Germany's Federal Council (Bundesrat) has approved significant amendments to the country's transplantation legislation on May 8, 2026, following the Bundestag's passage of the bill in late March. The new law introduces measures designed to expand access to living kidney donations and reduce the substantial waiting times faced by patients requiring transplants.
At the heart of the legislation is the authorization of crossover living kidney donations, a practice that pairs two incompatible donor-recipient couples to enable transplants between them. Under this arrangement, if a potential donor is incompatible with their intended recipient due to blood type or tissue incompatibility, they can be matched with another similarly incompatible pair. The donors exchange recipients, allowing both transplants to proceed successfully.
Previously, German law permitted crossover donations only when the two couples shared a close personal relationship, such as family ties. The new legislation removes this proximity requirement, meaning donor-recipient pairs need not know each other personally. However, each individual donor must still maintain a close relationship with their original intended recipient, preserving the ethical foundation of altruistic donation within existing relationships.
The legislation also permits non-directed anonymous kidney donations, allowing individuals to donate a kidney to an unknown recipient without specifying who will receive the organ. In these cases, donors have no influence over the selection of the recipient, with allocation determined by medical need and compatibility through established protocols.
To facilitate these new donation pathways, the law mandates the creation of a national program for crossover living kidney donations. Transplantation centers will coordinate the matching process and manage the logistics of these complex procedures.
The legislation introduces mandatory independent psychosocial counseling for all prospective living kidney donors before they proceed with donation. Donors must also receive individualized support throughout the entire donation process, including pre-operative preparation, the surgical procedure itself, and post-operative recovery and follow-up care.
In recognition of the risks living donors assume, the law establishes a provision ensuring that individuals who previously donated a kidney and later develop kidney failure themselves will receive appropriate priority consideration in the allocation of deceased donor kidneys.
The legislative reforms respond to Germany's persistent shortage of available kidneys for transplantation and the resulting extensive waiting periods. Patients awaiting deceased donor kidney transplants face average waiting times of up to eight years, during which they experience significant restrictions to their quality of life, typically requiring regular dialysis treatment.
As of late 2024, approximately 6,400 patients classified as suitable transplant candidates were registered on the waiting list for kidney transplants in Germany. During the same year, only about 2,000 kidney transplantations were performed across the country. In 2024 alone, 253 individuals who had been waiting for kidney transplants died before receiving an organ.
The legislation expands provisions for organ and tissue donation in specific medical situations. Organs or tissues removed during medical procedures involving patients unable to provide consent, such as functional heart valves from hearts explanted during heart transplantation, may now be donated for transplant use. Previously, these potentially viable organs were prohibited from being utilized.
The law also enables cryopreservation of sperm for male children and adolescents facing cancer treatments such as chemotherapy or radiation therapy that could impair future fertility. This provision allows young patients to preserve reproductive options before undergoing potentially sterilizing medical interventions.
Following the Bundesrat's approval, the legislative process is now complete. The law will be countersigned by the Federal Government and signed by the Federal President before being promulgated. It will enter into force on the first day of the calendar month following its official publication in the Federal Law Gazette.
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