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SG Berlin: Health insurance only pays if you are “personally connected”
Statutory health insurance companies only pay for living organ donation abroad in the EU if the requirements applicable in Germany are met. This was decided by the Berlin Social Court (SG) in a judgment announced on Wednesday, April 17, 2019 (file number: S 76 KR 1425/17). It rejected a kidney-sick man because the “personal connection” between donor and recipient required by the transplant law was missing.
The man has suffered from kidney failure for many years and has been on dialysis since late 2013. He is on the Eurotransplant waiting list, but has not yet received a kidney from there.
The husband's wife is not considered a donor of a kidney for health reasons. His sister originally agreed to donate, but then withdrew it.
The kidney-sick man has long been involved in an association that supports projects in Sierra Leone. There he had met a man from Sierra Leone who had been living in Germany for 20 years. The doctor was willing to donate a kidney, but was out of the question for medical reasons. But he told his family in Sierra Leone about the matter. After several "family reunions", a brother in Sierra Leone agreed to donate a kidney to life.
Hospitals in Berlin and Halle requested by the kidney patient refused the operation. The requirements of the Transplantation Act for living organ donation were not met. A clinic in Rotterdam wanted to carry out the operation. In December 2016, the man informed his health insurer and asked for a cost commitment. The cash register refused.
Rightly so, as the SG Berlin decided. The operation was not permitted in Germany. Therefore, it should not be carried out abroad at the expense of statutory health insurance. In certain cases, insured persons are entitled to procure benefits outside of the EU. The same conditions would then apply for this.
The prerequisites for a live donation kidney transplant are not given here, because the donor and the plaintiff are not "obviously closely related". So there was initially no contact at all, rather the initiative came from the donor's brother. The donor had declared his willingness at a time when he did not know the kidney-affected Germans personally, but only via internet chats and telephone.
The SG finally emphasized in its judgment of March 12, 2019 that the prerequisite of the Transplantation Act, according to which donors and recipients have to be personally related to a living organ donation, is "close to constitutional concerns".
END mwo / fle