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Transfer of children and adolescents form former eastern countries for dialysis
treatment to the University Hospital of Erlangen
Mammadova D, Benz K, Galiano M, Rascher W
University Children‘s Hospital
Background:
The treatment of children with dialysis for terminal renal failure require a high medical and technical standard for care and raises also
ethical questions. Increased patient mobility result in transfer of children and adolescents from countries with lower medical standards
to those with higher standards and well developed social care systems, i.e. Germany.
The aim of the project is to study the motivation and expectations of the patients as well as the course of the disease and treatment
options in a country with high medical standard.
Comparison of dialysis and transplantation condition in Germany, Azerbaijan, Armenia and Kosovo
Methods:
During recent years we have
recognized a substantial transfer of
children and adolescents from eastern
countries to the University Hospital
of Erlangen, Germany, to seek help
for chronic dialysis treatment with
the expectation to receive a renal
transplant. These developments have
not yet been adequately addressed or
taken into account. Therefore, we
analyzed retrospectively 8 pediatric
patients.
Germany: Currently there are about 800 dialysis centers and nearly 70 000 dialysis patients. The cost of one dialysis patient is about 40 000
Euro per year. Cost of one kidney transplantation is approximately 50 000 Euros. The dialysis centers receive about 520 Euros per patient per
week for dialysis treatment. Each year about 2000-2500 kidney transplants (cadaveric and living-donor) are performed.
Azerbaycan: There are approximately 2150 patients with end stage of kidney disease, which are being treated in 27 dialysis centers.
One dialysis costs 70 Euro, one dialysis-dependent patient costs 13.000-15.000 Euros per year, while a kidney transplant costs 15.000 Euros.
Since 2 years also peritoneal dialysis is available. Each year approximately 40 kidney transplantations (only living-donor) were performed.
The youngest patient was 6 years old. Minimum income in the country is 115 Euros per month. The costs for renal transplantation and
immunosuppressive medications are not covered.
Armenia: Five dialysis centers and only one of them in Erevan is able to carry out dialysis for children. Peritoneal dialysis is not yet available.
Kidney transplantation costs 15.000 Euros and approximately 10-12 transplantations are performed each year (only living-donor). Minimum
income is 87 US-Dollars per month. Similar as in Azerbaycan the costs for renal transplantation and medications are not covered.
Kosovo: The number of dialysis patients is approximately 750 in 6 dialysis centers. The annual budget of The Ministry of Health for dialysis is
3 million Euros. Peritoneal dialysis is available. Kidney transplantation is generally not possible. Due to the lack of erythropoietin and the higher
number of blood transfusions, dialysis patients had a higher risk to suffer from hepatitis B and C infections. The costs for renal transplantation
and medications are not covered.
No. 2 came for a second opinion to
Germany and moved permanently with
the family to Germany at an age of 4
years, when dialysis was necessary.
- diagnosis: dysplastic kidney, vesicoureteral reflux V°, 12 x pyelonephritis
until 5 months of age.
- Peritoneal dialysis at age of 4 years
- renal transplantation 15 month later.
No. 1 came at the age of 11 years with
severe dialysis catheter sepsis to Germany
for living kidney donation from the
mother.
- diagnosis: urethral valves, renal
dysplasia, hepatitis C
- mother: lymph node tuberculosis, kidney
donation not possible due to medical
reasons.
- initially with his sister‘s family, later
foster family.
- renal transplantation age of 14 years.
- currently again on dialysis due to severe
chronic hepatitis C and graft failure.
No. 5 came at an age of 11 years with her
mother for medical reason to Germany;
father und 2 brothers remained in Armenia.
- diagnosis: unclassified glomerulonephritis
- hemodialysis started in Armenia 1 year
before moving to Germany
- hemodialysis in Germany for 2.5 years ,
followed by peritoneal dialysis and
prepaired for transplantation.
No. 8 fled at the age of 11 years with
her father for medical reasons to
Germany.
- mother and little brother remained in
Armenia.
- diagnosis: end stage renal disease
- dialysis started one year earlier in
Armenia.
No. 4 was found at the age of 16 years
alone in critical condition in front of the
detention center for asylum.
- mother died, father unknown
- no language skills
- diagnosis: focal segmantal glomerulosclerosis
- dialysis started 2 years later
No. 6 came with 16 years of age as
politically persecuted (or medical
reasons?) with her parents to Germany.
- diagnosis: renal dysplasia
- since 2 years dialysis.
- parents are interested in a living
kidney donation.
No. 3 came at the age of 14 years with
his father as politically persecuted to
Germany. Mother died.
- diagnosis: unclear (end stage kidney
disease).
- hemodialysis started at age of 15
years for 18 month
- kidney transplantation
No. 7 came with 16 years of age alone to
Germany because of the diagnosis renal
failure without any language skills.
- could not be integrated into a foster family,
currently living in a nursing home.
- diagnosis: unclear, renal dysplasia?
- on dialysis since 1 year
- currently: preparation for transplantation
Conclusion:
Immigration for medical reasons is an increasingly explosive political and ethical issue. The core question arise if everybody
should have the same access to the resources of a society even if the person did not contribute into the well balanced system?
This phenomenon also raises questions about the expectations of the patients and their parents and the consequences for the
health system of the residence country.