First African American full face transplant recipient advocates for organ donors and medical racial parity

Robert Chelsea already had an unshakable faith in God. That connection was about to grow stronger in an unusual way when he was on his way home one night in 2013.

"My car overheated," said Robert. "I pulled to the side, the shoulder of the freeway, and a drunk driver swerved and rode straight into me, and boom! My car went up in the air, and it came down. I got hit, and the car blew up. It was a few seconds before, boom, fire all over the place."

Robert believes he survived by the grace of God and a good Samaritan bystander named Richard Robles, who is now a very close friend as well as his beautiful family.

"He helped me get out of that car," said Robert. "He said he tried to take my arms, but my arms were melting, so he had to take a belt buckle and help to escort me to a safe area."

His daughter, Ebony Chelsea, said she will never forget the phone call she got afterward.

"'Your dad has been in a car accident,'" Ebony said she heard a voice tell her on the other end of the phone. "I gasped, and then after that, they told me the details of what had occurred. Then I started screaming."

Facing a new reality

More than 60 percent of Robert's body was burnt, including his face.

"He was wrapped up from head to toe, like a mummy, like The Mummy movie, actually," said Ebony.

Robert was in a coma for six months, during which he had over 30 surgeries. He first saw himself as a burn survivor in the reflection of a metal paper towel holder as he was passing a bathroom in the hospital.

"What I thought was, I see now why everyone is making sympathetic comments," said Robert. "'Robert, this is something that, oh, I don't know if I could handle it. You've got to be really strong to be able to do it. I don't know how you do it.' I just realized, 'Oh, this is why all the people are making a fuss, because I look like this.' This is a burned face, but I don't mind."

Life was incredibly challenging without lips. Plastic surgery could rebuild his lips using tissue from the forearm as well as muscle and fat from the thigh, but Robert's body was too badly burned for the procedure to work. A full facial transplant became the best option to restore some form and function.

He wanted the transplant for two main reasons. First, it would give him lips, so drinking would be easier. Without lips, he needed to tilt his head back and use a syringe to inject fluids into his mouth.

"Today, as a result of the face transplant, fortunately, I'm able to drink with a straw," said Robert. "So, that's a great improvement."

The other reason was to rebuild his connection to his daughter, expressing his love for her in a way he couldn't.

"I certainly wanted to have the opportunity to kiss my daughter's cheek," he said.

Facing new challenges

Robert eventually became the first African American and oldest facial transplant recipient. He connected with Bohdan Pomahac, MD, a reconstructive facial surgeon. Yet, there were challenges to finding a donor. Just like for any organ, the donor's and receiver's blood type needed to match. Also, as a burn victim, Robert had several pre-existing conditions that could cause him to reject tissue from some donors. Additionally, he was the oldest face transplant recipient at age 68, so his ability to recover needed to be taken into consideration. Then, there was the matter of finding a color match to his skin.

"Because there are so many different shades of African Americans," said Robert.

One obstacle was being able to make a precise match using pictures.

"I didn't even realize how many shades of brown color there are that can look unnatural if it's just not a good fit," said Dr. Pomahac. "It's very difficult to gauge at the time of donor discovery because the lighting is suboptimal in the ICUs. It could be bright white, or it could be very yellow."

Robert waited about two years for a match. Once a donor was identified, Dr. Pomahac described the 24-hour-long operation to transplant the face as a marathon procedure. When Robert woke up, he had no bandages around his head.

"When I saw my new face, I don't know if I would call it happy," said Robert. "I guess more grateful."

He encountered another challenge after the surgery. The normal signs of rejection were difficult to monitor because of his skin color.

"A pale face, pink or red face, blue lips, white knuckles, well, clearly none of those are applicable to me," said Robert. "So, that would mean that until I got super sick, they would have no idea, no clue of any outward signs that I'm rejecting."

Ebony said her dad now has a new look on the outside, but one feature is still clearly recognizable.

"His voice never went away," said Ebony. "So, he's the same in voice. When he opens his mouth, it's like, 'Okay, Dad, I hear you.'"

Advocating for others of every color

His medical journey was spiritually transformative for him, causing him not only to serve God more fervently, but also to encourage other African Americans to consider organ donation and to advocate for racial parity in the medical system.

"It is very important for me to advocate because I wouldn't have this face if it weren't for another family that was that considerate," said Robert. "So how could I not appreciate having this kind of exposure to justify me advocating for our disabled diaspora?"

Ebony said she is proud of her father and his activism.

"I have Black history in my own home, so it's wonderful," said Ebony. "I hope people will wake up. I want people to know there are people out there who need help. It doesn't matter what race, what color, what anything you have. Help your fellow man and sister."

Dr. Pomahac said Robert's story shows the power of plastic surgeons.

"There's always something that we can cheer you up with," said Dr. Pomahac. "Because if it's not immediately an option, it will be an option in the next few years. The reality is we truly provide restoration rather than reconstruction in many cases and enhance the quality of life of so many patients that we can help."

Dr. Pomahac believes Robert is also enhancing lives by advocating for others. Robert continues to be an advocate for transplantation, amputees, burn victims and mental health, all of which he experienced. In a way, he is spreading the gospel.

"He's really a very important messenger that he relays from personal experience the message of the importance of donation," said Dr. Pomahac

Dr. Pomahac also stressed that being an organ donor means more than having a box checked on your driver's license.

"Just being willing to donate organs doesn't mean that somebody would recover your face or limbs or whatever is needed," said Dr. Pomahac. "It's a separate consent process. Right now, you cannot, even as a donor, identify that you would want to donate limbs, a face or other non-traditional organs. It would be up to your family, and the family would have to agree."

He encourages anyone wanting to donate organs of any type to have discussions with their families so their wishes are clear.

Robert feels the donation he received called him to advocate, so he travels across the globe to show and tell civic groups, medical staffers and students the value of transplant technologies for candidates with disabilities. In fact, show and tell is a key message in the programming for the Robert Chelsea Foundation.

"I want to do everything to express my gratitude that I have," said Robert. "Also, the empathy that I share about their loss, but also hopefully they'll embrace me as a possible gain to their family."

Robert was the first person of color to get a facial transplant, but he hopes his experience continues to pave the path for others so he will not be the last.

"If one size doesn't fit all, neither should one culture or color be a benchmark for everyone."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.