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BMJ. 2007 May 12; 334(7601): 973.
PMCID: PMC1867895

German ethics council demands opt-out system for transplants

An influential German advisory body is proposing a change in the law on organ donation so that it is assumed that everyone in the country has agreed to be a donor after death unless they have specifically opted out by registering their objection to donation.

The proposal from the German National Ethics Council has had a mixed reception, with opposition coming from politicians and a doctors' organisation.

The council's paper, published in April, was designed as an urgent response to the plight of the 12 000 German patients waiting for organs by asking for a change in legislation. Every year about 1000 patients die while awaiting a transplant.

The council, which is independent, issues regular statements and opinion papers on important ethical topics (www.ethikrat.org). It has up to 25 members who represent scientific, medical, theological, philosophical, social, legal, ecological, and economic interests.

The current German law on transplants, which dates from 1997, does not assume that everyone is prepared to be a donor after death. It requires that donors—or relatives—have opted in to the idea, either by the donor carrying a card, if available, or by the relatives giving permission when the patient is brain dead. The council wants to change this to an opt-out system where everybody is assumed to have consented unless they have previously registered their objection.

Their objection could, for instance, be registered on their health card—which is currently subject to trials and which in future everybody may have to carry at all times.

However, as a first step the council recommends that the population should be comprehensively informed about organ donation so that everybody has the chance to make an informed decision. Furthermore, the new law, the council proposes, should oblige hospitals to report all potential organ donors.

“The hope that the transplant law of 1997 would increase the number of organ donors has not been fulfilled,” says the council's paper.

“This is not just a problem of organisation but is due to the fact that by law organ donation is dependent on the potential donor's or the relatives' consent.”

The council acknowledges that positive developments in organ donation have occurred. From 2000 to 2006 the number of organ donors in Germany rose from just over 1000 to 1259. Last year, for the first time, more than 4000 patients in Germany received a transplant. But it says that further progress is needed.

Reacting to the publication of the paper, the main transplantation recruitment organisation in Germany, Deutsche Stiftung Organtransplantation (the German Foundation of Organ Transplantation), said that before a new law was introduced more should be done to increase the number of available transplants under the present system, through working with hospitals and the public.

The organisation thinks that donation could be increased to 40 organ donors per million people in Germany from the present 15 donors per million, even with the present opt-in system. (In comparison, in countries such as Spain and Austria, which have opt-out systems, the number of donors has already reached between 24 and 35 donors per million.)

The views of the Deutsche Stiftung Organtransplantation were echoed by the German Medical Association. “There is no need for a new law,” said Hans Lilie, chairman of the association's transplantation committee. He said it would be better to concentrate on providing more information to the public.

Most politicians were also opposed to the council's proposal of an opt-out system, insisting that organ donation must be a free decision.

The council responded by saying that the large deficit of transplants required new solutions. “However, we did not just suggest an opt-out system but first wanted to establish a safe way that people could register consent or dissent,” said Kristiane Weber-Hassemer, the council's chairwoman. “It appears that the critics have not read our paper.”


Articles from The BMJ are provided here courtesy of BMJ Publishing Group