU, and how has it set you up for success in your career?
Dr. Berman: I would have never had the opportunity to do anything I’m doing if I hadn’t first made the decision to go to SGU to get my MD. At the time, I was ready to go to medical school, and I didn’t want to wait for another US application cycle.
The foundation that the education at SGU provided me has allowed me to grow beyond what I ever imagined to be possible. I think coming from SGU gives you a sense of humility that will serve anybody well in the medical field. I have never felt entitled to anything. For me, I’ve always considered being a doctor and working with vulnerable patients to be an unbelievable privilege.
There’s also something sacred and beautiful about the island. I met my husband there (Matthew Bushman, MD ’16), who’s now an anesthesiologist, and my brother (Matthew Berman, MD ’17) also followed me to the island a semester later, who met his wife there (Taylor Dodds, MD ’19), and they’re both in residency now and doing well. We all had an incredible time at SGU, and considering where we all are now, I would never change my decision to go there.
– Brett Mauser