In July 2019, six years after he was disfigured in a near-fatal car accident, Robert Chelsea made history by becoming the first Black person to receive a full-face transplant. At 68, he was also the oldest patient to receive one. In a letter to the editor published in the The New England Journal of Medicine, the surgeons who performed the operation revealed that his race posed significant challenges.

On a warm night in the summer of 2013, Chelsea, a sales manager then in his early 60s, was driving home from church when his car overheated. While awaiting roadside assistance on the shoulder of the highway, he was struck by a drunk driver with three prior convictions, according to his personal website. “My car went up in the air, and when it came down, it blew up,” he told CNN. The explosion caused burns so severe that he spent the next six months in a coma and 18 more in recovery. Despite their best efforts, doctors could not save his lips, left ear or part of his nose.

Thus began Chelsea’s search for a new face. “To be able to address a person without intimidating them would be a major relief,” he told the BBC of his quest.

But Chelsea faced tremendous challenges. In the first place, there were only a few options. “There is a really remarkably low number of African-American donors,” Bohdan Pomahac, MD, director of plastic surgery transplantation at Brigham and Women’s Hospital in Boston, told U.S. News and World Report. Secondly, since Black people have a wider range of skin tones than white people, Chelsea had to wait until a donor whose complexion more or less matched his own became available. He declined the first two faces he was offered before accepting the third. Even so, the difference in coloration was so stark that Chelsea opted for a full-face transplant rather than a partial one.

In total, Chelsea spent 17 months on the donor waiting list, 13 more than the average length of time for a white person. But his patience paid off. After a marathon surgery that spanned 16 hours, Pomahac and more than 44 other medical professionals, including nurses, residents, research fellows, surgeons and anesthesiologists, successfully restored his appearance.

“May God bless the donor and his family who chose to donate this precious gift and give me a second chance,” Chelsea said afterward, according to a Brigham and Women’s press release. “Words cannot describe how I feel. I am overwhelmed with gratitude and feel very blessed to receive such an amazing gift.”

However, Chelsea still faced danger. In the days following an organ transplant, surgeons watch anxiously for signs of infection. One of the most telltale signs is skin redness. This aftereffect tends to be fairly obvious in Caucasian patients but can be hard to discern in Black patients, Pomahac said.

Consequently, Chelsea’s team had to find another way of evaluating his body’s response to the surgery. Instead of tracking the color of his face, the doctors regularly monitored and biopsied the inside of his cheeks and lips to ensure the transplanted tissue was assimilating.

Eventually, Chelsea recovered without major incident. Nearly two years later, he has regained a significant amount of sensation and motor function in his face.

Chelsea’s case highlights the need to encourage organ donation by Black people and other minorities, the surgeons wrote. The reluctance of such individuals to sign up as donors is partially rooted, according to Time, in the deep mistrust of the medical establishment many have internalized due to its history of racism.

“It’s important for African Americans and people with any type of color of complexion to be assured that we are here for them regardless of their background, and we’re able to help,” Pomahac said.

For more on organ donation and African Americans, read “Waiting for the Gift of Life—Increasing Number of African Americans on Waiting List for Organ Donation.” And for another story about a Black person who suffered scarring from an accident, read “About Face.”