About halfway through a marathon session on Thursday, the Bundestag, the lower house of Germany’s parliament, reignited a debate that had stopped six years ago: whether Germany should bring itself in line with several other European countries and make organ donation an “opt-out” rather than an “opt-in” option.
Despite pressure from the health ministry, Germany’s lawmakers rejected the so-called “presumed consent” system in 2020, and opted for a compromise where people would be asked when renewing their national ID card if they would like to be an organ donor.
Now, a cross-party group of lawmakers has launched a new effort to come up with an approximate consensus, which was debated for two hours on Thursday. Lawmakers want every German citizen to be considered an organ donor, unless they have explicitly objected to the idea.
Most MPs in favor of ‘opt-out’
Most speakers during Thursday’s debate were in favor of the opt-out system. Conservative Christian Democratic Union (CDU) MP Gita Könemann said all measures taken to increase the number of organ donors – currently around 40% of the population – were right, but not enough.
“We strengthened hospitals, we supported transplant ambassadors, we stepped up education efforts, we started campaigns, we created an online register,” he said. “But there is still a gap: More than 85% of people in this country are positive about organ donation, but only 45% have actually documented their preference.”
One of the voices against the change in the law was that of Christina Baum of the far-right Alternative for Germany (AfD), who called for a basic right to refrain from physical violence, which she said “goes beyond death.” “From that, we can only maintain the current rule: active consent for organ donation,” he told the chamber. He also suggested that changing the law would encourage illegal organ trafficking internationally.
Germany is largely alone in Europe on this issue. France, Italy, Austria, Spain, the Netherlands, Belgium, Poland and Portugal have all adopted some form of opt-out system.
according to German Organ Procurement Organization (DSO)In Germany, 633 people are expected to die while waiting for a donor organ in 2025, while more than 8,200 people are currently hoping for a life-saving donor organ. Most of them are waiting for a kidney, with the average wait time being around eight years.
Opt.Ink Organ Donor Tattoo
Angela Ipach, co-founder of the initiative opt.inc, He believes the change in the law is long overdue – and the deal agreed in 2020 has made no difference. “Six years have passed since the last vote in the Bundestag and the numbers have not changed at all,” he told DW in early June. “Many people have died. In what other field is it possible to have nothing for six years? Anyone who opposes the presumed consent system should now propose an effective solution.”
The campaign group Opt.Ink invites volunteers to get a tattoo (a circle next to two semicircles, resembling the letters O and D), indicating that they are organ donors. According to the organization, about 30,000 people now have the tattoo.
Ipach, whose sister died at age 30 after waiting four years for donor lungs, told DW that the idea for the tattoo was born out of frustration when the ‘opt-out’ system was rejected in 2020. “Then we launched this campaign, which won an award, mobilized hundreds of tattoo studios, and even got tattoos in the German Bundestag in May 2024,” he said. “That really gave the project a boost.”
Another campaigner in favor of the change, Frank Logemann, works as a transplant coordinator at the Medical University of Hanover. She has to initiate conversations with spouses or children when patients are at risk of brain death. What Logemann has learned: There’s no perfect time for this conversation — which has been a problem, because in many cases so soon after death, relatives often don’t want to give permission to use the organs.
“The most important thing is to reach out to the family early in the grieving process and determine whether the terminally ill person would want to be an organ donor,” he told DW. “If brain death is confirmed and you just start paying attention to it, it’s definitely too late.”
Edited by Reena Goldenberg