First scalp and skull transplant completed simultaneously with kidney and pancreas transplant

James (Jim) Boysen first met Jesse C. Selber, M.D., four years ago. The Austin-based software developer had come to MD Anderson for reconstructive surgery after successful treatment for leiomyosarcoma, a rare cancer of the smooth muscle, on his scalp had left him with a large, deep wound on his head.

But Jim, now age 55, didn't just need reconstructive surgery on his scalp and skull. He also needed another kidney and pancreas transplant. He'd previously received a kidney and pancreas transplant in 1992, due to complications from juvenile diabetes.

This presented a Catch-22 for Selber. The scalp and skull wound kept doctors from performing the second solid-organ transplant. Likewise, Jim's kidney and pancreas functions, along with his immunosuppression medications for his pancreas and kidney, complicated scalp reconstruction.

But Jim's wound, medication and organ failure ultimately became part of the solution. On May 22, he became the first person ever to receive a scalp and skull transplant simultaneously with solid organ transplants.

A transplant four years in the making
"When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing anti-rejection medication to support them, and receiving a full scalp and skull transplant at the same time that would be protected by those same medications," says Selber, who came up with the idea of performing the scalp and skull transplant at the same time as the kidney and pancreas transplant. "This was a unique situation that created the opportunity to perform this complex transplant."

But it took nearly four years before Selber could do the scalp and skull transplant, along with four MD Anderson plastic surgeons -- Mark Clemens, M.D.; Matthew Hanasono, M.D.; Edward Chang, M.D.; and Peirong Yu, M.D. -- and the transplant and plastic surgery teams from Houston Methodist Hospital. They needed to figure out exactly how to coordinate such a transplant. They also needed the right organ donor, someone who could provide the skull and scalp, as well as Jim's new kidney and pancreas.

On May 21, Selber learned that LifeGift had a potential organ donor. About 20 hours later, the team began the 15-hour surgery. More than 50 health care professionals performed, assisted with or supported the surgery. LifeGift, which hadn't ever before facilitated the procurement of a scalp and skull for transplant, also played a key role.

A new beginning
Today, less than two weeks later, Jim is due to be discharged from the hospital. He'll remain in Houston for three weeks of follow-up care. He's still a little shocked that he's already up and walking.

"This has been a long journey, and I am so grateful to all the doctors who performed my transplants," Jim says. "I'm amazed at how great I feel and am forever grateful that I have another chance to get back to doing the things I love and be with the people I love."