8 federal states pushing for opt-out organ donation in Germany

Eight German federal states are urging the government to adopt an opt-out organ donation system in an effort to increase the number of registered donors.

NRW leads Bundesrat call for opt-out organ donation

Representatives from North Rhine-Westphalia have introduced a draft law in the Bundesrat for Germany to adopt an opt-out organ donation policy. The Bundesrat is the upper house of the German parliament, which represents the country’s 16 federal states. 

The draft law is also supported by representatives from Baden-Württemberg, Hesse, Mecklenburg-Vorpommern, Rheinland-Palatinate, Saarland, Schleswig-Holstein and Thuringia.

Germany currently has an opt-in organ donation system, but there are not enough organs donated for the number of urgent transplants, despite the fact that the public generally views organ donation positively.

North Rhine-Westphalia’s Health Minister Karl-Josef Laumann (CDU) told the Bundesrat that an opt-out system would likely increase donations. “According to studies, 80 percent of people in Germany approve of organ donation. So we don’t have a lack of people who want to donate their organs after death, but a documentation problem,” Laumann argued.

In March 2024, the German government introduced the option for people to complete the organ donation registration process online, which was previously only possible by post. Digitising the process proved widely successful, with nearly 100.000 prospective donors registering in the first month.

In 2020, a previous attempt to introduce an opt-out system failed in the Bundestag, the upper parliamentary house. In 2024, the Bundesrat passed the corresponding bill, but Bundestag discussions were put on ice due to the February 2025 federal election. The Bundesrat will now resubmit this proposal.

Does an opt-out system actually increase organ donations?

Despite Laumann’s adamance that an opt-out system will solve Germany’s problems, a 2024 study by the Max Planck Institute for Human Development found that “switching to an opt-out organ donation policy [...] does not increase donations from deceased donors".

The longitudinal study examined organ donation rates among deceased donors in five countries with opt-out donation systems: Argentina, Chile, Sweden, Uruguay, and Wales, and found that the switch to an opt-out policy did not increase organ donation rates in these five countries.

To improve donation rates, the study recommended that countries “invest in transplant coordination services and infrastructure, encourage individuals to talk about their donation wishes with relatives, and train medical teams to navigate difficult conversations with families".