The proposed opt-out model

A cross-party group of lawmakers from the CDU, CSU, SPD, Greens, and Die Linke introduced legislation in the German Bundestag on Thursday to reform the national organ donation system. Under the draft bill, every adult capable of consent would automatically be registered as an organ donor upon death unless they formally record an objection. The proposal represents the third attempt by German lawmakers to establish an opt-out model, following a rejected bill in 2020 and a second initiative in 2025 that did not reach a vote due to snap federal elections. A separate draft bill pursuing the same policy has also arrived from the Bundesrat. Proponents argue that voluntary opt-in mechanisms have failed to yield a sufficient increase in donor numbers over past years.

Shortages on the waiting list

The push for reform follows years of low organ donation figures in Germany relative to other European nations. According to data from the German Organ Transplantation Foundation, 985 people became posthumous donors in 2025, while 8,199 patients remained on the waiting list for a transplant. Eurotransplant recorded that 615 patients in Germany died while on the transplant waiting list during the same year, representing an average of three deaths each day. Patients waiting for a kidney often endure delays of up to eight years, undergoing regular dialysis while awaiting a match. Lawmakers backing the opt-out mechanism note that while polling shows broad public willingness to donate, few individuals take the step to register.

Posthumous donors985

Deaths on waiting list615

Posthumous donors

985 people

Deaths on waiting list

615 people

Data from the article text

Counter-proposals and bodily autonomy

A competing group of members of parliament opposes automatic enrollment, arguing that the state should not interpret silence as consent. Their counter-proposal calls for targeted educational campaigns and structured prompts, including asking citizens shortly after their 18th birthday to document whether their choice is yes, no, or undecided. During the debate, Green lawmaker Sven Lehmann described the opt-out concept as a state socialization of the human body. CDU lawmaker Michael Brand argued that explicit consent remains standard across society, including simple website terms, and should not be discarded for bodily integrity.

“Ausgerechnet bei den Organen wollen wir es jetzt staatlich umdrehen?”

Personal appeals and criteria debate

Supporters of the reform pointed to individual experiences to defend the necessity of presumption rules. Lawmaker Bodo Ramelow spoke to colleagues about donating bone marrow to his daughter, calling on citizens to make a conscious decision. Green lawmaker Michael Kellner recounted the story of a friend who lived for 17 years following a 2009 liver transplant before dying in 2026 without securing a second donor organ. Health Minister Karl-Josef Laumann of North Rhine-Westphalia argued that asking adults to register their preference is a reasonable civic expectation given the acute shortage.

“Niemand muss Spender sein. Die Würde des Menschen, die Selbstbestimmung bleibt unberührt, weil man immer Nein sagen kann.”

The wider regulatory framework is also receiving scrutiny within the executive branch. Federal Health Minister Carsten Linnemann indicated openness to permitting organ procurement following cardiac arrest, a procedure known as donation after circulatory death. Current German legal standards strictly require the confirmation of brain death before any posthumous organ retrieval can proceed.