Four years after a lung transplant, Harpreet Singh’s mornings begin with tea, gurbani, a walk and, later in the day, an hour on his bicycle. On July 12, the 51-year-old from Kapurthala drove to Amritsar airport to receive his son, flying in from Canada. He had already taken his morning walk with his wife through Sardar Udham Singh Park. The rest of the day would follow its familiar rhythm: work at his readymade garments shop in Model Town, an evening cycle ride, dinner time with his grandson and sleep. It seems an unremarkable routine. Except that four years ago, Harpreet was so ill that even walking to the toilet had become an ordeal.From asthma to a failing lungHarpreet has had asthma since childhood. He studied up to graduation, opened a wholesale readymade garments shop in Model Town and carried on working and raising his family. Then, as he puts it, “Haule haule” — slowly, slowly — his lung condition worsened.His wife, Simarjeet, remembers the progression as a succession of hospital visits that gradually exhausted every available option. “When we got married, around 25 years ago, he told me he used an asthma pump. He was fine for the most part, but the lung issue never fully went away. Then in 2016, his condition worsened. We took him to local hospitals, then the bigger hospitals in Punjab — everyone eventually gave up.”Also read | For 10 years, she couldn’t breathe without oxygen. At 65, a double lung transplant gave her second lifeFor almost a year, Harpreet was completely bed-ridden. “I used to bathe him, feed him, he was on oxygen support round the clock,” Simarjeet says.By the time he reached Medanta, his illness had progressed to bronchiectasis, a condition in which the airways are permanently damaged, causing mucus and repeated infections to build up. Progressively, his lungs could not deliver enough oxygen effectively.Harpreet had been on oxygen support for more than a year and required 10-12 litres just to maintain his oxygen saturation. His muscles had wasted away, his appetite had deteriorated and the prolonged illness had begun affecting him psychologically as well. Dr Arvind Kumar, Chairman of the Institute of Chest Surgery & Lung Transplant at Medanta Hospital, Gurugram, recalled just how dire Harpreet’s condition had become. “Transplant was the only option left,” he told The Indian Express.Challenges of an organ donorEven when a patient meets all criteria, getting a transplant is far from straightforward. According to NOTTO, India recorded 910 lung transplants between 2021 and 2025 — 394 in Telangana, 273 in Karnataka and just 26 in Delhi.Story continues below this ad“The southern states do better simply because there are more centres, more expertise, more awareness, and better organ availability there compared to the north,” Dr Kumar said. The bigger problem, however, is the shortage of suitable donor lungs. “There’s a fundamental demand-supply gap — the need runs into lakhs, while supply is only in the hundreds. Even when a donor family agrees, only around 30% of the time are the lungs actually fit for donation. The donor also has to be a confirmed brain-dead case, which makes family consent itself a major hurdle. Even then, the organ has to be medically fit for transplant,” he said.For Harpreet, the opportunity eventually came through a deceased donor at a local Delhi hospital.A race against timeOn November 17, 2022, Harpreet underwent a bilateral lung transplant at Medanta. The surgery was complicated by significant infection in his existing lungs, making their removal particularly delicate. “We had to be extremely careful while removing them, given the risk to the chest cavity. A team of 25 doctors across multiple specialities, ranging from anaesthetists and pulmonologists to general surgeons, was involved,” said Dr Kumar.There was also a strict clock running in the background. “From the time the organ became available to the completion of surgery, we had a window of about 24 hours — the lungs travelled from the local hospital to Medanta, preserved in Perfadex fluid, a solution specifically used to keep donor lungs viable during transport,” he added.Story continues below this adThe operation was over, but for Harpreet, the more painstaking part of the journey was only beginning.The first year after transplantThe first year after a lung transplant is a period of intense caution. Harpreet stayed away from people, avoided handshakes and kept his exposure to infection to a minimum. “I took precautions for a full year after the operation — no meeting people, no handshakes, nothing. After that, honestly, every single day has felt like a gift,” he says, laughing.Lung transplant recipients require significant immunosuppression because the lungs contain a particularly high number of immunogenic cells. This helps prevent rejection, but also leaves patients more vulnerable to infections and other complications. “The first year carries the highest infection risk of all. A person breathes roughly 25,000 times a day, so exposure to polluted air remains a real risk for at least that first year,” Dr Kumar said.For Harpreet, recovery also meant rebuilding a body that had been weakened by years of illness. The man who once needed help to bathe, eat and walk to the toilet gradually began moving again. Today, he takes his morning walks with Simarjeet and cycles alone in the fields.Story continues below this adLearning to live againSimarjeet, who spent years caring for a husband tethered to an oxygen machine, now fusses over what he eats instead. “I make him paneer daliya, roti-chawal, saag, chicken — whatever he feels like having. These days, I’m just spoiling him,” she says. For Harpreet, the changes are perhaps most visible in the small freedoms that have returned: going to his shop, walking with his wife, cycling by himself, eating normally and spending time with his grandson.Dr Kumar puts the average post-transplant survival at 7.6 years, while stressing that it is only an average. Some patients have survived for 20 years. The first year remains the biggest hurdle. Those who cross it have a much better chance of reaching the five-year mark. “Patients who cross that first year have a 95% chance of making it to five years,” Dr Kumar said. The five-year mark is also significant because the field itself continues to evolve. “We don’t yet know what advances medical science will bring in the years after that — a live problem is always better than a dead solution.”Harpreet, meanwhile, is less interested in statistics. “Whatever time I’ve been given is God’s gift,” he says. So he lives it better.