A 27-year-old Pakistani physician, Dr. Maryam Shoukat, died just about 30 minutes on September 28th, before she was scheduled to receive a liver transplant at Rutgers University Hospital in Newark, United States. Her passing follows a rapid deterioration of liver function while awaiting the procedure.
Dr. Shoukat had been admitted with severe hepatic failure and had been placed on the transplant list. She developed Tylenol toxicity, which led to Acute Fulminant Liver Failure and Acute Respiratory Failure. She was in the ICU on a ventilator, fighting for her life, and urgently needed a Liver Transplant to survive.
She had passed USMLE Steps 1, 2 and 3 with excellent scores, and recently came to USA for a clinical observer-ship in New Jersey as an applicant for this year’s residency match. As a visitor without a Social Security number, she did not qualify for medical insurance or government assistance. However, all the international medical fraternity came forward to help her with donations and raising funds for her life saving liver transplant surgery.
Her husband, Dr. Hamza Zafar, appealed for financial help through APPNA (Association of Physicians of Pakistani Descent of North America). The community responded rapidly, raising USD 273,000 in a single day, and eventually close to USD 400,000.
Initially, the hospital had quoted a cost of around USD 900,000 for the transplant, but after community efforts and negotiations, the estimate was reduced to USD 450,000. APPNA deposited USD 100,000 upfront, which allowed Dr. Shoukat’s name to be officially placed on the transplant waiting list.
A matching donor liver was identified, and surgery was scheduled. However, before the procedure could begin, Dr. Shoukat suffered brain herniation, slipped into a coma, and was placed on life support. She was later declared unable to recover and died minutes before the transplant.
Acute liver failure (ALF) is a medical emergency characterized by a rapid decline in liver function in individuals without previously known chronic liver disease. Key features include:
Coagulopathy: Impaired blood clotting function.
Hepatic encephalopathy: Altered mental status or confusion due to toxin buildup.
Onset within a limited time frame: Typically under 26 weeks from the initial liver injury.
Lack of prior liver disease is what distinguishes it from chronic or chronic-on-acute liver failure.
ALF’s onset is often abrupt, and patients may progress rapidly to multiorgan dysfunction, cerebral edema, and death if not managed promptly.
ALF can arise from a variety of causes, which differ regionally.
In India specifically, ALF has been documented to frequently stem from viral hepatitis or drug-induced causes (e.g., antitubercular drugs) more than in Western countries.
When ALF is suspected, patients generally require intensive care and aggressive supportive treatment. This may include:
Monitoring and managing intracranial pressure
Controlling infections and preventing sepsis
Supporting kidney function (renal replacement therapy, if needed)
Plasma exchange or other liver support modalities in select centers
Early evaluation for liver transplantation, often the only definitive therapy in many severe cases.
Prognostic scoring systems help identify which patients may deteriorate without a transplant, but predicting who will recover spontaneously remains challenging.
Studies in medical literature show that patients with ALF can deteriorate within hours to days, with cerebral edema and brain herniation being major causes of death. Even when a donor is available, delays between listing and surgery significantly increase the risk of fatal outcomes.
(Rh/Eth/TL/MSM)