June 24th, 2026 (The Berlin Spectator) – Germany’s Bundestag is set to revisit one of bioethics’ most contentious questions this Thursday, when lawmakers debate whether the country should switch to an opt-out system for organ donation — meaning every citizen would be considered a potential donor by default unless they had explicitly objected during their lifetime.
Under the current framework, in place since 1997, organs may only be removed after death if the deceased had given explicit prior consent, typically by carrying a donor card. Relatives or designated persons may also decide on behalf of the deceased, provided it reflects that person’s presumed wishes. The proposed change would reverse that logic entirely.
As German-language media are reporting, cross-party group of legislators has submitted a motion calling for the opt-out model to be introduced, arguing that it would significantly increase the number of available donors. Supporters, including the German Organ Transplantation Foundation and the German Medical Association, point out that public willingness to donate is generally high — but that more than half of all citizens have left no written statement, leaving bereaved relatives to make difficult decisions under pressure, often leading them to decline.
Spain, the global leader in organ donation with around 50 donors per million inhabitants, has operated under an opt-out system for years. Germany, by contrast, records roughly eleven donors per million — one of the lowest rates in the developed world — and has long depended on donations from abroad through the Eurotransplant network.
This is not the first time the Bundestag has grappled with the issue. In 2020, lawmakers rejected the opt-out model and instead passed a package of measures designed to encourage voluntary registration, including prompting citizens to consider donation when applying for an ID card and tasking health insurers, doctors’ offices, and driving schools with providing information. A national online donor registry was also established.
Progress has been made: in 2025, 985 people donated one or more organs after death, the highest figure since 2012 and a 3.4 percent increase over the previous year. But the gains have fallen short of expectations, and the online registry — which requires an ID card with an online function, an electronic residence permit or eID card, plus health insurance details — has been widely criticized as too cumbersome. Fewer than 570,000 people had signed up by mid-June.
Opposition to the opt-out model spans the political and religious spectrum. A rival cross-party group of legislators, including members from the CDU, SPD, Linke, Greens, and CSU, argues that silence must not be interpreted as consent and that the proposal infringes on fundamental rights. They instead call for voluntary participation, a major public awareness campaign, and a simpler registration process. Critics from the medical ethics community, including former German Ethics Council chairman Peter Dabrock, warn that abandoning the consent principle could erode public trust in transplant medicine more broadly.
Religious communities have taken a clear stance. The Central Council of Jews in Germany, the Catholic bishops, and the Protestant church all support organ donation in principle but insist it must remain a voluntary act of charity rooted in an explicit personal decision. The Central Council addressed the issue in its 2025 annual report, reaffirming its opposition to the opt-out model on ethical grounds.
Experts also caution that changing the legal framework alone may not be sufficient. Countries with high donation rates, they note, achieved those numbers through systemic improvements in hospital procedures and, crucially, by cultivating a broader social culture of donation. The impact of public figures on that culture should not be underestimated: when it emerged that Norwegian Crown Princess Mette-Marit was in urgent need of a donor lung, willingness to donate in Norway rose markedly.
Whether the Bundestag will reverse its 2020 decision remains to be seen. What is clear is that the ethical, legal, and logistical questions surrounding organ donation are far from resolved in Germany — and that Thursday’s debate is unlikely to be the last.
