Boy Meets Two-Time Living Donor Who Helped Save Him: “Organ Donors Are Heroes”

Ask anyone who knows Ahmad Rai, and they’ll mention his contagious smile and optimistic attitude. Looking at him now, you wouldn’t know the 11 year old has gone through multiple major surgeries, including a recent life-saving liver transplant.

“No matter what he’s feeling or going through, he always has a smile on his face,” says Ahmad’s mom, Aya Akkad. “Everyone who meets Ahmad describes him as the happiest kid.”

Aya says the selfless gift of organ donation is the reason Ahmad is thriving today. His most recent surgery was made possible because of 42-year-old Nathan Howe. Nathan is a pastor from Kent, Ohio, who decided to become an anonymous living liver donor after previously giving a kidney to his father.

According to the United Network for Organ Sharing (UNOS), Nathan is one of approximately 241 people in the United States who has donated more than one organ, to two different people, in the past 30 years.

“I think it's important we support one another in whatever ways we can. Whether it’s giving time, money or even an organ – all donations are incredibly life-giving for both the donor and the recipient,” says Nathan, who adds the process with his first kidney donation went so well with Alvin Wee, MD, the Surgical Director of Cleveland Clinic’s Kidney Transplant Program, he felt comfortable making the decision to donate again.

Ahmad has a rare genetic disease called progressive familial intrahepatic cholestasis type 2 (PFIC2). The condition affects how the liver processes bile – a fluid that helps with digestion – causing it to build up in the liver, which can damage it.

“After some time, medications weren’t enough to keep his condition stable. With his liver deteriorating, his doctors told us he needed a transplant,” says Aya, who explains they were traveling back and forth from Dubai, where they primarily live, to Cleveland Clinic’s main campus in Cleveland, Ohio, where he was diagnosed with the condition.

In 2016, Ahmad received his first liver transplant at Cleveland Clinic from a living donor named Becky Cable. Most organs for transplants come from deceased donors, but the liver is the only organ that can regenerate itself and grow from a small piece back to its full size. That means a living donor can give a portion of their liver to someone in need.

“For the living donor, the liver grows back to its original size within one year. The body can tell when there’s a lack of liver cells and begins replicating them,” says Choon Hyuck David Kwon, MD, PhD, the Director of Minimally Invasive Liver Surgery in Cleveland Clinic's Digestive Disease Institute.

“On the recipient side, we transplant a small piece of liver from the donor to the child, and then it’s able to grow along with them,” says Koji Hashimoto, MD, PhD, the Director of Liver Transplantation at Cleveland Clinic. “There are many people waiting for a transplant, and living liver donors give us another option to do the transplantation before the child gets too sick.”

After Ahmad recovered from his 2016 transplant, he was able to return to Dubai with his family. He was making progress and doing well overall but was experiencing an ongoing bile duct drainage issue. Ahmad and his family came back to Cleveland Clinic main campus as complications from this issue became more severe.

“We tried to put drains in the liver and do other surgical interventions to fix this, but his liver was not improving and started failing again. It was ultimately decided he would need a second liver transplant,” says Cleveland Clinic Children’s pediatric gastroenterologist and hepatologist Kadakkal Radhakrishnan, MD.

Around the time Ahmad was on the transplant waiting list, Nathan was going through his assessment at Cleveland Clinic to make sure it was safe for him to become a dual-organ donor.

“2020 is when I donated a kidney to my dad, and that’s what really raised my awareness of living organ donation. After that experience, I reached out to Cleveland Clinic again about liver donation,” says Nathan.

After his care team determined it was safe for him to donate, Nathan was able to undergo the procedure laparoscopically, or minimally invasive. Cleveland Clinic is one of the few transplant centers in the United States using this approach. In 2024, at Cleveland Clinic’s main campus, all living-donor surgeries for liver transplant were performed laparoscopically. Dr. Kwon says there are a number of benefits to the donor, including less time in the hospital.

“When comparing laparoscopic to traditional surgery, the recovery time is cut down by about half. This is especially important for our donors who have to get back to work and other obligations,” says Dr. Kwon.

Nathan adds, “Everything went smoothly, and I was really grateful to have a laparoscopic surgery. I’m thankful to the health professionals who provide this care and offer this opportunity to give to someone else.”

Although Nathan didn’t know who he was donating to at the time, the portion of his liver was a match for Ahmad, and in July 2024, he underwent his transplant surgery at Cleveland Clinic.

“After Ahmad’s transplant, he did really well. So far, there have been no signs of complications, and the new liver is functioning normally,” says Dr. Hashimoto.

Ahmad is now back in school, enjoying his favorite subjects: English and science. In his free time, he likes playing soccer and video games as well as spending time with his sister, Rebecca.

“I’ve known him since he was a baby, and it's been great to see the progress he’s made. He’s a very smart kid, and he hasn’t let any of these life events limit him in any way,” says Dr. Radhakrishnan.

As he continues making progress and following up with his doctors, both Ahmad and Aya say they’re thankful to the care team who has helped get him to this point.

“Cleveland Clinic wasn’t just a hospital for us – it felt like a second home. Everybody there gave us what we needed at that time: emotions, feeling, support, everything,” says Aya.

Ahmad adds, “They didn’t just talk to us like doctors – they treated us like family and were really kind.”

Along with the care team, Ahmad and Aya say the organ donors are a crucial part of this success story. Ahmad and his family were able to meet Nathan by working with their transplant coordinator.

Surrounded by family and friends, shortly after Ahmad met Nathan, he told him, “When my mom got the call there was a donor I started jumping, and I hugged my dad.”

Ahmad and Nathan talked about Ahmad’s love for soccer, their journeys to transplant and a shared sense of hope they’ve given to each other.

“I’m very grateful to Becky and Nathan, and I wouldn't be where I’m at today without them,” says Ahmad.

Aya adds, “Ahmad’s donors not only saved his life, but they saved mine as well because Ahmad is my life. No words can explain how thankful I am to them. What happened is a miracle, and they gave Ahmad another chance at life. Organ donors are heroes.”