1 day Ago By Dené K. Dryden
ROCHESTER — Ten years ago, as Derek Pfaff was on life support following a self-inflicted gunshot wound, his family was preparing 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 Mayo Clinic in Rochester. "We're just very thankful," said Jerry Pfaff, Derek's father.
Two and a half years of preparation went into the 50-hour procedure, which began on Feb. 4, 2024. The operation was the second of its kind at Mayo Clinic and places Derek Pfaff among just a few dozen people in the world who have received a face transplant.
"You need to have a connection with your patient, and with face transplant, that comes at the highest level where you have to work with them through good times and through bad times," said Dr. Samir Mardini, a facial plastic surgeon and chair of Mayo Clinic's Division of Plastic and Reconstructive Surgery. Derek Pfaff doesn't remember what happened the night he attempted suicide.
His mom, 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 night, Derek Pfaff had just come back from a ski trip and was hanging out with some friends at his parents' house. At 1:30 a.
m., 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 elsewhere in the house.
"(Jerry) had noticed that the gun cabinet was open, and he went outside," Lisa Pfaff said. "And then I heard him screeching, yelling, 'No, Derek, no, why?' " Derek had shot himself. After the family arrived at the nearest trauma hospital, the doctors there told Derek's parents that his chances of survival didn't look good.
Two of his four siblings came to the hospital to say goodbye. Derek was then airlifted to a different hospital, where he underwent surgery. It was the first of almost 60 surgeries leading up to his face transplant.
"We were prepared to have the discussion of organ donation, and they said, 'There is brain activity,' " Lisa Pfaff said. "We don't know what Derek's quality of life is going to be, but there's hope." The injuries to his face were extensive — he was missing his upper and lower jaw, 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 couldn't 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, at first, 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.' " Over the next several years, Derek gradually recovered, going under the knife again and again to reconstruct parts of his face and try to regain some functions.
But, up 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 spirits up. "Keep it all moving forward," Derek Pfaff said.
"One surgery down, 'All right, what's next up?' Keep it moving." In 2021, Derek's doctors in Michigan reached a point where there was nothing else that could be done except a face transplant. "If that's something he wanted to do, then we would support him and make that happen," Lisa said.
"And he said to me, 'Mom, I went through 58 surgeries. Why would I not finish now?' " That's when the Pfaff family reached out to Mayo Clinic and got in touch with Dr. Mardini, who led the team for Mayo Clinic's first face transplant in 2016.
"I met an amazing guy who's fought through adversities over the years," Mardini said. "He was able to push through all of that, get back to life, and Derek and his family were looking for him to get his life back." From there, the two-and-a-half-year journey to transplant began.
For Derek, that meant testing, scans, blood work, exercise to build strength for surgery, and meeting 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 logged thousands of hours studying Derek's facial anatomy and practicing the procedure more than 35 times on cadavers. "Our goal wasn't to just do a face transplant," Mardini said.
"Our goal was to achieve the goals that he had and ...
restore the functions that he was missing, and that meant making sure the surgery was done as good as possible." The Pfaffs got the life-changing call on Feb. 1, 2024.
Lisa had just spoken with Dr. Mardini earlier that day. "Dr.
Mardini has a special ringtone on my phone," Lisa said. "The first words he said to me (were), 'Hi, bet you don't think you were going to talk to me twice today?' " Then, the news: Mardini had a potential donor for Derek. "I was up in my room .
.. playing on my phone," Derek said, "all of a sudden, the door just burst open.
Mom told me we have a potential donor." As the Pfaffs hopped on a plane to Minnesota, Mardini and his colleagues began preparing for the marathon operation: clearing schedules, getting staff in place and putting each piece of the logistical puzzle together. "One of the first phone calls is to our anesthesiologist team — our anesthesia team has to provide incredible support," Mardini said.
"We had to get a team of nurses to cover all the shifts for two rooms for 20 hours or so, and then the rest of the operation on Derek." Over 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 the width of human hair.
"Face transplantation is a combination of many of the other surgeries that we do every day," Mardini said. The team replaced about 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, which now lets Derek's tears drain through his nose.
When Derek woke up in the intensive care unit, he wasn't able to see his face at first. Derek was under sedation for two weeks as he recovered. He got to see his new face on March 5, exactly 10 years after his injury.
"After that, we were transferred more to a regular floor, and then we were there for a month," Lisa said. "He did so well that they actually brought in an exercise bike for him to continue working out in his room while we were at Mayo. He bounced back really quickly.
" Everything went well, Derek said, and recovery wasn't too painful. Now a few months out, Derek said he is feeling 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 under their breath.
I look like a normal human being." Derek's future includes further surgeries to refine the function of his eyelids and tongue. He'll continue enjoying his hobbies.
And Derek and Lisa have already embarked on their mission to speak to large groups about mental health and suicide awareness. "I want to help others any way I can," Derek said..
