Germany debates opt-out organ donation system to increase transplants

Germany's parliament has reignited a long-running debate over organ donation, with lawmakers considering a shift to an opt-out system amid persistent shortages of donor organs and growing waiting lists.

The proposal, debated in the Bundestag on Thursday (June25), would automatically classify all citizens as potential organ donors unless they have explicitly registered their objection, Caliber.Az reports via German media.

The move would align Germany with several European countries that already operate under a presumed-consent model.

The issue was last debated in 2020, when lawmakers rejected an opt-out system despite support from the Health Ministry. Instead, parliament adopted a compromise requiring citizens to be asked about organ donation when renewing national identity cards.

Six years later, a cross-party group of lawmakers is pushing for a fresh vote, arguing that previous measures have failed to significantly increase donor numbers.

During Thursday's debate, many parliamentarians spoke in favour of the proposed change. Gitta Connemann, a member of the conservative Christian Democratic Union (CDU), acknowledged efforts already made to encourage organ donation but said they had fallen short.

"We strengthened hospitals, we supported transplantation ambassadors, we have intensified education efforts, we started campaigns, we created an online register," she said. "But there is still a gap: More than 85% of the people in this country are positive about organ donation, but only 45% have actually documented their preference."

Opponents argue that presumed consent could undermine individual rights. Christina Baum of the far-right Alternative for Germany (AfD) said the current system should remain in place because citizens must actively agree to donate their organs.

She argued that the basic right to physical integrity "goes beyond death." "From that, we can only derive maintaining the current rule: The active consent to organ donation," she told parliament. She also warned that changing the law could encourage international illegal organ trafficking.

Germany remains one of the few European countries without an opt-out framework. Nations including France, Italy, Austria, Spain, the Netherlands, Belgium, Poland and Portugal have all adopted some form of presumed consent.

The shortage of donor organs remains acute. According to the German Organ Procurement Organisation (DSO), 633 people died in Germany in 2025 while waiting for a transplant. More than 8,200 patients are currently awaiting a life-saving organ, with kidney recipients facing average waiting times of around eight years.

Campaigners say the current system has failed to deliver meaningful progress. Angela Ipach, co-founder of the initiative Opt.Ink, said the compromise introduced in 2020 had made little difference.

"Six years have passed since the last vote in the Bundestag, and the numbers haven't changed at all," she told DW. "Many people have died. In what other area is it possible for nothing to happen for six years? Anyone who opposes the presumed consent system must now propose an effective solution."

Ipach's organisation promotes organ donation through a distinctive tattoo symbol, which resembles the letters "O" and "D." Around 30,000 people have reportedly received the tattoo since the campaign began.

The issue is also deeply personal for Ipach, whose sister died at the age of 30 after waiting four years for a donor lung.

Medical professionals have also voiced support for reform. Frank Logemann, a transplant coordinator at Hannover Medical School, said families are often approached at extremely difficult moments, making decisions about organ donation more challenging.

"The most important thing is to reach out to the family early enough in their grieving process and determine whether the critically ill person would have wanted to be an organ donor," he told DW. "If brain death has been confirmed and you only start addressing this then, it's definitely too late.”

By Aghakazim Guliyev