German parliament: Explicit consent still necessary from organ donors

Germany’s parliament has rejected a health ministry proposal for a new organ donation system. With low donor numbers, the health minister wanted a presumed-consent system, with the onus on people to refuse to donate.
Germany’s organ donation rules will remain largely unchanged after an emotional debate in the Bundestag on Thursday morning. The country will stick with a system of informed consent, whereby only people who voluntarily register as organ donors are eligible. Most, but not all EU members have moved to an opt-out system that presumes a willingness to donate.
Presumed vs. informed consent
Health Minister Jens Spahn, a Christian Democrat, had led the push to reform the system along with a Social Democrat, Karl Lauterbach. They had proposed a system of presumed consent, albeit also adding the chance for relatives to object to organ donations after the person’s death. The motion failed by 292 votes to 397.
A rival proposal, put forward by a group led by Green party lawmaker Annalene Baerbock, passed by 432 votes to 200, with 37 abstentions, in the decisive final vote. It advocated keeping the existing system of informed consent. However, in a bid to shorten Germany’s transplant waiting lists, people will be asked in future if they’d like to donate organs on a regular basis, when renewing their national identity card.
After the defeat, Spahn pledged to enthusiastically implement the rival proposal, saying both proposals had the same ultimate goal, even if they disagreed on the best method.
“I hope I will be proven wrong and that we will indeed manage to significantly increase the number of organ donors [in this way],” he said.
Karl Lauterbach, meanwhile, told DW he regretted his motion’s defeat: “There’s people dying on the waiting list every day … The law will change literally nothing, it depends on people changing their minds while they get a passport. I don’t know of anyone who reconsiders his position about organ transplantation while he gets a passport,” he said.
A third proposal from the AfD, based on a public information campaign to try to attract donors, never came to a vote once the second motion passed.

Graphic showing how European countries currently approach organ donation.

Read more:  Organ donation: Germany debates how to get people on the list
Why was the debate taking place? 
Germany’s organ donation figures are doggedly low. More than 9,000 people are currently on the organ waiting list, while only 932 people last year agreed to donate, a reduction of 23 compared to 2018.
With 11.5 donors per million people, Germany’s organ donation rate is almost three times lower than that of the United States, despite the US having rules that are more strict than the current German system.

Graphic showing numbers of organ donors by country. EN

Were politicians tied to party lines?
No. As with all votes on purely ethical issues, politicians had a free vote on the topic. Somewhat unusually, Thursday morning’s emotional debate in the Bundestag saw party allies passionately advocating opposing positions.
Christian Democrat Thomas Rachel spoke against his government’s proposal, asking the chamber: “Can silence be considered consent?”
Meanwhile, the CDU’s Gitta Connemann saw the issue differently, arguing that a different fundamental question was in play: “Can the state demand a decision from its citizens? A decision for, on in this case, against, donating organs? That’s all this debate is about. Of course it cannot force them to donate … This is about life and death, and nothing is more important. A simple ‘no’ suffices.”

Donor Organ Recipients – Second Chance at Life

Other politicians drew on personal stories in their comments. The Left party’s Kathrin Vogler alluded to a friend who had been on dialysis, hoping for a kidney transplant, for over a year.
“She needs an organ transplant in the near future just to survive,” Vogler said. “But she said to me: ‘I’m an organ donor myself and have been for years. For me, it’s a no-brainer. But it’s also important to me that I can decide voluntarily. I do not want to be forced to go somewhere to put what I do not want on the record.'”
Claudia Schmidtke (CDU) instead singled out a young man in the audience who had benefited from an organ transplant despite Germany’s shortages. He became Germany’s first person to receive a lung transplant from living donors eight years ago, when aged 11. Both his parents had donated parts of their lungs to save their son, Schmidtke said, concluding that the shortage had ultimately endangered three lives in his case.

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