The story of Mayo Clinic’s second face transplant, ten years in the making: Twin Cities

ROCHESTER, Minn. — Ten years ago, when Derek Pfaff was on life support after a self-inflicted gunshot wound, his family prepared to donate his organs if he died.

Now 30-year-old Derek Pfaff is on the other side of organ and tissue donation — earlier this year the Harbor Beach, Michigan man received 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 went into 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 just a few dozen people in the world who have received a face transplant .

“You have to have a bond with your patient, and with facial transplantation, that comes at the highest level, working with them in good times and bad,” says Dr. Samir Mardini, plastic surgeon and chairman of facial care. from the Department of Plastic and Reconstructive Surgery at Mayo Clinic.

A terrible night

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

When Jerry got up for work at 2:30 a.m., 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 locker was open and he went outside,” Lisa Pfaff said. “And then I heard him screaming and yelling, ‘No, Derek, no, why?’ ”

Derek had shot himself. After the family arrived at the nearest trauma hospital, doctors there told Derek’s parents that his chances of survival did not look 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 nearly sixty operations prior to his face transplant.

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

The injuries to his face were extensive: he was missing his upper and lower jaws, many of his teeth, the hard palate at the top of his mouth, his nose and one of his eyes. When Derek was able to come off life support two weeks after the incident, he could no longer speak or see.

“But he could write in a notebook, and that’s how he and I communicated,” 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 had been hurt.

“And I told him he didn’t,” Lisa Pfaff said. ‘I told him what he had done and he wrote back to me: ‘Are you sure? I would never do that to myself.’ ”

So many operations

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

“Let it all move forward,” said Derek Pfaff. ‘One operation behind us: ‘Okay, what’s the next step?’ Keep it moving.”

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

“If that’s something he wants to do, we would support him and make that happen,” Lisa said. “And he said to me, ‘Mom, I’ve had 58 surgeries. Why shouldn’t I finish now?’ ”

At that point, the Pfaff family contacted the Mayo Clinic and was put in touch with Dr. Mardini, who led the team for the Mayo Clinic’s first face transplant in 2016.

“I met a great guy who has fought adversity over the years,” Mardini said. “He was able to get through all that, come back to life, and Derek and his family were looking for him to get his life back.”

Journey to transplant

From there the two and a half year journey to transplantation began. For Derek, that meant tests, scans, blood work, exercises to build strength for surgery and meetings with mental health professionals to make sure he understood what would happen and how to be 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 just perform a face transplant,” Mardini said. “Our goal was to achieve the goals he had and … restore the functions he was missing, and that meant making sure the surgery was done as well as possible.”

The Pfaffs received the life-changing phone call on February 1, 2024. Lisa had just talked to Dr. earlier that day. Mardini spoken.

“Dr. Mardini has a special ringtone on my phone,” said Lisa. ‘The first words he said to me (were): ‘Hello, 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, “suddenly the door burst open. My mother told me we have a potential donor.”

As the Pfaffs boarded a plane to Minnesota, Mardini and his colleagues began preparing for the marathon operation: drawing up schedules, getting staff in place and putting together every piece of the logistical puzzle.

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

For more than 50 hours, more than 80 medical staff – nurses, surgeons, anesthesiologists, technicians and more – participated in Derek’s face transplant. Mardini and five other surgeons used microsurgery techniques to connect nerves, blood vessels and tissues using microscopes and sutures as wide as human hair.

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

The team replaced approximately 85% of Derek’s face, transplanting the donor’s facial and neck skin, eyelids, jaws, teeth, nose, hard palate, part of the soft palate, and the fat that surrounds and supports the eyes. They even transplanted the donor’s tear drainage system, so Derek’s tears now flow through his nose.

A new beginning

When Derek woke up in the intensive care unit, he initially couldn’t see his face. Derek was under anesthesia for two weeks as he recovered. He got to see his new face on March 5, exactly 10 years after his injury.

“Then we were moved to a regular floor, and we stayed there for a month,” says Lisa. “He did so well that they even brought an exercise bike so he could continue training in his room while we were in Mayo. He recovered very quickly.”

Everything went well, Derek said, and the recovery wasn’t too painful. Now that we’re a few months along, Derek said he feels great.

‘My face doesn’t hurt. I have a nose. I can wear my glasses now,” Derek said. “I can go out in public, people won’t point at me or talk softly. I look like a normal person.”

Derek’s future includes further surgeries to refine the function of his eyelids and tongue. He will continue to enjoy his hobbies.

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

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

Suicide prevention information

• • If you need help: If you are in crisis, call free 988 or text ‘Home’ to 741741, 24/7 support from the Crisis text line. Or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
  • If you want to help: Five steps to help others as well as yourself Take5tosavelives.org.
  • Please stay: Read the stories of survivors Livethroughthis.org: “Our stories can save lives. You’re not alone. Please stay.”
  • Local sources: More local resources at Suicide Awareness Voices of Education (SAVE) at Save.org.