LAHORE: The liver transplant programme at the Shaikh Zayed Hospital, Lahore continues to face hiccup as no surgery could be performed for the last two months or so due to a lack of critical facilities.

“The hospital management is currently accommodating many departments on the newly-built second floor of the institute but it has flatly refused to shift the liver transplant centre to the same floor despite knowing the fact that it (centre) has no separate ward, operation theatre, intensive care unit, high dependency unit and even teaching staff according to the PC-I,” an official told Dawn.

Initially, the institute had given a go-ahead to shift five units on the second floor promising that it would fully facilitate them by public funds.

Surgeons reluctant to take ‘liver transplant risk’

The official said it was the only liver transplant facility among the public hospitals in Pakistan which was offering services to the patients at discounted rates – Rs3 million per operation which is 40pc less than the amount being charged in India. The Punjab government also was providing funds to the programme for free surgeries of the needy patients under a CM Secretariat scheme, he said.

He said during the last two months, four waiting-list patients including a woman had died as the procedures could not be performed due to a lack of facilities. Right from day one, he said, surgeons were being forced to conduct highly-sensitive liver transplant surgeries in the urology operating theatres.

Also read: Rot sets in’ at Shaikh Zayed Hospital

“We are not shifting the liver transplant centre because the institute is trying to accommodate the surgeons at the place where it was established,” Shaikh Zayed Hospital chairman Prof Dr Fa rrukh Iqbal told Dawn.

He said though there were a number of complaints about infections in the urology-specified operating theatres, the institute was considering some other proposals to accommodate the liver transplant centre. “The issue was also discussed during the recent visit of the health secretary,” Prof Farrukh said, adding that the immediate option was to allow them to use cardiothoracic department theatres as a stopgap arrangement.

Asked why the institute was not considering this most critical facility for the newly-established floor of the institute, Prof Iqbal said it was not possible due to some reasons. He expressed ignorance about the death of four patients during the last two months.

Also read: Long wait for surgeries: 18 liver patients on Shaikh Zayed Hospital ‘waiting list’ die

The official said surgeons were reluctant to conduct more procedures because of “imbalanced air-flow system in the urology theatres which are built for conventional turbulent ventilation.

“In laminar air flow, the entire air mass circulates in one direction and displaces the existing air in the operating area,” he said adding that some Indian surgeons had also raised the same issue during their visit to this institute last year.

The Indian surgeons had briefed their Pakistan counterparts that the operating theatre was the source of more than one quarter of all infections from hospital and recommended them to ensure negative pressure of the air in the theatre to avoid risk of infection.

The official pointed out that 20 patients were awaiting liver transplants in the list and out of them 10 needed surgery immediately. He said these patients were fully prepared for liver transplant as the donors were available.

He said the surgeons had again intimated last week to the management of the institute that urology-related procedures had been categorised as “dirty surgeries” in the medical profession due to high risk of infection particularly when they were linked to urine-related diseases.

They requested the admin to shift their centre to the second floor but it was forcing them to use the urology-specified operating theatres for the purpose.

Meanwhile, the SZH management has again kicked off its efforts to convince the Indian doctors to re-visit the institute in December. The Indian surgeons have been collaborating with their Pakistani counterparts in liver transplantation under a Memorandum of Understanding (MoU) signed on July 20, 2013, between the Surgery Centre for Liver and Biliary Sciences, New Delhi, and the Centre for Liver Disease and Liver Transplant, Shaikh Zayed Postgraduate Medical Institute, Lahore.

The official said the Indian doctors terminated this agreement in 2014 in the wake of a death of a liver-transplant patient. The patient had died due to infection during procedure. The Indian surgeons were shocked to learn that the liver transplant centre of the institute was sharing urology theatre.

They strongly recommended detaching it from the urology department and further refused to extend the MoU till the provision of other critical facilities including separate theatre, ward, ICU and HDU for the liver transplant surgeries. Since then the SZH doctors were conducting selective procedures in the highly risky environment and continued to put pressure on the management to shift the centre to the second floor.

“A team of SZH surgeons is due to visit the neighbouring country in November to convince the Indians to extend the MoU,” the official said.

Published in Dawn, November 1st, 2014