Boston, MA – A Life Saved By A Jewish Nose: Inside The First Facial Transplant

Boston, MA – They had asked for his kidneys. His liver. Even his heart. So when the organ-harvest coordinator, Esther Charves, worked up the nerve to visit the widow one more time, she almost couldn’t bring herself to ask for one more gift.

She cleared her throat nervously, and shifted in her chair in front of Susan Whitman Helfgot, whose husband, Joseph, had died only 24 hours before in a Boston hospital.

“Don’t tell me you want his Jewish nose?” Susan joked.

Well, actually . . .

“We have a man who needs a face,” Charves said.

“Oh my God,” Helfgot said. “You really do want Joseph’s nose.”

It was the beginning of a groundbreaking experiment, one of the world’s first-ever face transplants. As told in “The Match” (Simon & Schuster), a new memoir from Susan and author William Novak out this week, it was a journey fraught with medical ethics, cutting-edge science and not a small amount of trepidation. Susan knew Joseph wanted, even in death, to help everyone he could. But was she ready for someone else to have his face?

TWO FACES

Joseph Helfgot, the son of two Holocaust survivors, was born into a displacement camp before moving to the then-gritty streets of the Lower East Side. Helfgot became a professor at Boston University and switched fields to start a successful Hollywood ad-research company that launched such films as “The Silence of the Lambs” and “Dances with Wolves.”

Though lucky in business and love (he raised four children with his second wife, Susan), his heart broke the streak. A decade before his death, Helfgot was placed on a heart transplant list and went into cardiac arrest in 2005, intermittently spending the next four years in and out of the hospital waiting for a donor.

In April 2009, the moment finally came, but it was too late. Helfgot, 60, died on the operating table from a blood clot in his aorta.

Jim Maki, the adopted son of two Japanese immigrants, was raised for part of his life in an internment camp during World War II. His mother noticed that from a young age that Maki was mixed race: Likely part Japanese and part Native American, although Maki couldn’t afford the DNA tests nor was he able to track down his biological parents.

He had a tough childhood growing up in Seattle — where he often fought his tormentors who singled him out for being different — and rebelled against his strict professor father. In defiance of his father, Maki enlisted as a soldier in Vietnam, where he first sampled heroin. His drug addiction continued, estranging him from his wife and landing him in jail.

One afternoon, strung out on drugs at a Boston train station, he fell face first onto the third rail of the subway tracks. Rushed to the emergency room, Maki had become unrecognizable. His face was eviscerated, everything from his nose to his chin had been burned off and in its place a gaping hole. Doctors doubted he’d make it through the night.

THE GIFT

To be an organ donor — let alone a face donor — there are things that must be matched. The two must be around the same age and have similar skin pigment. They are required to share the same blood type and tissue type or else the foreign parts will be rejected by the body’s immune system.

Not only did the two men share all the above, but the hospital where Helfgot died, Brigham and Women’s Hospital in Boston, was one of only two hospitals in the country that had approved face transplantation.

When faced with the remarkable decision to donate, Helfgot consulted her children.

“We were in favor of doing what my husband would have wanted,” Helfgot told The Post. “The person who is dead cannot hear the question, nor can they answer it. So you have to do what you think the person would have wanted you do.”

She drew upon their shared experiences of waiting for a heart donation for nearly a decade and the thought of her husband with a tracheotomy, unable to swallow thin liquids, just like the faceless and nameless man her husband’s face would help.

Helfgot’s answer was an unequivocal yes.

Maki, 59, who lived in a veteran’s home nearby, was living the life of a leper. He couldn’t eat, talk or breathe on his own. A trachea tube and a feeding tube were the only things always by his side — he hardly saw his beautiful college-bound daughter and his wife anymore.

He often refused offers to leave the veteran’s home to join the others on trips to local restaurants.

“People don’t want to look at a big crater where a person’s face ought to be, especially when they’re out to dinner,” the authors write. “People have been known to scream when they see him.”

