Germany Debates Reintroducing 'Opt-Out' Organ Donation System

About halfway through a marathon session on Thursday, Germany's lower house of parliament, the Bundestag, re-opened a debate that had last closed six years ago: Should Germany bring itself in line with many other European countries and make organ donation an "opt-out" rather than an "opt-in" choice.

Germany's parliamentarians rejected the so-called "presumed consent" system in 2020, despite a push from the Health Ministry, and opted for a compromise where people would be asked when renewing their national ID cards whether they would like to become organ donors.

Now, an inter-party group of parliamentarians has launched a new push to bring presumed consent in, which was debated for two hours on Thursday. The parliamentarians want every German citizen to be considered an organ donor, unless they have expressly objected to the idea.

Most parliamentarians in favor of 'opt-out'

During Thursday's debate, the majority of speakers were in favor of the opt-out system. Gitta Connemann, parliamentarian for the conservative Christian Democratic Union (CDU), said that all the measures taken to increase the number of organ donors — currently around 40% of the population — had been right, but had not been enough.

"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."

One of the voices against the law change was from Christina Baum, of the far-right Alternative for Germany (AfD), who invoked the basic right to physical inviolability, which, she said, "goes beyond death." "From that, we can only derive maintaining the current rule: The active consent to organ donation," she told the chamber. She also suggested that changing the law would encourage international illegal organ-trafficking.

Germany is largely alone in Europe on the issue. France, Italy, Austria, Spain, the Netherlands, Belgium, Poland, and Portugal have all adopted an opt-out system of some kind.

According to the German Organ Procurement Organization (DSO), 633 people died in Germany in 2025 waiting for a donor organ, while more than 8,200 people are currently hoping for a life-saving donor organ. Most of them are waiting for a kidney, an average waiting time of about eight years.

The Opt.Ink organ donor tattoo

Angela Ipach, co-founder of the initiative Opt.Ink, believes a law change is long overdue — and that the compromise agreed in 2020 has made no difference at all. "Six years have passed since the last vote in the Bundestag, and the numbers haven't changed at all," she told DW in early June. "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."

The campaign group Opt.Ink invites volunteers to get a tattoo (a circle next to two semi-circles, arranged to resemble the letter O and D), indicating that they are organ donors. According to the organization, some 30,000 people now have the tattoo.

Ipach, whose sister died aged 30 after waiting four years for a donor lung, told DW that the idea for the tattoo was born 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 did tattoos in the German Bundestag in May 2024," she said. "That really gave the project a boost."

Another campaigner in favor of change, Frank Logemann works as a transplant coordinator at the Medical University of Hannover. He has to initiate conversations with spouses or children when brain death is likely in patients. What Logemann has learned: There is no perfect time for this conversation — which has been a problem, because in many cases shortly after death, relatives often don't want to allow organs to be used.

"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.”