Lahore, Pakistan – February 2026

The Pakistan Kidney and Liver Institute & Research Center (PKLI & RC) has successfully performed a rare and highly complex domino auxiliary liver transplant, creating a powerful chain of hope for two children through one act of donation.

This extraordinary medical achievement was described by Prof. Dr. Saeed Akhter, President, Pakistan Kidney Institute (PKI); Chairman, Pakistan Kidney and Liver Institute (PKLI); and Member, Prime Minister’s Task Force for Hepatitis C Elimination (JMC & RC), as:

“History in the making, Alhumdulillah. Proud of my team. In simple words, the mother gave half of her liver to her child who had an enzyme deficiency and was developing liver failure. Half of the child’s liver was removed and the mother’s liver piece was attached. Instead of throwing away the removed liver, this piece was placed into another child who had a different enzyme deficiency with cholesterol in the thousands. This defective liver has already lowered the cholesterol of the other child. Isn’t that remarkable?”

A Mother’s Gift That Saved Two Lives

In this extraordinary medical case, a mother donated part of her liver to her child, who was born with Crigler–Najjar Syndrome Type I, a rare genetic condition in which the liver lacks an essential enzyme to process bilirubin. Without surgical intervention, the child was developing progressive liver failure.
Using an advanced surgical technique known as Auxiliary Partial Orthotopic Liver Transplantation (APOLT), surgeons implanted the left lateral segment of the mother’s liver into the child, while part of the child’s own liver was removed.
What followed turned this into a truly remarkable domino transplant story.
Instead of discarding the child’s removed liver tissue — which was non-cancerous and structurally healthy but metabolically defective — the same liver was transplanted into another child suffering from homozygous familial hypercholesterolemia, a severe inherited disorder that causes extremely high cholesterol levels from birth.

A Domino Effect That Multiplied Hope

This approach is known as a domino metabolic liver transplant, where one transplant creates the opportunity for another — allowing two patients to benefit from a single living donor.
In this single coordinated medical effort:
• A mother became a living liver donor
• Her child became both a recipient and a domino donor
• A second child received a life-saving liver graft
All three patients — the donor and both recipients — had smooth post-operative recoveries and were discharged safely.
According to early clinical outcomes:
• Bilirubin levels returned to normal in the Crigler–Najjar patient
• Cholesterol levels in the second child showed a dramatic early reduction, dropping from over 1000 mg/dL to below 400 mg/dL shortly after surgery

A Powerful Example of Ethical and Advanced Transplant Care

Cases like this show how advanced transplant medicine, when combined with ethical organ donation, can help more than one patient through a single act of generosity.
This approach:
• Maximizes the benefit of living donation
• Prevents wastage of viable organs
• Expands treatment options for metabolic liver disorders
• Offers new hope for children with rare genetic conditions
The success of this domino transplant shows the growing capacity of PKLI & RC to perform highly complex liver procedures and to provide care for patients with rare and challenging diseases.

A Story of Faith, Science, and Hope

From one mother’s courage, two children now have a future.
Not through coincidence — but through medical expertise, compassion, and faith.
As summarized in Prof. Dr. Saeed Akhter’s words:


“One liver saved two lives. This is history in the making.”