The lawsuit was filed by a 66-year-old man from Emsland who suffers from advanced kidney failure and has been on regular dialysis since 2020. At the end of 2018, he applied to his statutory health insurance company for approval for a kidney transplant in the Netherlands. The waiting times for a donor organ are significantly shorter there than in Germany. However, the health insurance company rejected the application and pointed out that equivalent care was also possible in German transplant centers.
Despite the rejection, the man had the transplant carried out in Groningen in January 2022 and then demanded reimbursement of the treatment costs amounting to around 42,000 euros. While the Osnabrück Social Court ruled in favor of the plaintiff in the first instance, the LSG overturned this decision on appeal.
According to the court, there is no entitlement to reimbursement of costs for treatment abroad if equivalent medical care is generally available in the country. The mere fact that the waiting time in Germany is two to four years longer does not constitute a supply deficit. This time can be bridged with further dialysis treatments. According to the judges, there was no particular medical urgency in this specific case.
The court also emphasized the importance of equal opportunities when allocating donor organs. Access to a transplant should not depend on place of residence or proximity to foreign transplant centers. The appeal against the judgment with the file number L 16 KR 452/23 was not permitted.
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