CGHS – CS(MA) – Guidelines, Ceiling Rates for Liver Transplant surgery
CGHS – CS(MA) – Guidelines, Ceiling Rates for Liver Transplant Surgery in respect of CGHS / CS(MA) beneficiaries
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Dated the 16th January, 2013
OFFICE MEMORANDUM
With reference to the above mentioned matter the undersigned is directed to state that the Ministry of Health and Family Welfare has been receiving requests from the Central Government employees and pensioners covered under CGHS / CS(MA) Rules, 1944 seeking approvals for Liver Transplantation surgery in respect of themselves and their eligible family members under CGHS / CS(MA) Rules. The Ministry has been examining these proposals on case to case basis for allowing the medical treatment to the beneficiaries on merits. In view of the increasing number of cases, the matter has been reviewed by this Ministry and it has now been decided to issue guidelines and ceiling rates for permission / reimbursement for Liver Transplant Surgery in respect of CGHS / CS (MA) beneficiaries as per the details mentioned below: –
I. SELECTION CRITERIA
A. INDICATIONS
1. Adult Liver diseases
Acute liver failure | Non-Paracetamol (Viral, drug, induced, Wilson’s, Autoimmune hepatitis etc.) | Prothrombin time >100 sec or 3 of 5: Interval jaundice-encephalopathy > 7 days Age < 10 or > 40 Years Prothrombin time > 50 sec. / INR > 3.5 Bilirubin > 30 umol/1 Cause non-viral or unknown. |
Paracetamol induced | Arterial Ph <7.30 or all 3 criteria Encephalopathy grade III or IV Prothrombin time >100 sec./INR > 6.5 Creatinine >300 umol/I |
|
Chronic Liver disease | Cirrhosis (Non- Cholestatic) | Child-Pugh score >or equal 10 or Meld Score > 14 |
Cholestatic with or without Cirrhosis | According to American criteria based on MELD scoring | |
Miscellaneous | case to case basis | |
Liver Tumors | Heptocellular Carcinoma |
Single Tumor <6.5 cm or Two Tumors < or equal 4.5 cm No Vascular invasion No distant Metastasis |
Other types | Case to case basis |
2. Pediatric Liver diseases: – EHBA and Metabolic Liver Disease to be decided on case to case basis.
B. CONTRAINDICATIONS
Absolute | Systemic extra hepatic infections Extra hepatic malignancy (if not definitely cured) Irreversible brain damage Irreversible multi-organ failure Substance abusc ( if not abstinent for > 6 months) |
Relative | HIV seropositivity Age > 65 years Mental incapacity Extra hepatic disease limiting the chance of survival Residency outside India (unless emergency) |
Liver Transplant Surgery shall be allowed only in Government Hospitals/ Pvt. Hospitals, which are registered under the Transplantation of Human Organs Act, 1994, as amended from time to time.
The Liver Transplant Surgery will be permitted / reimbursed only after the request has been approved and recommended by a Standing Committee, comprising of the following:
1. | Addi. DG, CGHS/DDG (M) (as the case may be) | Chairman |
2 | HOD, GI Surgery, AIIMS | Member |
3. | HOD, Gastroenterology and Human Nutrition, | Member AIIMS |
4. | HOD, Gastroenterology, G.B. Pant Hospital | Member |
5 | HOD, GI Surgery, R&R Hospital | Member |
6. | HOD, Gastroenterology, R&R Hospital | Member |
7. | Joint Director (R & H), CGHS/Addl. DDG(MG-l1) | Member Secy. |
The above Standing Committee shall consider the cases in respect of CGHS as well as CS (MA) beneficiaries.
[V.P. Singh]
Deputy Secretary to the Government of India
Download Office Memorandum F.No.S-14025/3/2010-MS/CGHS (P) dated 16.01.2013