Coverage by the mandatory health insurance of a liver transplantation from a living donor

Facts

On December 4, 2001, [C.], born in 1957, underwent a liver transplant from a living donor, in this case her sister J., born in 1959. The procedure was performed at the University Hospitals of Geneva (HUG). By decision of July 8, 2003, confirmed on October 14, 2003, the insurer Concordia refused to cover the costs related to this transplantation and the post-operative treatments. The Cantonal Social Insurance Court of the Canton of Geneva dismissed C.'s appeal against this decision.

[C.] filed an administrative law appeal with the Federal Insurance Court, concluding to the annulment of the cantonal decision and the coverage of the costs by the mandatory health insurance.

Considerations

The Federal Court considers that the liver transplantation from a living donor constitutes an effective, appropriate and economical measure within the meaning of Art. 32 para. 1 KVG. Although the Federal Council or the Federal Department of the Interior have not yet designated the authorized centers to perform this type of procedure, the Court considers that the absence of such a decision does not prevent the coverage of the costs by the mandatory health insurance, since the intervention was carried out in an establishment offering all the…