It was a testing time for young Mustafa Raza, 26, who sat on the table facing a team of liver transplant surgeons questioning him. He was in the boardroom of Apollo Hospital in Delhi that he was visiting from Lahore to donate liver to his ailing mother.

His father Ghulam Ahmed Raza, who had come along as an attendant, was asked to leave the room and let the boy rethink his decision to donate. "I was told I would have to part with 65 per cent of my liver and that I could die instantly. They asked if I was doing this due to my family’s pressure or without knowing the high risks involved," says junior Raza, who had seen his mother suffering from severe pain for over a year.

But he was determined… and he wanted to convey this to the board of doctors that felt morally bound to inform him about this highly serious affair.

The operation went well and his mother gained consciousness.

But in the following three days, she developed complications and could not survive. As the body had to be brought back home, Raza was left in Delhi and not informed about his mother’s death on doctors’ advice.

The ordeal the family had to go through is just one example and there are many other heart-wrenching accounts that one can share. It was too difficult for the family to make this journey and the attendant to look after the patient and the donor -- his wife and son, in old age. There was no support of extended family members and friends, which could have been available if the transplant had taken place in Lahore.

Besides, it is much easier to arrange for any additional amount required to treat post-operation complications if you are in your hometown.

A look into the accounts of different liver transplant patients shows that there is always a long waiting list of patients to be operated on.

Raza’s family had spent its entire savings on the patient’s preliminary treatment and diagnosis. His father had struggled hard and got a grant of Rs 3,500,000 approved from the Punjab government after it was ensured that the patient was curable and the family could not bear the cost of liver transplant. But even then the patient could not be treated in Lahore.

The question is, what led to the denial of a facility available in the country to a deserving patient facing life risk?

There are reports that 16 patients who had arranged for donors died as they could not be treated in time.

Dr Tariq Bangash, incharge of the Liver Transplant Centre (IT) at Shaikh Zayed Hospital (SKH), explains the centre, which was launched with great enthusiasm in 2011, has suffered due to the neglect shown by the government authorities and the deadlock following the passage of 18th amendment -- as the federal government took a long time to transfer SZH to the provincial government.

"Can one believe the centre does not have its own operation theatre and an Intensive Care Unit (ICU)? Whenever there is an operation I have to request professors of other departments to spare the facilities. They can extend this favour at most once or twice but not for more; their schedule gets disturbed too," he says.

But the most pressing challenge, he adds, is the required skilled manpower.

It was envisaged at the time of the launch that sufficient surgeons and doctors would be at the disposal of the department so that they could be trained - "but it did not happen. So, the operation is conducted mostly when teams come from India and the required number of transplant surgeons is trained. These reasons lead to unavoidable long waits for the patients," he adds.

The initiative of setting up the centre was taken by Dr Anwaar A. Khan, ex-chairman of SZH, who contacted Dr Bangash and Dr Aamir Latif in UK and Dr Umar Ali in China, and persuaded them to come to Pakistan and run it as local expertise was not available.

They came and took charge on nominal salary packages as compared to what they could earn abroad. The LT Centre came into limelight when it carried out first cadaver transplant in the country on August 11, 2011 and used the liver of a 16-year-old Arsalan, who died in a road accident.

Arsalan had expressed his desire to donate his organs after his death.

To date, LT Centre at SZH has carried out 34 liver transplants which are far less than the desired number. Thirty of these patients have survived whereas four died within one to four weeks due to post-operation infections. About 80 per cent of the transplants were carried out by teams of Indian surgeons.

About 70 per cent of the liver transplants were funded by the donations provided by Punjab government and a couple of cases were paid for by philanthropists. The rest were self-funded.

An average liver transplant takes 16 hours to complete and the margin of error is zero. "So, there have to be multiple teams who take turns while others take rest. Loss of concentration and fatigue can lead to negligence which can be lethal," says Dr Bangash.

He is all praise for Dr Subhash Gupta of Apollo Hospital who regularly visits the centre along with his team for liver transplants.

Dr Gupta, he says, has conducted above 1,500 transplants and comes here despite travel warnings and opposition of groups who fear loss of business to India.

However, the volume of liver transplant patients is too high to be treated in the country where there are only two such facilities -- one at SZH and other at Al Shifa Hospital, Rawalpindi which can handle limited cases.

This makes treatment in India a highly viable option for Pakistani patients, says Dr Mian Aziz-ur-Rehman who arranges free OPDs conducted by Indian transplant surgeons for patients in Pakistan. A gastroenterologist, ex-registrar at Services Hospital and a liver donor, he says, he feels strongly for patients and can relate to what they and their families go through.

According to him, hundreds of patients from all over the country converge in Lahore to attend these free OPDs under the auspices of Pak Health Care Centre. These include fresh patients who need opinion on whether to go for transplant or not as well as those with transplanted livers needing routine follow-up check-ups.

In the first OPD, patients were charged Rs5,000 per person which gradually came down and in the current year it is free. This was possible due to the financial assistance of philanthropists. There are some, he says, that have even financed diagnostic tests and complete transplants in India which cost between Pak Rs3.5 million to Rs4 million.

Dr Rehman’s clinic is always crowded by relatives of patients scavenging for medicines which are neither produced in Pakistan nor formally imported from India. These are brought into the country via Dubai, personal baggage or even smuggled. "We try to ensure the life-saving drugs are easily available to patients. Absence or shortage may cause threat to a patient’s life," says Dr Rehman while handing over a pack of medicines to a visitor who had come from Balochistan.

Dr Bangash also confirms that these medicines are brought into the country through informal channels and are not registered. The government, he says, must look into it and do the needful to facilitate patients who may suffer due to overpricing, shortage or sale of spurious drugs.

He suggests the government must launch compulsory Hepatitis C screening programmes and Hepatitis prevention and awareness initiatives to reduce the number of patients needing liver transplants. The liver shrinks and gets damaged once this disease aggravates. Besides, he calls for promotion of cadaver transplants which will end the shortage of donors.

He says seven different organs can be extracted from the body of a person declared brain-stem dead without any risk.