The primary negotiations geared towards establishing a formal liver transplant PPP occurred at a clinician level, between public sector clinicians and the incumbent politicians in the GDoH at the time.
In addition, a written agreement between WDGMC and the GDoH, which could formalise the arrangement as a PPP, was never signed when the 2008-2011 negotiations concluded.
The financial woes of the GDoH have further compounded the tenuous financial arrangement for liver transplant provision to state patients.
The GDoH took no steps to ensure the acceptability of the NGOs.
 The GDoH, however, by unashamedly failing to adhere to ethical norms and standards, abominably violated the right to dignity of these patients.
The GDoH did not take all the necessary measures to fulfil the right to life of these patients.
The entire study population had severe mental illness and had been admitted to LE under the MHCA as assisted MHCUs, according to the prevailing agreement between the GDoH and LE.
These included LE, the GDoH, the task team that supervised the relocation of patients back into a hospital environment, the Department of Home Affairs, the South African Social Security Agency and the Office of the Health Ombud.
The termination of the contract between the GDoH and LE was done in the interests of affordability and the need to re-prioritise the budget.
The GDoH proceeded with their now infamous 'marathon project' in arrogance, and in particular, with specific disregard for the opinions of individual and collective clinicians, several of whom were also employed by the GDoH.
SAMA condemned the GDoH for ignoring the concerns that had been expressed by representatives of the medical and psychiatric fraternity, and in particular, by SASOP, South African Depression and Anxiety Group (SADAG) and the South African Mental Health Federation (SAMHF).