New Delhi: Last month, 35-year-old Vansh Jagga, who had lived with Type 1 diabetes for nearly two decades, underwent complex two-and-a-half-hour surgery to receive a new kidney and pancreas from the same donor, both transplanted in the same procedure.
Eighteen months ago, Jagga’s kidneys had failed. He was on dialysis three times a week, injecting insulin four times a day, and managing the constant threat of hypoglycaemia—episodes of blood sugar crashing without warning, sometimes fatally. Years of poorly controlled glucose had damaged his heart so severely that it was functioning at barely 25 per cent of its normal capacity.
Jaga is now off dialysis. His blood sugar is near normal. Insulin requirement has dropped by 90 to 95 percent.
Simultaneous Pancreas-Kidney transplant, or SPK, is what made this possible. It is considered the gold standard treatment for Type 1 diabetics who have developed kidney failure. But the procedure is extraordinarily rare in India.
“AIIMS has performed it exactly three times. First in 2004, then in 2008, and now in 2026. The gap between the second and third was 18 years,” said Dr Virinder Kumar Bansal, Professor of Surgery and Head, Surgical Unit at All India Institute of Medical Sciences (AIIMS) in New Delhi, who headed the surgical team that performed the procedure on 14 April.
“Unfortunately, in India, presently organ donation rates for cadavers (diseased donors) are very low,” he added.
Dr Asuri Krishna from the Department of Surgery at AIIMS, who was part of the operating team, explained that beyond donor availability, the process is medically complex and time-sensitive. It involves careful blood group matching, cross-matching to ensure compatibility, and an extensive pre-transplant evaluation of the recipient. “There is a detailed patient work-up and strict selection criteria before the patient is even considered suitable for the procedure,” he added.
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Understanding SPK
Type 1 diabetes is not the common, lifestyle-linked condition familiar to most Indians. It is an autoimmune disorder in which the body’s immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. It typically strikes in childhood or early adulthood, and leaves patients entirely dependent on external insulin for life because their own bodies produce none.
Over 15 to 20 years, chronically high blood sugar silently damages the kidneys. Between 30 and 40 per cent of Type 1 diabetics eventually develop end-stage renal disease—a condition in which the kidneys can no longer filter waste from the blood—and require dialysis to survive.
The intuitive solution would be a kidney transplant. But that only solves half the problem.
“If you do only a kidney transplant, the patient will continue to require insulin and this diabetes, which has not been cured, may cause the new kidney to fail again in 10 to 15 years,” said Dr Manish Malik, nephrologist at Sir Ganga Ram Hospital in New Delhi.
“In an SPK, you are giving the patient his insulin factory back—the one he lost 20 years ago,” he told ThePrint.
Dr Krishna from AIIMS explained that beyond controlling blood sugar, a pancreas transplant can halt the progression of diabetes-related complications such as retinopathy (eye damage) and neuropathy (nerve damage), even if it does not reverse them.
During the procedure, surgeons implant a donor kidney on the left side of the patient’s abdomen and a donor pancreas on the right, connecting each organ to the body’s blood supply and drainage systems. Once blood begins flowing into the new pancreas, it starts producing insulin on its own, often within hours.
Dr Krishna noted that Jagga’s blood sugar began to fall within one to two hours of the transplanted pancreas being connected, reflecting how quickly the new organ started producing insulin. He was discharged after two weeks on standard immunosuppressive medication to prevent organ rejection.
Immunosuppressive medications are essential because the body’s immune system is designed to recognise and attack anything it sees as “foreign.” A transplanted organ, even if life-saving, is identified as non-self by immune cells. Without immunosuppression, the body would mount an immune response against the new kidney and pancreas, leading to inflammation, damage, and eventual graft failure.
Among the most complex surgeries
The pancreas is, by consensus of transplant surgeons, the most technically demanding organ to transplant.
It is soft, fragile, and uniquely prone to pancreatitis — a condition in which the organ essentially begins digesting itself, which can be fatal. Even minimal mishandling during retrieval or implantation can trigger it.
“Pancreas is a very sensitive organ. If we touch it more, it goes into pancreatitis, and pancreatitis is very difficult to handle,” explained Dr Krishna. To avoid this, surgeons minimise direct contact with the pancreas during retrieval.
Preparing a kidney for transplant takes just 10 to 15 minutes, but preparing the pancreas can take nearly an hour because it is much more delicate.
“Pancreas transplant has a higher complication rate than other organ transplants,” said Dr Mohan Keshavamurthy, Principal Director, Renal Sciences, Fortis Hospitals, Bengaluru, who performed SPK surgeries in Canada 30 years ago.
He added that the organ is soft and fragile, and about 20 to 25 per cent of patients may face complications.
Jagga’s case carried additional risk, the team of AIIMS doctors explained. His severely weakened heart—functioning at just 25 percent capacity, with both the left and right ventricles compromised—meant that fluid management during surgery had to be calibrated with exceptional precision.
“If you give too much fluid, it is going to accumulate in the lungs. If you give too less, blood pressures will be low and organ perfusion will be poor,” said Dr Rahul Kumar Anand from the Department of Anaesthesiology and Critical Care at AIIMS.
Blood sugar swings between 60 and 300 had to be managed in real time. “Intraoperatively, because of surgical stress and the steroids we give for immunosuppression, sugar will move from maybe 60 to 300. One has to manage it well,” he added.
The surgery was not an AIIMS-only effort. A team of doctors from the Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh flew in to assist. The pancreas was retrieved from a 51-year-old brain-dead donor at the Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, who had suffered a brain bleed from a benign tumour and whose family had agreed to donate his organs.
“The organ was retrieved at 6.30 am, a green corridor was activated with coordination between Haryana Police and Delhi Police, and it arrived at AIIMS in under two hours, ” said Dr Krishna.
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Not by skill alone
The SPK requires a brain-dead donor. Unlike a kidney, or a segment of a liver, a pancreas cannot be donated by a living person.
Dr Krishna said that the procedure remains uncommon despite their transformative outcomes.
He added that a simultaneous pancreas-kidney transplant requires a brain-dead donor, which is already a limited pool in India. Even among these donors, not all organs are suitable. “The pancreas is particularly sensitive. It is usually not retrieved from older donors, so you need a relatively young donor for a viable transplant,” he said.
India’s deceased-donor rate stands at less than one per million population, among the lowest in the world. As of August 2025, over 63,000 individuals needed kidney transplants, and around 22,000 needed liver transplants
Only around five centres are actively doing pancreas transplants in India at present. They include PGI Chandigarh, and hospitals in Ahmedabad, Chennai, and Hyderabad. “The total number of pancreatic transplants done in India would not be more than 150 to 200. PGI has done around 35 transplants in total,” Dr Krishna said.
In Delhi, AIIMS is the only hospital licensed for pancreatic transplantation. In the United States, around 800 to 900 SPK transplants are performed every year across all centres.
The waiting list at AIIMS currently has 8 to 10 patients. Several, the doctors said, have died waiting.
Doctors explained that patients considered for this surgery are often medically fragile. “They have a long history of diabetes, and over time, multiple organs are affected. Once they reach the stage of dialysis, complications tend to increase. So even if we actively look for candidates, only a small number are fit enough to undergo a transplant,” Dr Bansal said.
The need, however, is expected to rise. AIIMS alone follows around 1,500 young patients with Type 1 diabetes. “Nearly 30 per cent of them may, over the next 15 years, progress to a stage where they need renal replacement therapy,” said Dr Krishna.
(Edited by Nardeep Singh Dahiya)
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