diff --git a/hapi-fhir-jpaserver-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTask.java b/hapi-fhir-jpaserver-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTask.java
index 57aee17fe56..7e40827ffa1 100644
--- a/hapi-fhir-jpaserver-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTask.java
+++ b/hapi-fhir-jpaserver-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTask.java
@@ -23,6 +23,7 @@ package ca.uhn.fhir.jpa.migrate.taskdef;
 import ca.uhn.fhir.jpa.migrate.DriverTypeEnum;
 import ca.uhn.fhir.jpa.migrate.JdbcUtils;
 import ca.uhn.fhir.rest.server.exceptions.InternalErrorException;
+import com.google.common.annotations.VisibleForTesting;
 import org.apache.commons.lang3.Validate;
 import org.apache.commons.lang3.builder.HashCodeBuilder;
 import org.slf4j.Logger;
@@ -42,6 +43,8 @@ public class RenameColumnTask extends BaseTableTask {
 	private boolean myIsOkayIfNeitherColumnExists;
 	private boolean myDeleteTargetColumnFirstIfBothExist;
 
+	private boolean mySimulateMySQLForTest = false;
+
 	public RenameColumnTask(String theProductVersion, String theSchemaVersion) {
 		super(theProductVersion, theSchemaVersion);
 	}
@@ -84,8 +87,8 @@ public class RenameColumnTask extends BaseTableTask {
 					throw new SQLException("Can not rename " + getTableName() + "." + myOldName + " to " + myNewName + " because both columns exist and data exists in " + myNewName);
 				}
 
-				if (getDriverType().equals(DriverTypeEnum.MYSQL_5_7)) {
-					// Some DBs such as MYSQL require that foreign keys depending on the column be dropped before the column itself is dropped.
+				if (getDriverType().equals(DriverTypeEnum.MYSQL_5_7) || mySimulateMySQLForTest) {
+					// Some DBs such as MYSQL require that foreign keys depending on the column be explicitly dropped before the column itself is dropped.
 					logInfo(ourLog, "Table {} has columns {} and {} - Going to drop any foreign keys depending on column {} before renaming", getTableName(), myOldName, myNewName, myNewName);
 					Set<String> foreignKeys = JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), myNewName, getTableName());
 					if(foreignKeys != null) {
@@ -173,4 +176,9 @@ public class RenameColumnTask extends BaseTableTask {
 		theBuilder.append(myOldName);
 		theBuilder.append(myNewName);
 	}
+
+	@VisibleForTesting
+	void setSimulateMySQLForTest(boolean theSimulateMySQLForTest) {
+		mySimulateMySQLForTest = theSimulateMySQLForTest;
+	}
 }
diff --git a/hapi-fhir-jpaserver-migrate/src/test/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTaskTest.java b/hapi-fhir-jpaserver-migrate/src/test/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTaskTest.java
index f1927501f69..f4f2dddf4f4 100644
--- a/hapi-fhir-jpaserver-migrate/src/test/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTaskTest.java
+++ b/hapi-fhir-jpaserver-migrate/src/test/java/ca/uhn/fhir/jpa/migrate/taskdef/RenameColumnTaskTest.java
@@ -8,7 +8,10 @@ import java.sql.SQLException;
 import java.util.Set;
 import java.util.function.Supplier;
 
+import static org.hamcrest.Matchers.contains;
 import static org.hamcrest.Matchers.containsInAnyOrder;
+import static org.hamcrest.Matchers.empty;
+import static org.hamcrest.Matchers.hasSize;
 import static org.junit.Assert.assertEquals;
 import static org.junit.Assert.assertThat;
 import static org.junit.Assert.fail;
@@ -35,6 +38,41 @@ public class RenameColumnTaskTest extends BaseTest {
 		assertThat(JdbcUtils.getColumnNames(getConnectionProperties(), "SOMETABLE"), containsInAnyOrder("PID", "TEXTCOL"));
 	}
 
+	@Test
+	public void testForeignKeyColumnAlreadyExists_MySql() throws SQLException {
+		testForeignKeyColumnAlreadyExists(true);
+	}
+
+	private void testForeignKeyColumnAlreadyExists(boolean isMySql) throws SQLException {
+		executeSql("create table PARENT (PID bigint not null, TEXTCOL varchar(255), primary key (PID))");
+		executeSql("create table CHILD (PID bigint not null, PARENTREF bigint)");
+		executeSql("alter table CHILD add constraint FK_MOM foreign key (PARENTREF) references PARENT(PID)");
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "PARENTREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+
+		RenameColumnTask task = new RenameColumnTask("1",  "1");
+		task.setTableName("CHILD");
+		task.setOldName("myParentRef");
+		task.setNewName("PARENTREF");
+		task.setSimulateMySQLForTest(isMySql);
+		getMigrator().addTask(task);
+
+		getMigrator().migrate();
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getColumnNames(getConnectionProperties(), "CHILD"), containsInAnyOrder("PID", "PARENTREF"));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "PARENTREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+	}
+
+	@Test
+	public void testForeignKeyColumnAlreadyExists_OtherDB() throws SQLException {
+		testForeignKeyColumnAlreadyExists(false);
+	}
+
 	@Test
 	public void testBothExistDeleteTargetFirst() throws SQLException {
 		executeSql("create table SOMETABLE (PID bigint not null, TEXTCOL varchar(255), myTextCol varchar(255))");
@@ -53,6 +91,48 @@ public class RenameColumnTaskTest extends BaseTest {
 		assertThat(columnNames.toString(), columnNames, containsInAnyOrder("PID", "TEXTCOL"));
 	}
 
