Shadab was battling IgA nephropathy and peripheral neuropathy, a neurological complication associated with advanced kidney disease. Joginder had undergone a previous transplant that had failed, and doctors said his heart function was critically low. Vinod had a history of coronary artery disease and had undergone bypass surgery before his kidneys deteriorated.

Although all three had relatives willing to donate, none was compatible with their own patient. According to hospital officials, that changed when the families agreed to participate in a paired kidney exchange.

Under the arrangement, Shadab’s wife, 30-year-old Simran Parveen, donated her kidney to Joginder. Joginder’s sister, 41-year-old Suman, donated to Vinod. Vinod’s wife, 51-year-old Poonam Devi, donated to Shadab.

Dr Anant Kumar, chairman of urology, renal transplant and robotics at Max Saket, who led the transplant team, said the case was “a moving example of unity and empathy”.

“Families who had never met before placed complete trust in one another, defying religious and regional divides to give the ultimate gift of life,” he said.

For him, the challenge was not only surgical but emotional. “Coordinating six simultaneous transplants, including patients with cardiac and neurological complications, was a major challenge, but the collaboration between the families and the hospital teams made it a success,” Kumar said.

Dr Dinesh Khullar, group chairman of nephrology and renal transplant medicine at the hospital, said paired kidney exchanges are becoming increasingly necessary.

“Kidney transplants in India largely depend on living related donors, but this pool is shrinking as nuclear families become the norm. Often, a willing donor cannot donate because of a blood group mismatch or immune sensitisation from previous transplants, transfusions or pregnancies. In such cases, a paired or swap transplant becomes the way forward,” he said.

Khullar said advanced software helped the team identify the cross-matches needed to carry out all three surgeries on the same day.