For the past few years, Ajay Kumar Gill had been living on borrowed time. His liver and kidneys had deteriorated, dialysis had become routine, and the possibility of waiting for a deceased donor carried a frightening question: would suitable organs become available before his condition deteriorated further?
For Ajay (51), the answer eventually came not from the deceased-donor pool but from within his own family. His wife and daughter stepped forward as living donors, giving him a chance to undergo the complex transplant he needed.
His better-half Seema, 51, donated a part of her liver while daughter Shivani, 28, gave one of her kidneys. Both organs were transplanted into Ajay during a complex 15-16-hour simultaneous liver-kidney transplant at Yatharth Hospital, Noida Extension, on May 22, 2026.
Nearly three months later, the family hailing from Kaniya Kalyanpur and Babugarh Chawani in Uttar Pradesh’s Hapur district is now beginning to look beyond the hospital corridor and medical reports.
Talking about Ajay’s complex medical health condition, Dr Vishal Chaurasia, Group Director-Liver Transplant, GI and Robotic Surgery, said, "The patient had been living with chronic liver disease caused by hepatitis B and end-stage kidney disease. His kidney problems had become particularly severe after he underwent removal of his right kidney about a year earlier for a tumour. He subsequently developed chronic kidney disease and had to undergo haemodialysis three times a week.”
A patient of diabetes since the age of 39, diabetic kidney damage and neuropathy, hypertension and single-vessel coronary artery disease further complicated his condition, said Dr Chaurasia.
The medical problem, therefore, was not confined to one failing organ.
“He needed both organs to be replaced,” added Dr Upendra Singh, Senior Consultant and Head of Nephrology at the hospital.
The family, meanwhile, was confronting a different reality. A deceased-donor transplant could not be guaranteed within the time Ajay had. His wife and daughter decided to become living donors.
That decision, however, did not mean simply entering an operating theatre.
Before any living donation, donors undergo extensive medical evaluation to establish whether they are fit enough to undergo major surgery and whether donation could compromise their long-term health. Psychological assessment and counselling are also important because the decision must be voluntary and informed.
For Seema, who weighed around 95 kg and had an HbA1c of about 6.1, which was in the prediabetic range, the preparation became a journey of her own. Her own health had to be addressed before she could safely donate part of her liver. “I had to make myself fit first,” she recalled.
She changed her diet, became more conscious of her daily routine and worked on losing weight. Nearly a year went into preparing herself.
There was an unexpected personal dividend to that effort. Seema's metabolic health improved, and the fatty changes previously detected in her liver also improved.
Her experience is a reminder that sustained changes in diet, weight and physical activity can, in some people, improve metabolic problems and fatty liver disease. It also underlines an often-overlooked aspect of living donation: the donor's health cannot be secondary to the recipient's needs.
Shivani, who has been preparing for the judiciary examination, meanwhile, underwent evaluation to establish that she could safely donate a kidney. Her decision also meant understanding that kidney donation is major surgery followed by lifelong attention to health, blood pressure, weight and regular medical follow-up. “My brother is just 25 years old and has his own health issues. So he was not considered fit for donating the organs,” said Shivani.
The two women were not merely donors on an operating list. They were healthy individuals taking on medical risks to give another person a chance to live.
The surgery itself presented several challenges.
Ajay had an O-positive blood group while Seema was B-positive, making the liver transplant ABO-incompatible. The donated liver also showed fatty changes.
The kidney transplant brought another technical difficulty. “Shivani's left kidney had two renal arteries, requiring vascular reconstruction to ensure adequate blood supply, while Ajay's right iliac vessels were unsuitable for connecting the transplanted kidney, so we had to use the left iliac vessels,” Dr Pragnesh Desai, Senior Director and Head of Orology, Renal Transplant, Robotics and Uro-Oncology, said.
As a result, simultaneous liver and kidney transplantation was conducted, considered to be one of the most complex forms of transplant surgery. “This requires meticulous planning, a high level of expertise and seamless coordination,” added Dr Desai.
The blood-group incompatibility required additional preparation and treatment. During the transplant process, Ajay developed a high antibody titre and underwent extensive plasma exchange, according to the family.
Even after the surgery, recovery was not straightforward. A subsequent complication involving the bile duct and stones required another procedure.
