Referral for Transplant cases standard instructions in HMIS based digital referral protocol

 सरकार GOVERNMENT OF INDIA

रेल मंत्रालय MINISTRY OF RAILWAYS

रेलवे बोर्ड RAILWAY 

New Delhi, Date: 12.11.2025

No.2022/H/8/HMIS/Pt-committee

The General Managers
PCMD, PCPO

All PHODS

All Indian Railways

Subject: Referral for Transplant cases standard instructions in HMIS based digital referral protocol

An instance regarding referral for a transplant case given by a Railway Hospital was found to have been issued mentioning "Referred procedure/ treatment:. ..workup..." and "Type of Service: treatment /procedure (outdoor) (approved session: 1 no.)". The ambiguity /incongruity caused considerable confusion and inconvenience to the patient and the empanelled hospital.

2. Transplant cases, being highly complex, constitute a unique category of referrals. Unlike other referrals, all transplant cases essentially undergo four broad steps/processes viz. Workup tests Medico-legal/NOTTO compliance Transplant procedure Follow-up. Workup tests are a complex battery of tests on the patient/donor spread over several sessions over a period of time. The transplant procedure is dependent on and decided based on the workup tests. Hence, the locus of workup or transplant procedure cannot be at different empanelled HCOs and must necessarily be covered under a single comprehensive referral.

3. In order to preclude repeat of such instances or error in issuing such referrals, the following has been incorporated as standard/dropdown auto-select menu in the HMIS referral /doctors' desk (from where digital. referral is generated in HMIS) and should be ensured/ rechecked in all transplant referral cases:

L Specialty: (to be picked from drop down menu in HMIS e.g., kidney/liver/lungs etc.)

IL Referred procedure/treatment: "Transplant with workup" (drop down menu in HMIS)

iii. Referring doctor's remarks: (clinical remarks to be recorded).

iv. Type of service:(auto select in HMIS, if referred procedure/treatment is as per ii. above) -"OPD/IPD for comprehensive treatment including follow up". [note: Kidney transplant cases would be inclusive of the dialysis required during the entire treatment period.)

Footnote in all transplant cases: Applicable CGHS package and due compliance with medico-legal /NOTTO requirements to be ensured by the empanelled HCO. Dialysis for kidney transplant cases may be billed separately as per CGHS rates (if not a part of the transplant package rate) or the patient may claim reimbursement for such dialysis.

This issues with the approval of DG(RHS).

Kindly acknowledge receipt and ensure compliance.

(Pranav Kumar Mallick)

Executive Director (Transformation)

Railway Board

email: pranav.mallick@nic.in