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Organ donation day: why there are not enough donors


Thousands of people are hoping for a vital organ transplant. Many of them in vain. For years politicians have been looking for ways to motivate more people to donate.

Around 8,500 people in Germany are waiting for an organ donation. But not all of them will get a vital organ. Last year fewer than 900 people donated one or more organs.

In Germany, for example, anyone who needs a new kidney has to wait around eight years for a donor organ, which is significantly longer than in other European countries. The waiting time is a great burden for those affected and their families. Physicians are campaigning for people to deal with the issue of organ donation.

Basic willingness to donate

According to the Federal Center for Health Education, around 40 percent of people have an organ donor card or an entry in the living will. The German Foundation for Organ Transplants assumes a lower number.

Surveys show that significantly more people would be willing to donate their organs. The problem with this is that this willingness must also be recorded in writing. Because organs may only be removed if the person actively consented during their lifetime or if relatives do so after their death. In many cases, however, the relatives do not know whether the deceased wanted to donate their organs.

A tattoo as a symbol?

That is one reason for the “Young Heroes” association to draw attention to the topic. A tattoo should indicate whether someone wants to be an organ donor. 300 tattoo studios in Germany are already participating and tattooing the symbol free of charge.

The tattoo cannot legally replace an organ donor card, but it can be of help to relatives. For the chairman of the association, Anna Barbara Sum, a tattoo is particularly good for getting people to talk to each other, because people often ask about the meaning of organ donation tattoos. “We want this to be discussed again at the family table, in public, among friends,” says Sum.

Last year there were almost 900 organ donors in Germany.

contradiction solution without a majority

The Bundestag has also discussed for years how more people can be persuaded to donate organs. One idea was to introduce the so-called contradiction solution. This means that everyone is an organ donor, unless they expressly object. This is what many European countries do, such as Spain, Austria or the Netherlands, where proportionately more people donate their organs.

Health Minister Karl Lauterbach has been campaigning for the contradiction solution for years, but so far it has not found a majority in the Bundestag. Initially, Lauterbach, as Federal Minister of Health, wanted to make a new attempt to enshrine the objection solution in law. In the meantime, the SPD politician has changed his mind. In his role as federal minister, he does not want to submit a legislative proposal, preferring to leave this ethical decision entirely to parliament.

Far too few people are organ donors – that is well known. And the planned donation registry is being delayed.

Germany particularly complicated?

Nevertheless, there is still enough to do for Lauterbach, because so far not even all points of the last amendment to the law, which the Bundestag passed in 2020, have been implemented. Tino Sorge, health policy spokesman for the Union faction, criticizes this: “We are always world champions in Germany when it comes to implementing complicated things and providing some regulations for all eventualities.”

Politicians wanted to provide better information about organ donation. General practitioners are allowed to give advice on request, and identification offices should have been distributing educational material and organ donor cards for a long time. An online register for organ donations should have started last year, but the technical implementation is stuck – as is the agreement between the federal and state governments.

It is not the first time that a digital project has been delayed. Union politician concern calls for quick and uncomplicated solutions and makes the health minister responsible. Lauterbach must build up more pressure and find pragmatic solutions to the problems.

duty to decide instead of contradiction solution?

Union politician Sorge, like Lauterbach, is a supporter of the contradiction solution and could imagine changing the current law at least again, having to decide towards an obligation. In contrast to the opt-out solution, people would not automatically be organ donors, but would only be obliged to make a decision once. “I think you can ask people to do that these days,” says the CDU politician.

Stephan Thomae from the FDP could also imagine making the decision mandatory. Thomae, on the other hand, doesn’t think a whole new legislative process, in which the contradiction solution is debated again, is a good idea. This cannot be discussed in every legislative period.

Most agree on the goal: they want to save lives and shorten the waiting times for donor organs. A new political solution, how this can work better, is not in sight for the time being.

Organ donation: the most important models

contradiction solution

The state assumes that basically every citizen is a potential organ donor – unless he has expressly contradicted. So silence is taken as consent. A no to organ donation can be documented in an objection register. In the case of an extended or double objection solution, the relatives also come into play: If the patient has not left a written statement, they are asked how the person concerned felt about the organ donation. In contrast to the consent regulation, however, they themselves have no right of co-decision.

consent solution

With the consent solution, organs and tissue can only be removed if the deceased person expressly consented to an organ donation during their lifetime.

With the extended consent solution, the relatives can also decide on behalf of the deceased person if they did not document a decision during their lifetime. If there are no statements from the patient, the relatives can decide for themselves.

decision solution

The decision solution is an extension of the extended consent solution that the Bundestag decided in 2012. It obliges the health insurance companies and insurance companies to send their customers regular information about organ donation. All citizens should deal with their own willingness to donate on the basis of well-founded information.

reciprocity solution

In the so-called reciprocity solution, those who register themselves as potential donors receive an organ in return in the event of illness. This would increase an incentive to register as a donor and at the same time ensure more justice by preventing free-riding.