Robert Chelsea, before his face transplant Lightchaser Photography
(HealthDay News) — WEDNESDAY, March 17, 2021 (HealthDay News) — After losing most of his face in a devastating Los Angeles traffic accident years ago, Robert Chelsea needed a new one.
According to a new study, Chelsea is Black, and the process of giving him the first-ever face transplant presented unique complications for his doctors.
Due to a shortage of donors and the greater variety in skin tone among Black Americans, doctors said it took four times as long to find Chelsea a qualified donor as it does for white patients.
In an interview with the BBC, Chelsea added, "It's very uncommon to find a Black face [for transplant]." "We had no idea how uncommon it was."
Due to Chelsea's darker skin tone, doctors were less able to see the redness that serves as an early warning sign for rejection, which made tracking his post-surgery progress more difficult, according to lead surgeon Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's Hospital in Boston.
"Redness might be seen on a white patient as a sign of infection or rejection. You can't really detect with African-American patients "Pomahac explained. "If it's possible to perceive the redness, it's quite subtle."
Chelsea's crippled car was hit by a drunk driver on an L.A. freeway in August 2013 with such power that the vehicle exploded.
Chelsea was burned on more than 60% of his torso and face. He lost his lips, a portion of his nose, and a portion of an ear, and he needed more than 40 surgeries to get back on his feet.
Chelsea was put on the transplant list after doctors recommended a face transplant.
Chelsea told the BBC before his surgery, "To be able to address a person without intimidating them would be a great comfort."
Finding a qualified donor, on the other hand, was not straightforward.
Chelsea was on the waiting list for nine months before receiving the first offer of a donor, and he was on it for a total of 17 months before his operation, according to researchers who published their findings in the New England Journal of Medicine on March 18. For a white patient on the waiting list, the average duration to find a donor is four months.
Finding a qualified donor, on the other hand, was not straightforward.
Robert Chelsea with Dr. Bohdan Pomahac Lightchaser Photography
Chelsea was on the waiting list for nine months before receiving the first offer of a donor, and he was on it for a total of 17 months before his operation, according to researchers who published their findings in the New England Journal of Medicine on March 18. For a white patient on the waiting list, the average duration to find a donor is four months.
One issue was a scarcity of donors. "The amount of African-American donors is quite low," Pomahac remarked.
A good match for your skin tone
Another issue was finding an appropriate match for skin tone, which can range from almost dark black-blue to light cappuccino in a Black patient, according to Pomahac.
"There are so many various ranges of different colors," Pomahac noted, "that a transplant with a mismatched tone would seem really unsettling."
Chelsea turned down two potential donors before finding one he liked. Other donors, according to Pomahac, were not even brought to Chelsea as a possibility since they were so mismatched from the start.
The eventual amount of the procedure was also influenced by skin tone. Chelsea only required a half face transplant, but "we eventually chose to do full-face because I was scared the face would look strange" with two distinct skin tones, according to Pomahac.
Chelsea, aged 68, became the oldest person and the first Black American to have a face transplant at Brigham and Women's Hospital in a 16-hour surgical surgery involving a team of nearly 45 medical specialists.
In 2005, France performed the world's first partial face transplant, and Spain conducted the first full-face transplant in 2010. Prior to Chelsea, only roughly 40 similar procedures had been performed, all on Caucasian people.
The procedure went well, but Pomahac and his team ran into another issue as they tried to figure out if Chelsea's body would accept or reject the transplant.
Lightchaser Photography with Robert Chelsea and Dr. Bohdan Pomahac
Skin redness is such a strong marker of rejection in white patients that "we feel like we can monitor rejection in real time, very much," according to Pomahac.
Doctors added regular inspection and biopsies of Chelsea's mucous membranes — the inside of his cheek, the lining of his lips — as a technique of tracking rejection because such redness is harder to discern in the skin of a Black patient.
Organ donation is in high demand.
Chelsea's transplant was successful, but his ordeal has highlighted the importance of encouraging Blacks and other ethnic groups to donate organs, according to specialists.
In a news release, Alexandra Glazier, president and CEO of New England Donor Services, said, "It is very important for persons of all races and ethnicities to explore organ donation, especially the donation of external grafts, such as the face and hands." "Unlike internal organs, the donor's skin tone may play a role in identifying a match."
Following his surgery, Chelsea said, "May God bless the donor and his family who chose to donate this beautiful gift and offer me a second shot." "Words are inadequate to express how I feel. I'm overwhelmed with appreciation and consider myself extremely fortunate to have received such a wonderful gift."
Patients of color should take heart from Chelsea's story and seek medical help if they require comparable procedures, according to Pomahac.
"It's critical for African Americans and individuals of all skin colors to know that we are here for them, regardless of their history, and that we can assist them," Pomahac added.
Additional information
More information regarding Robert Chelsea's face transplant can be found at Brigham and Women's Hospital.
SOURCES: Bohdan Pomahac, MD, plastic surgery transplantation director, Brigham and Women's Hospital, Boston; New England Journal of Medicine, March 18, 2021; BBC.
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