+	@Test
+	public void testForeignKeyColumnBothExistDeleteTargetFirst_MySql() throws SQLException {
+		testForeignKeyColumnBothExistDeleteTargetFirst(true);
+	}
+
+	private void testForeignKeyColumnBothExistDeleteTargetFirst(boolean isMySql) throws SQLException {
+		executeSql("create table PARENT (PARENTID bigint not null, TEXTCOL varchar(255), primary key (PARENTID))");
+		executeSql("create table RELATION (RELATIONID bigint not null, TEXTCOL varchar(255), primary key (RELATIONID))");
+		executeSql("create table CHILD (PID bigint not null, PARENTREF bigint, NOKREF bigint)");
+		executeSql("alter table CHILD add constraint FK_MOM foreign key (PARENTREF) references PARENT(PARENTID)");
+		executeSql("alter table CHILD add constraint FK_NOK foreign key (NOKREF) references RELATION(RELATIONID)");
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "RELATION", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "PARENTREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "NOKREF", "CHILD"), containsInAnyOrder("FK_NOK"));
+
+		RenameColumnTask task = new RenameColumnTask("1",  "1");
+		task.setTableName("CHILD");
+		task.setOldName("PARENTREF");
+		task.setNewName("NOKREF");
+		task.setDeleteTargetColumnFirstIfBothExist(true);
+		task.setSimulateMySQLForTest(isMySql);
+		getMigrator().addTask(task);
+
+		getMigrator().migrate();
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "RELATION", "CHILD"), empty());
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getColumnNames(getConnectionProperties(), "CHILD"), containsInAnyOrder("PID", "NOKREF"));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "NOKREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+
+	}
+
+	@Test
+	public void testForeignKeyColumnBothExistDeleteTargetFirst_OtherDB() throws SQLException {
+		testForeignKeyColumnBothExistDeleteTargetFirst(false);
+	}
+
 	@Test
 	public void testBothExistDeleteTargetFirstDataExistsInSourceAndTarget() throws SQLException {
 		executeSql("create table SOMETABLE (PID bigint not null, TEXTCOL varchar(255), myTextCol varchar(255))");
@@ -91,6 +171,42 @@ public class RenameColumnTaskTest extends BaseTest {
 		assertThat(JdbcUtils.getColumnNames(getConnectionProperties(), "SOMETABLE"), containsInAnyOrder("PID", "TEXTCOL"));
 	}
 
+	@Test
+	public void testForeignKeyColumnDoesntAlreadyExist_MySql() throws SQLException {
+		testForeignKeyColumnDoesntAlreadyExist(true);
+	}
+
+	private void testForeignKeyColumnDoesntAlreadyExist(boolean isMySql) throws SQLException {
+		executeSql("create table PARENT (PARENTID bigint not null, TEXTCOL varchar(255), primary key (PARENTID))");
+		executeSql("create table CHILD (PID bigint not null, PARENTREF bigint)");
+		executeSql("alter table CHILD add constraint FK_MOM foreign key (PARENTREF) references PARENT(PARENTID)");
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "PARENTREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+
+		RenameColumnTask task = new RenameColumnTask("1",  "1");
+		task.setTableName("CHILD");
+		task.setOldName("PARENTREF");
+		task.setNewName("MOMREF");
+		task.setSimulateMySQLForTest(isMySql);
+		getMigrator().addTask(task);
+
+		getMigrator().migrate();
+
+		assertThat(JdbcUtils.getForeignKeys(getConnectionProperties(), "PARENT", "CHILD"), hasSize(1));
+
+		assertThat(JdbcUtils.getColumnNames(getConnectionProperties(), "CHILD"), containsInAnyOrder("PID", "MOMREF"));
+
+		assertThat(JdbcUtils.getForeignKeysForColumn(getConnectionProperties(), "MOMREF", "CHILD"), containsInAnyOrder("FK_MOM"));
+
+	}
+
+	@Test
+	public void testForeignKeyColumnDoesntAlreadyExist_OtherDB() throws SQLException {
+		testForeignKeyColumnDoesntAlreadyExist(false);
+	}
+
 	@Test
 	public void testNeitherColumnExists() {
 		executeSql("create table SOMETABLE (PID bigint not null)");