1. 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. 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. 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 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. 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 glomerulo- sclerosis - dialysis started 2 years 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. 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. 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 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. 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. 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, vesico- ureteral reflux V°, 12 x pyelonephritis until 5 months of age. - Peritoneal dialysis at age of 4 years - renal transplantation 15 month later. Comparison of dialysis and transplantation condition in Germany, Azerbaijan, Armenia and Kosovo 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. 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