Guidelines & Ceiling Rates or Liver Transplant Surgery in respect of CGHS/ CS(MA) beneficiaries
I. SELECTION CRITERIA
1. Adult Liver diseases
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 µmol/1
Cause non-viral or unknown.
Arterial Ph <7.30 or all 3 criteria
Encephalopathy grade III or IV
Prothrombin time >100 sec./INR>6.5
Creatinine >300 µmol/1
Child-Pugh score ≥ 10 or
Meld Score > 14
According to American criteria based on
case to case basis
Single Tumor < 6.5 cm or
Two Tumors ≥ 4.5 cm
No Vascular invasion
No distant Metastasis
Case to case basis
2. Pediatric Liver diseases: - EHBA and Metabolic Liver Disease to be decided on case to case basis.
Systemic extra hepatic infections
Extra hepatic malignancy (if not definitely cured)
Irreversible brain damage
Irreversible multi-organ failure
Substance abuse (if not abstinent for > 6 months)
Age > 65 years
Extra hepatic disease limiting the chance of survival
Residency outside India unless emergency
II. Type of Transplant: permitted for reimbursement.
(a) Cadaveric donorIII. Centres Approved for Liver Transplantation Surgery
(b) Live donor
i. Related (Near Relatives)ii. Unrelated (Only after approval by Authorization Committee)
IV. Permission ex-post facto approval for Liver Transplantation Surgery
Addl. DG, CGFIS/DDG- (M) (as the case may he)
HOD, GI Surgery, AIIMS
HOD, Gastroenterology and Human Nutrition, AIIMS
HOD, Gastroenterology, Cr.B. Pant Hospital
HOD, GI Surgery, R&R Hospital
HOD, Gastroenterology, R86 R Hospital
Joint Director (R 86 H), CGHS/Addl. DDG(MG-II)
V. Documents required to be submitted for consideration of reimbursement / permission.
- Recommendation by Govt. Gastroenterologist / GI Surgeon by at least one surgeons doing Liver Transplant Surgery.
- CT /MRI Liver report.
- Etiology evaluation report.
- Histopathological report, wherever available
- Current Child Pugh /MELD score report
- Other relevant document.
VI. Reimbursement Criteria
(a) The package rate for Liver Transplantation surgery involving live liver donor shall be as follows:
Rs.11,50,000/- ( Rupees Eleven lakh fifty thousand only) + pre transplant evaluation of donor and recipient- Rs. 2,50,000/- (Rupees Two lakh fifty thousand only).
(b) The package rate for Liver Transplant surgery involving a deceased donor shall be :
Rs.11,00,000/- ( Rupees Eleven lakh only)
This includes, the cost of consumables during the organ retrieval and the cost of preservative solution, etc.
- 30 days stay of the recipient and 15 days for the donor starting one day prior to the transplant surgery.
- Charges for Medical and Surgical Consumables, surgical and Procedure Charges, Operation theater Charges, Anesthesia Charges, Pharmacy, Investigations and in house doctor consultation for both donor and recipient during the above period. This also includes all post operative investigations and procedures during the above mentioned period.
- Charges for drugs like Basiliximabi/Daclizumab, HBIG, and peg Interferon.
- Cross Matching charges for Blood and Blood products.
- The extra stay if any may be reimbursed after justification by the treating specialists for the reason of additional stay and only as per CGHS guidelines.
- The drugs mentioned above would be reimbursed as per CGHS rates or actual whichever is lower.