Connie Culp, the first patient in the United States to receive a face transplant, died on Wednesday at the Cleveland Clinic, where her procedure was performed in 2008. She was 57.
The cause was an infection unrelated to her transplant, a spokeswoman for the hospital said. She said Ms. Culp had been the longest-living face transplant patient in the world.
Dr. Frank Papay, chairman of the Cleveland Clinic’s Dermatology and Plastic Surgery Institute, said of Ms. Culp, “Her decision to undergo a sometimes-daunting procedure is an enduring gift for all of humanity.”
Dr. Papay was part of the surgical team that performed the operation, replacing Ms. Culp’s damaged face with that of a recently deceased woman. Lasting 23 hours, it was the most extensive and complicated face transplant at the time. Three face transplants had been done before hers: two in France and one in China.
A Cleveland Clinic ethics committee had approved such a procedure only in 2004, the first such committee to do so. Dr. Eric Kodish, then the chairman of the clinic’s bioethics department, told The New York Times that before the transplant Ms. Culp had undergone psychological testing, in which she was asked whether it was she or a family member who wanted the transplant. She was also asked how she felt about the prospect of living with the face of someone who had died.
Most of her face had been damaged when she was shot by her husband, Thomas Culp, in 2004; her wounds had left her unable to breathe or eat on her own.
Her husband, with whom she had a common-law marriage, according to The Plain Dealer of Cleveland, was sentenced to seven years in prison for aggravated attempted murder and released in 2011.
After shooting his wife, Mr. Culp turned the shotgun on himself but lost only a few teeth and some vision in his left eye.
Ms. Culp said she had forgiven her husband. “I still love my husband,” she told the ABC program “Good Morning America” in 2009. “I forgave him the day he did it. I have to.”
About 40 such surgeries have been performed worldwide since Ms. Culp’s, said Dr. Thomas Romo III, director of facial plastic and reconstructive surgery at Lenox Hill Hospital and Manhattan Eye, Ear and Throat Hospital.
Her procedure was successful, and for the rest of her life she needed to take drugs to prevent her immune system from rejecting the transplant. The drugs, however, make the recipient more susceptible to infections.
Charla Nash, who received a full face transplant in 2011 after being mauled by a friend’s pet chimpanzee in Stamford, Conn., was hospitalized in 2016 after she participated in a trial to determine if transplant patients could be weaned off the anti-rejection drugs.
Most face transplant procedures are necessitated by gunshot wounds or accidents involving animals, Dr. Romo said.
After successful transplants, most patients are able to speak, eat and otherwise live a more normal life. If not for the surgery, Ms. Culp would not have been able to smile or talk, Dr. Romo said, adding that face transplants can have positive psychological effects for patients.
She was chosen for the experimental surgery because of her optimism and willingness to follow medical orders, according to a 2010 profile of her in The Plain Dealer, which described her as having been “a hard-working, fun-loving, Harley-riding, thumb-wrestling, small-town Ohio woman.”
Ms. Culp and her husband ran a drywall, painting and wallpapering business before they bought a restaurant and bar in 2004. She often worked there from the early morning until late at night, The Plain Dealer reported.
After spending six years in hospitals and nursing homes, she returned to her home in coal-mining country in southeastern Ohio, where a daughter, Alicia, helped care for her, the newspaper said. She also had a son, Steven. Complete information on her survivors was not available.
Connie Wagoner was born on March 26, 1963, and grew up in eastern Ohio, near the Pennsylvania border.
“Don’t judge people who don’t look the same as you do,” she said. “Because you never know. One day it might be all taken away.”