HMIS Guidelines for Transplant Referrals: New Standard Instructions Issued by Railway Board
The Ministry of Railways has introduced clearer and more streamlined guidelines in HMIS for handling transplant-related referrals across all Railway Hospitals. These instructions were released through an official circular dated 12 November 2025 to ensure that transplant cases—being complex and multi-stage in nature—are processed without ambiguity, confusion, or inconvenience to patients or empanelled hospitals.
Why These New HMIS Instructions Were Needed
A recent incident highlighted gaps in how transplant referrals were being generated in HMIS. A referral mentioned “workup” under procedure and selected the service type as “treatment/procedure (outdoor)”, which created confusion for both the patient and the empanelled hospital.
Transplant cases involve multiple stages, and any inconsistency in referral entry can disrupt patient management. Hence, the Railway Board has now standardized the entire digital referral process.
Four Essential Stages of All Transplant Cases
Every transplant case, whether kidney, liver, lungs, or any other organ, goes through four broad steps:
- Workup tests – A detailed and multi-session clinical evaluation of both patient and donor.
- Medico-legal & NOTTO compliance – Mandatory regulatory processes.
- The transplant procedure – The core surgical intervention.
- Follow-up care – Post-transplant management over time.
To avoid fragmentation, all these stages must fall under a single comprehensive referral in HMIS.
New Standard Instructions Added to HMIS for Transplant Referrals
To eliminate mistakes, HMIS now includes predefined, auto-select options for doctors while creating a transplant referral. These must be strictly followed for every transplant case.
1. Specialty
Select the relevant specialty from the HMIS dropdown menu (e.g., kidney, liver, lungs).
2. Referred Procedure/Treatment
Select: “Transplant with workup” (newly added dropdown option).
3. Referring Doctor’s Clinical Remarks
Doctors must record clear clinical remarks supporting the need for transplant.
4. Type of Service
Auto-selected by HMIS when the treatment type is chosen as above:
“OPD/IPD for comprehensive treatment including follow-up”
- For kidney transplants, this includes all required dialysis sessions throughout the treatment period.
5. Mandatory Footnote for All Transplant Cases
- Applicable CGHS package must be followed.
- Empanelled HCO must ensure complete medico-legal and NOTTO compliance.
- Dialysis for kidney transplant cases may be billed separately as per CGHS rates if not covered within the package, or patients may claim reimbursement.
Purpose of the Updated HMIS Protocol
These standardized instructions aim to:
- Ensure accuracy in referrals
- Reduce confusion for both patients and hospitals
- Maintain consistency across all Indian Railways healthcare units
- Improve coordination between Railway Hospitals and empanelled HCOs
- Strengthen compliance with national transplant regulations
The directive has been issued with the approval of DG(RHS), and all Railway medical units are required to acknowledge and implement it immediately.