Connie Culp, the first patient in the United States to have a face transplant, died Wednesday at the Cleveland Clinic that performed her surgery in 2008. She was 57 years old.
She died of complications from an infection that had nothing to do with her transplant, a hospital spokeswoman said. The clinic confirmed Ms. Culp's death on Twitter.
Ms. Culp was the longest living face transplant patient in the world, the spokeswoman said.
"She was a great pioneer and her decision to undergo a sometimes daunting process is a lasting gift for all of humanity," said Dr. Frank Papay, chair of the Cleveland Clinic's Dermatology and Plastic Surgery Institute.
Dr. Papay was part of the surgical team that performed Ms. Culp's 23-hour operation in 2008, replacing her damaged face with that of a recently deceased woman.
It was the most extensive and complicated face transplant at the time. Three facial transplants were performed before Ms. Culps: two in France and one in China.
A Cleveland Clinic ethics committee had only approved such a procedure in 2004, the first of its kind. Eric Kodish, then chair of the clinic's bioethics department, told the New York Times after the transplant that Ms. Culp had undergone psychological tests before the operation.
She was asked if she or a family member wanted the transplant and how she felt when she lived with the face of a dead person, Dr. Kodish.
Ms. Culp was shot in 2004 by her husband Thomas Culp, which damaged most of her face and made her unable to breathe or eat alone. Her husband, with whom she had a general marriage, according to The Plain Dealer, was sentenced to seven years in prison for attempted murder and released in 2011.
After shooting his wife, Mr. Culp turned the shotgun towards himself, but lost only a few teeth and part of the view in his left eye. He still looked the same, Ms. Culp said to The Plain Dealer.
She said she forgave her husband. "I still love my husband," she said to Good Morning America in 2009. "I forgave him the day he did it. I must."
Around 40 such operations have been performed worldwide since Ms. Culps, said Dr. Thomas Romo III, director of facial plastic and reconstructive surgery at Lenox Hill Hospital and Manhattan Eye, Ear and Throat Hospital.
Her intervention was immediately successful and Ms. Culp's body did not reject the transplant, although she had to take anti-rejection medication for the rest of her life because her body could have refused the transplant at any time. The drugs suppress a patient's immune system to prevent it from rejecting the graft, but also make the person more susceptible to infection.
Most face transplants relate to gunshot wounds or animal accidents, said Dr. Romo.
Charla Nash, who received a full-face transplant in 2011 after being abused by her friend's chimpanzee in Stamford, Connecticut, was hospitalized in 2016 after participating in a study to determine if transplant patients could be weaned from the medication .
Face transplants are more than just cosmetic improvements for patients, said Dr. Romo. After successful transplants, most patients can speak, eat, and otherwise live a more normal life.
Without the surgery, Ms. Culp would have been unable to smile or speak, said Dr. Romo and added that face transplants can have positive psychological effects on patients.
Ms. Culp is "a milestone in medical history and will be forever," he said.
She was selected for her experimental operation at the time because of her optimism and willingness to follow medical instructions, according to a 2010 profile in The Plain Dealer.
Ms. Culp and her husband previously ran a drywall, paint, and wallpaper shop before buying a restaurant and bar in 2004, where they often worked from early morning until late at night, The Plain Dealer reported.
She was born on March 26, 1963. Details of survivors were not immediately available.
At a press conference that unveiled her new face in 2009, Ms. Culp asked others to be kind to people with facial changes.
"Don't judge people who don't look like you," she said. "Because you never know. One day everything could be taken away. "