Pakistani Doctor Dies Just 30 Minutes Before Liver Transplant — A Tragic Reminder of Transplant Waiting Risks

A 27-year-old Pakistani physician, Dr. Maryam Shoukat, died just about 30 minutes 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.

Background of the Case

Dr. Shoukat had been admitted with severe hepatic failure and had been placed on the transplant list. She was working in the U.S. as a medical resident when she developed acute liver failure, which progressed swiftly. Supporters and the medical community rallied to raise funds about USD 400,000 from APPNA (Association of Physicians of Pakistani Descent of North America) to cover transplant expenses.

Her husband, Dr. Hamza Zafar, appealed for financial help through APPNA. 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.

What Is Acute Liver Failure?

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.

Common Causes of Acute Liver Failure

ALF can arise from a variety of causes, which differ regionally and by patient demographics:

• Drug-induced liver injury (DILI): Overdose of acetaminophen (paracetamol) is a leading cause in many Western settings.

• Viral hepatitis: Particularly hepatitis B (new infection or reactivation) remains a major cause in many countries. Less commonly, hepatitis A or E can precipitate ALF.

• Idiosyncratic drug reactions & toxins: Some pharmaceutical agents (e.g., anti-tuberculosis drugs, anticonvulsants) and certain herbs or toxins may cause unpredictable severe injury.

• Ischemic injury / shock: Conditions causing extremely low blood flow or oxygen delivery to the liver may trigger hepatic necrosis that leads to ALF.

• Autoimmune hepatitis, Wilson disease, or metabolic conditions: These are rarer causes but recognized in certain contexts.

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.

Clinical Course and Treatment

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)