The operation, therefore, was not the end of the story. It was the beginning of another long phase — recovery, infection prevention, monitoring and adjustment to life with transplanted organs. Dr Prahlad Agrawal, COO – Yatharth Hospital, Noida Extension, said, “This outcome demonstrates that our hospital is equipped to undertake highly complex medical procedures. Successfully completing such a complicated transplant surgery requires not only clinical expertise but also strong and continuous administrative and operational support.”
For Seema and Shivani, recovery after donation has its own rules.
Dr Desai cautioned that liver donors generally require follow-up to monitor liver function, wound healing, nutrition and overall recovery. At the same time, he said, kidney donors need continued attention to blood pressure, kidney function, weight and healthy lifestyle habits. Neither should assume that donation means they can ignore their own health once the recipient recovers, he added.
For Ajay, the precautions are more stringent. As a transplant recipient, he will need lifelong immunosuppressive medicines to prevent rejection. Regular monitoring of kidney and liver function, blood pressure, blood sugar and other parameters become part of everyday life. Avoiding infections, maintaining food and hygiene precautions and reporting symptoms promptly are equally important.
A much-relieved Seema says that her husband Ajay, who had fallen to around 49 kg during his prolonged illness, has begun gaining weight and strength. His creatinine was around 1.04 at the three-month stage, according to the treating team.
But recovery cannot be measured only through laboratory values. For a man whose days were once organised around dialysis, being able to imagine ordinary life again is itself a milestone.
Ajay's story also draws attention to India's persistent shortage of deceased-donor organs. A deceased donor can potentially help several recipients. A single donor may provide kidneys, liver, heart, lungs, pancreas and tissues, depending on medical suitability. But for this chain of life to begin, families have to make an extraordinarily difficult decision at a time of grief.
Though living donation has saved thousands of lives, particularly in kidney and liver transplantation, doctors say, relying heavily on relatives and other living donors has limitations. This is where deceased donation becomes critical.
Yet awareness about deceased donation remains uneven, and myths surrounding the process continue to influence decisions.
“It's a matter of vital importance. There isn't enough awareness about organ donation in India, and people aren't much familiar with it or not keen to come forward to donate the organs of their loved ones after their death,” Dr Chaurasia said.
The issue is therefore larger than Ajay's family.
His case demonstrates both sides of India's transplant story. His wife and daughter could donate because they were willing and medically suitable. Also, they managed financial help which was as high as Rs 45 lakhs. But countless patients do not have that option. More than 61,000 patients are currently on the official waiting list for a kidney transplant in India, while medical experts estimate that 2 lakh (200,000) to 3 lakh patients need a new kidney every year.
In contrast, only about 13,000 to 14,000 kidney transplants happen annually, leaving a massive gap. Ditto is the case with liver organ availability. India needs about 50,000 livers for transplantation every year, but deceased donation rates remain very low at around 0.08 to 0.5 per million people.
There is also a quieter lesson in Seema's journey. In preparing herself to become a donor, she ended up confronting her own health — her weight, prediabetic-range HbA1c and fatty liver.
Her subsequent improvement shows why lifestyle changes deserve greater attention even amid a serious medical crisis. A healthier diet, weight management and regular physical activity can make a meaningful difference in metabolic health, and fatty liver associated with metabolic dysfunction can improve substantially with sustained lifestyle changes, asserted Dr Singh.
For Shivani, the decision to donate was equally personal. “I believe that when you are educated and know that you can stand on your own feet, you can make your own decisions,” she says.
She did not frame her decision as heroism. It was, for her, as she said, a daughter's response to a father whose health was deteriorating. On the other hand, Ajay, a farmer by profession, said that his wife and daughter have shown that women remain a classic case of sacrifice and love, and he was indebted to them throughout his life.
The family had also faced a formidable financial burden. The transplant and prolonged treatment cost around ₹45 lakh, according to the family. Land was sold and money was borrowed from relatives to meet the expenses.
That burden itself reveals another dimension of transplantation in India: access is shaped not only by the availability of organs but also by affordability.
For Ajay's family, however, the biggest expense was measured in something other than money — years of uncertainty.
The story that began with two failing organs now carries a larger message.
India needs better transplant infrastructure, financial aid and doctors’ expertise, but it also needs a culture of informed deceased donation. Awareness cannot begin only when a family loses someone. It has to begin much earlier — through schools, communities, workplaces and public-health campaigns — so that people understand what deceased organ donation means and how it can transform another family's tragedy into a second chance.
For families like Ajay's, living donors can become a lifeline. For thousands waiting without one, a deceased donor may be the only lifeline left.
