Federal Council makes a new attempt at the opt-out solution

Thousands of seriously ill patients are on organ donor waiting lists. In light of this, the countries are making a new push for more organ donors at the federal level. In parallel, there is also movement in the Bundestag on this issue.

New approach for more organ donations: The Bundesrat has decided to submit a legislative proposal for the implementation of the so-called opt-out system at the Bundestag. This was supported by a majority of the states. According to this proposal, all persons with a registered address in Germany are to be considered organ donors after death, unless there is a declared objection or an "opposing will" of the deceased. Currently, organ retrieval is only permitted with explicit consent.

The opt-out solution is "not a compulsory imposition" and "everyone is free to say, I do not donate my organs," said Baden-Württemberg's Health Minister Manfred Lucha in the Länderkammer.

The right of the individual to decide for or against organ donation remains expressly unchanged in the state proposal. The objection can be recorded in the Organ Donor Register, an Organ Donor Card, a patient directive, or in another way. For persons who are unable to recognize the meaning, significance, and implications of organ donation, organ retrieval should be generally impermissible.

Almost 8,400 people on the waiting list

The countries justified their initiative with the low number of organ donors and donors: This has been stagnant at a low level for over ten years, according to the draft. In the previous year, 8,385 patients had waited for an organ, but only 2,877 organs from 965 people were donated. The March 2024 Organ Donor Register alone would not lead to a noticeable improvement in the situation, warn the countries.

More organs such as kidneys, livers, or hearts are needed for seriously ill patients for years. For donations to even be considered, two independent medical experts must determine the brain death of the deceased.

The initiative of eight federal states was already presented to the Bundesrat at the last plenary session in mid-June. Subsequently, the Health Committee of the Länderkammer discussed the draft. It goes to the federal government for comment after the now successful vote, which then submits it to the Bundestag.

Two previous attempts in the Bundestag

In addition to the Bundesrat, a cross-factional group of Bundestag members made a new attempt for the opt-out solution last week to push for a reform before the Bundestag election 2025. The initiators and initiators want to initiate a legislative procedure that should lead to a legislative decision in the spring of 2025. Federal Health Minister Karl Lauterbach welcomed the two initiatives for the opt-out solution. Criticism came, however, from patient advocates and the FDP.

The Bundestag had already voted on an opt-out solution in the year 2020, but there was no majority for it then. Instead, the model for the so-called decision-making solution was adopted: This means that each person should document whether they want to donate organs or not.

The Bundesrat Initiative was initiated by North Rhine-Westphalia, supported by seven further states. According to the Basic Law, the Bundesrat can also submit legislative proposals to the Bundestag. They are then referred to the parliament by the Federal Government. The Bundestag must then deliberate and pass a resolution on this matter "within an appropriate timeframe."

The German Bundestag is also actively engaging in discussions regarding organ donation, with a cross-factional group proposing an opt-out solution before the 2025 election.
The Federal Council, in its support for more organ donors, has decided to submit a legislative proposal to the Bundestag for the implementation of an opt-out system, which aligns with existing health policy.
The implementation of opt-out organ donation at the federal level, as proposed by the Federal Council, would be a significant shift in health policy, moving towards a presumed consent model, but the individual's right to make their own decision will remain intact.