After his accident, he spent two years supine in bed contemplating his future. But he wasn’t suicidal. Maki wanted to live, to right all the wrongs that he had done during years of drug abuse.

That second chance came on April 8, 2009 at 9 a.m.

“Mr. Maki, it’s Dr. Pomahac. I have some great news. I’d like you to come in right away. We found a donor.”

Maki, who could really only manage to make garbling sounds, phoned his wife.

“Cindy, they found a face,” he mumbled.

THE OPERATION

Due to strict privacy laws, Helfgot had no description of Maki. Likewise, Maki had no knowledge of the man whose face he would inherit.

At midnight on Wednesday, April 9, Helfgot’s body, attached to respirators pumping air in and out of his lungs to keep his blood circulating and the tissue healthy, was wheeled into the operating room. There, plastic surgeon Dr. Bohdan Pomahac and his team worked for seven straight hours removing Helfgot’s face, down to the bone, from the upper teeth to the orbital floor that supports the eye.

They injected syringes full of epinephrine to stop the blood as they dug out important nerve bundles that would be necessary for Maki to register touch and express emotions on his new face.

In a nearby operating room, Maki was anesthetized. As a tester, they grafted a piece of Helfgot’s skin to see if the foreign tissue would be rejected by Maki’s immune system. Luckily, it was a clear match.

Then the face arrived.

Pomahac began on the left side of the cheek, attaching one nerve at a time using a technique called neurorrhaphy. Slowly, the deathly pale skin gained a pinkish hue. “Gradually color creeps across his patient’s new skin, slowing down a little as it struggles against the gravity at the bump of the nose, then moving faster down the other side, toward the right cheek,” the authors write.

Pomahac installed Helfgot’s upper palate and teeth into Maki, attaching them together using titanium plates. Almost a full day later, they were finally done. Helfgot’s respirator was turned off and he was officially pronounced dead.

THE BOND

Several days later, Maki would finally get a look at himself.

“My new face looks just like my old one,” he said.

It was far from the truth. Maki’s facial nerves had not yet healed and he could still not feel touch or make facial expressions. It still felt weird, the authors note: “The nose belonged to another man. These teeth and upper lip used to live in someone else’s mouth, drinking his water and speaking his words.”

Eventually, the other man’s face became his own. His borrowed nose filled with his own snot, he could finally speak real sentences, and he could drink thickened liquids without a feeding tube. Speckles of a beard appeared on his face — an ode to its former owner Helfgot, who had a beard his whole adult life.

Still, Maki was still haunted by thoughts of his face’s original owner — and Helfgot’s widow wanted to see the man whose life was improved by her husband’s death. But before a meeting, there were things Helfgot needed to know about the patient.

“Before you meet Mr. Maki, he asked me to share something with you,” a hospital representative told the widow.

Terrible images ran through her mind — Maki was dead or sick; it was all in vain.

“It’s about his past,” he continued.

Other images followed. Was he a murderer? A rapist with her husband’s face?

“Mr. Maki has a history of drug use.”

Relief washed over Helfgot. This she could handle. After she heard Maki’s story, she felt validated.

“There are things that should be forgiven. There are things that are not irreconcilable,” she told The Post. “Jim had lived for four years after that accident as a very crippled and disabled person. If anybody deserved that chance, I think he did.”

Yet nothing could prepare her for the emotion of the initial meeting.

“I look at the nose, and I think that’s my husband’s nose,” she said.

Now, more than a year after the fateful operation, the two remain close. When Helfgot sees Maki now, she no longers sees her dead husband. Maki continues to improve.

“Jim looks terrific. And by look, I mean all of Jim, he’s healthier and stronger,” she said.

He can laugh, eat foods and speak perfectly. There are plans for a second set of operations to add lower dentures to his mouth and to remove the excess skin from his face to improve his appearance. The two still talk on the phone several times a day.

“It’s the same kind of feeling you have when you go to a family funeral or wedding and you meet some cousin twice removed,” Helfgot said. “You may have nothing in common with that person, but there will always be a relationship. He’s family.”