Referral for Transplant cases — standard instructions in HMIS based digital referral protocol: Railway board dated 12.11.2025
GOVERNMENT OF INDIA
MINISTRY OF RAILWAYS
RAILWAY BOARD
No.2022/H/8/HMIS/Pt-committee
New Delhi, Date:12.11.2025
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:
- Specialty: (to be picked from drop down menu in HMIS e.g., kidney/liver/lungs etc.)
- Referred procedure/treatment: “Transplant with workup” (drop down menu in HMIS)
- Referring doctor’s remarks: (clinical remarks to be recorded).
- 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
(Dr. Ashutosh Garg)
Director/Health (Policy & Projects)
Railway Board
Tele: 011-47843134 / email:dirhpp[@]rb.railnet.gov.in
Copy as per list enclosed:
Copy to:
No.2022/H/8/HMIS/Pt-committee
New Delhi, Date:12.11.2025
Copy for information to:
- The Director General, National Academy of Indian Railways, Vadodara.
- The Director General, Indian Railway Institute of Civil Engineering, Pune.
- The Director General, Indian Railway Institute of Mechanical and Electrical Engineering, Jamalpur.
- The Director General, Indian Railway Institute of Signal Engineering and Telecommunications, Secunderabad.
- The Director General, Indian Railway Institute of Electrical Engineering, Nasik.
- The Director General, Indian Railway Institute of Transport Management, Lucknow.
- The Executive Director, Indian Railways Centre for Advanced Maintenance Technology, Gwalior.
- The Registrar, Railway Claims Tribunal, Delhi.
- The Chief Commissioner of Railway Safety, Lucknow.
- The Secretary, Railway Rates Tribunal, Chennai.
- The Chairman. Railway Recruitment Board, Ahmedabad. Ajmer, Allahabad, Bangalore, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Gorakhpur. Guwahati, Jammu & Srinagar, Kolkata, Malda, Mumbai, Muzaffarpur, Patna, Ranchi, Secunderabad and Trivendrum.
- The Genl. Secy., AIRF, Room No. 253, & NFIR Room No. 256-C, Rail Bhavan
- The Secy. Genl., IRPOF, Room No. 268. FROA, Room No. 256-A & AIRPFA, Room No. 256-D Rail Bhavan
(Dr. Ashutosh Garg)
Director/Health (Policy & Projects)
Railway Board
Tele: 01 1-47843134 / email: dirhpp[@]rb.railnet.gov.in
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