3D Printing for a Face and Bilateral Arm Transplant

By Keith Allison | March 16, 2021

3D printer in the process of printing a set of arms

LaGuardia Studio Helps Restore the Identity of the Donor in Groundbreaking Surgery Performed at NYU Langone Health

In 2018, experts from NYU’s 3D printing facility, LaGuardia Studio (LGS), navigated a blizzard to assist Dr. Eduardo D. Rodriguez of NYU Langone Health’s Hansjörg Wyss Department of Plastic Surgery with a groundbreaking operation: transplanting a human face. The Studio’s task was to scan the donor’s face and print a lifelike mask that would restore the donor’s identity and provide comfort and dignity to their loved ones. The operation performed by Dr. Rodriguez and the mask printing done by LGS staff were successes, and the two teams looked forward to working together again. 

That opportunity came in October 2019, when Leslie Bernstein, Department of Plastic Surgery department administrator, contacted the Studio to let them know there was another patient in need of a transplant—only this time, it wasn’t just a face. Twenty-two-year-old New Jersey resident Joe DiMeo had been severely burned in a car crash. To restore his independence and mobility, Dr. Rodriguez planned a transplant of the face and both arms.

Finding a donor for a face transplant is difficult. Aside from the need for compatible biology and physical structure, one must also find a family willing to make such a dramatic sacrifice. Finding a donor for the face and arms was, in the words of Dr. Rodriguez, “like finding a needle in a haystack.”1 Dr. Rodriguez worked with LiveOnNY, an organ recovery organization for the greater New York metropolitan area, and Gift of Life, the regional organ donor program serving southern New Jersey, Pennsylvania, and Delaware.

Familiar Procedures, New Challenges

Meanwhile, the LGS team—Shelly J. Smith, Andrew Buckland, Dhemerae Ford, Taylor Absher, and Taylor Shields—reviewed the task ahead of them. Their experience with the 2018 face transplant had them well-prepared. The arms, however, were a new endeavor with unique challenges and benefits.

While they would not be able to model a face mask until a donor was located (as the finished mask needs to look like the donor), they would be able to work on the arms ahead of time, knowing that they would have to be very similar to DiMeo’s arms. In consultation with Dr. Rodriguez, the LGS team began to sketch what they’d be looking for—until Dr. Rodriguez pointed at LGS team member Dhemerae Ford’s arms. They were exactly what Dr. Rodriguez was looking for.

Capturing a 3D scan of a human being is difficult. Movements imperceptible to the eye can render a scan unusable. Ford’s arms had to be completely still for multiple scans, each one lasting about 30 minutes. Her teammates built a rig that would enable them to pose her arm and keep it steady. Knowing that the final prints would need to be positioned to Dr. Rodriguez’s specifications, a moveable digital “skeleton” was laid under the scans.

Another challenge was finding the proper material in which to print the arms. Because they would be attached to the donor, the prints had to be hollow. The initial print did not hold its form well. A new combination of materials was engineered to ensure the hollow prints did not collapse. This material was developed by 3D printer manufacturer Stratasys after the 2018 transplant, when they realized a more flexible, skin-like material would enhance the quality of the print. The demand for better materials and faster print times meant that, as in 2018, Stratasys granted LGS access to technology that was not yet on the market. Each finished arm took two and a half days to print.

Everything was going well as 2019 became 2020. The LGS team was ready to spring into action as soon as they got the call.

Then came March 2020.

3D printed arms

The final 3D print of the arms, based on the Studio’s Dhemerae Ford, used in the transplant procedure.

A Pandemic and a Hurricane

Completing the 2018 transplant during a blizzard had been complicated. As COVID-19 became a full-blown pandemic necessitating global shutdowns, it was obvious that 2020 was going to be much worse. When NYU moved to remote learning, LaGuardia Studio’s equipment was turned off. Andrew Buckland and Dhemerae Ford partnered with NYU Langone to print much-needed personal protection equipment. Dr. Rodriguez, along with all of Langone, shifted to supporting the fight against COVID. Joe DiMeo, because of a compromised immune system, was at high risk of contracting the virus.

Convening remotely, the LGS team began to address the biggest complication they would face should a transplant donor be found while NYU was on lockdown: how can you be ready with a few hours notice to use machines that can take four days to restart? Buckland worked with Stratasys engineers to solve the issue. 

“When we went into the stay-at-home order,” explains Buckland, “we had to put the printers in a state of long-term shut-down. Typically, when you shut it down for long term, you have to drain the fluids. You basically prepare it as if it was a brand new printer. It needs all of the calibrations redone when you restart. Sometimes you have to replace parts, because liquids congeal.”

Which, it turns out, happened to one of the two printers. This meant the safety net of having two printers to print a primary and a back-up mask at the same time would not be possible. There would only be one mask. If anything went wrong with the printing, it would mean disaster.

During the summer of 2020, Hurricane Isaias hit New York, causing power outages throughout the Hudson Valley, affecting both Smith and Buckland at a crucial time. 

Buckland’s power was restored just in time to receive a text from Leslie Bernstein. The transplant was happening. Navigating transit and power outages, downed trees and the dangers of traveling during the pandemic, Buckland got in touch with Smith, while the rest of the LGS team secured permission to be on-campus and made their way to the Studio.

Waking Up LaGuardia Studio

Thanks to the research that had been done ahead of time, the printers were brought out of deep sleep and made operational in a span of time that would have impressed head engineer Mr. Scott from Star Trek.

“A three-to-four day start-up time, we finagled our way through in about four hours,” said Buckland.

Scans of the donor were procured. During the 23-hour surgery performed by Dr. Rodriguez the LGS team perfected the geometry of the scans—about 75 gigs of data in total. Buckland and his colleague, Taylor Absher, worked for roughly seven hours, building the mask then sectioning it in a way that would facilitate printing. Every step of this process required interaction and monitoring. Similarly, printing required non-stop, in-person monitoring since there was no back-up and even state-of-the-art 3D printers are prone to malfunction.

The preparation paid off. Both the arms and the face mask were exactly what Dr. Rodriguez wanted for the donor and their loved ones. The entire process took 48 hours, or as Buckland put it, “we saw two sunsets at Laguardia Studio.”

Dr. Eduardo D. Rodriguez with transplant recipient Joe DiMeo

Dr. Eduardo D. Rodriguez with transplant recipient Joe DiMeo. Photo: NYU Langone Staff

The Value of 3D printing

For Dr. Rodriguez, the mask and arms printed by LaGuardia Studio serve two purposes. They restore the dignity of the donor and help loved ones make a difficult decision. As Dr. Rodriguez said, “This transplant was possible because a selfless family said yes to this unique donation.” Knowing that the donor’s identity can be restored after the operation helps the team at NYU Langone Health achieve the second purpose: moving toward the more normalized acceptance of face and limb donation. There is still no formalized way in which an individual can denote they’re willing to be a face or limb donor, as there is with registering to be an organ donor on your driver’s license or voter registration.

This means the decision rests on the next of kin. If they know that a potential donor’s face—and now, arms—can be restored, it can remove some of the stress of the decision. For the recipient, it means a restoration of identity as well. No one is in a better position than Joe DiMeo to put into words exactly what the willingness to make such a donation means: “This is a once-in-a-lifetime gift, and I hope the family can take some comfort knowing that part of the donor lives on with me.”