In Germany, the decision or consent solution applies to organ donation. This means that a person decides during their lifetime whether and which organs they would like to donate after brain death occurs. This wish can be recorded on the organ donor card or in the organ donor register, which was set up in 2022.
With the objection solution, however, every person automatically becomes an organ donor if they have not actively objected to this during their lifetime. In most neighboring European countries, the contradiction solution is common. In some countries, such as Norway or Greece, this applies with the right of objection for relatives, in other countries, such as France, without the right of objection for relatives.
Arguments for the contradiction solution
The cross-party group of 254 parliamentarians who are campaigning for the introduction of the objection solution argue that it would "significantly improve the care of people who are dependent on organ or tissue donation".
In addition, the objection regulation creates more certainty for everyone involved as to whether someone is eligible to be an organ donor or not. And this regulation also relieves the relatives of having to make the decision for or against organ donation in the face of death.
The bill introduced by the Bundesrat also complained that the current legal situation in Germany is not sufficient to improve the situation of seriously ill patients who are dependent on a transplant. “The situation of organ donation is characterized by a significant shortage of organs…”.
In Germany, 985 people donated one or more organs last year, while 8,199 people were on the waiting list for an organ transplant, according to data from the German Organ Transplantation Foundation. Another argument from supporters: Although 85 percent of those surveyed in a representative survey in 2024 declared their general willingness to donate organs, only around 45 percent documented this. According to supporters of the contradiction solution, this discrepancy could be eliminated by introducing the contradiction solution.
Arguments against the objection regulation
A third proposed law is still being debated in the Bundestag. It was introduced by a smaller, cross-party group of 58 parliamentarians. They are calling for the current regulation of the consent solution to be retained, but to be expanded to include educational and information offerings.
The parliamentarians are also pushing to introduce the regulations that were passed in 2020 as a law to “strengthen the current decision-making system” but have not yet been implemented. Accordingly, all German citizens should be informed about organ donation when applying for identification documents and should be able to be entered in the organ donation register.
However, this has not yet been implemented by the countries responsible “due to the high costs”. With this counterproposal, this smaller group of parliamentarians is also pursuing the goal of increasing the number of organ donors. However, they firmly reject the introduction of the contradiction solution. Rather, they focus on protecting people's self-determination. “Silence should not be viewed as consent.”
Does the contradiction solution enable more transplants?
In addition to ethical concerns, it is also not scientifically clear whether the switch from consent to objection resolution actually leads to more organ transplants. In November 2024, the Max Planck Institute for Human Development in Berlin published a study in which they examined longitudinal data from five countries to determine whether the objection solution could significantly increase the number of donated organs. The researchers were unable to find a clear connection.
Another study by the OECD, in which the University of Hamburg was involved, comes to a similar conclusion. 24 countries that had introduced the objection solution were examined. However, the data showed that the opt-out solution only slightly increased the number of organ donations after death.
Cardiac death instead of brain death definition?
In countries that have particularly high organ donation rates, not only the contradiction solution, but also another death criterion is a prerequisite for organ removal: cardiac death. This has been the case in Spain, for example, since 2012. That is why the German Interdisciplinary Association for Intensive Care and Emergency Medicine recently published a position paper in which it also advocates this expanded definition of death.
The argument: Irreversible brain death only occurs extremely rarely. Most people in an intensive care unit die from cardiovascular disease. In many cases, people are not brain dead, but still have no chance of surviving without a ventilator. In these cases, "the ventilator should be switched off in a controlled manner," argues heart surgeon Jan Gummert from the board of the German Society for Thoracic Heart and Vascular Surgery, for example: "Then you wait until the heart stops beating, and then you would take the patient, who then formally died of cardiac death, into the operating room and then remove the organs that are to be donated."
The prerequisite for this would always be that the brain is irreparably damaged. This does not mean an unexpected cardiac arrest, in which people can be resuscitated.
However, these considerations regarding the cardiac death criterion for organ donation do not play a role in the current draft laws. In its statement on the upcoming debate and a possible change in the law, the federal government said that the issue of organ donation is ethically relevant and that the decision for and against an objection solution should therefore be classified as a decision of conscience. In concrete terms, this means that MPs are freed from party discipline.
