The surgical intervention, of extreme technical and organizational complexity, lasted about 12 hours and was carried out by a team of around 60 professionals from more than 10 different medical and surgical departments.
The team was led by Dr. Anna López Ojeda and Dr. Oriol Bermejo, head of service and section head, respectively, of the Plastic and Reconstructive Surgery Department at the hospital, with coordination managed by the hospital’s Transplant Director, Dr. Gabriel Moreno González.
As Dr. Anna López Ojeda emphasizes, "The challenge of this procedure was not only the complexity of the technique but also the organization; it required mobilizing a very large and diverse group of professionals, and their perfect coordination was the key to success."
In the same vein, Dr. Oriol Bermejo states, "Bellvitge Hospital stands out for always working in a very multidisciplinary way, and in this case, it has been more evident than ever." He also underscores that "performing the first transplant was the most difficult part; we are prepared to repeat the experience if the opportunity arises."
The patient was a 47-year-old man suffering from type 1 neurofibromatosis, a hereditary condition that causes benign tumors of the nervous tissue (neurofibromas) to form on the face and other parts of the body. In this case, the patient had a giant plexiform neurofibroma on the right side of his face, which caused severe aesthetic, psychological, social, and functional issues—including significant difficulty moving his face and vision impairment—that had no other possible treatment.
The surgeons removed the giant neurofibroma from his face, which also involved the complete removal of his upper lip, nose, right eyelid, the right half of his face, and right scalp. They then implanted the donor's face, connecting one artery, four veins, and four nerves. The transplanted face will gradually take the shape of the recipient’s face as it adjusts to his bone structure.
This transplant was groundbreaking on a global scale because it was one of the first times that tissues were not obtained from a brain-dead donor but from a donor in controlled asystole (with the heart stopped). Specifically, it was the first time in the world that an organ retrieval in controlled asystole allowed for the extraction of the heart, face, and kidneys, a feat made possible by the extensive expertise of Bellvitge Hospital in organ retrieval for transplantation in asystole, including the heart.
The procedure was a success, and the patient is currently following the usual recovery process without significant complications.
Four Simultaneous Transplants and an Urgent Surgery
Another aspect highlighted by the professionals is the fact that, on the same day the facial transplant was performed, the medical and surgical teams at Bellvitge University Hospital also carried out a heart transplant, a liver transplant, and a kidney transplant, in addition to an aortic dissection surgery, an urgent cardiac surgery emergency.
According to Dr. Gabriel Moreno González, Director of Transplants at Bellvitge Hospital, this accumulation of four complex and urgent procedures almost simultaneously "is an achievement that few centers can reach and demonstrates the great capability of our professionals to tackle highly difficult challenges, both in terms of the expertise required and the timing and adaptability needed."
Bellvitge University Hospital ranks each year among the top centers in Spain for the number of liver, heart, and kidney transplants performed, and is also among those that achieve the best results in terms of low complication rates and survival outcomes.
Only 18 Facial Transplant Centers in the World
Facial transplantation is an extremely complex surgical procedure that has only been performed at 18 centers worldwide. These transplant centers must be large tertiary hospitals with multiple expert surgical teams, well-trained in areas such as reconstructive microsurgery, as well as specialized anesthesia and nursing teams, along with extensive experience in transplants and immunosuppression, among other areas.
The indications for a person to be considered a candidate for a facial transplant are very specific. A consensus document published in 2024, which involved many of the surgeons who have performed these procedures worldwide, confirms the effectiveness of this procedure if the selection criteria are appropriate.
This is the 5th facial transplant carried out in Spain. The previous ones took place at the Hospital Universitari i Politècnic La Fe in Valencia (2009), the Hospital Universitario Virgen del Rocío in Seville (2010), and, on two occasions, at the Hospital Universitari Vall d'Hebron (2010 and 2015). On a global scale, it is the 53rd facial transplant performed since the Centre Hospitalier Universitaire d’Amiens-Picardie in France carried out the first one in 2005.
Bellvitge University Hospital began preparations for this type of procedure over ten years ago, developing the first protocols. The process leading to the current surgery started about three years ago, during which the hospital obtained the necessary accreditations and authorizations, and its professionals specifically trained in this technique. In April of this year, the search for a donor began, and the usual timelines were shortened thanks to the possibility of performing the extraction in asystole.