Organ donation has become a question of conscience as the Bundestag debated a possible reform on Thursday. The discussion, conducted in a reflective tone and at times shaped by personal stories, focused on whether Germany should introduce an opt-out system for organ donation. Supporters of the so-called opt-out system called for people to make a conscious decision for or against organ donation. Opponents of the reform warned against state interference and argued for maintaining voluntary consent. However, lawmakers agreed on the need to increase the number of organ donors.
The Bundestag held its first reading of two cross-party initiatives. A group of 254 lawmakers from the CDU/CSU, SPD, Greens and Left Party is backing a bill to introduce an opt-out system. Under the proposal, everyone would generally be considered a potential organ donor unless they had explicitly objected. The Bundestag also discussed a bill from the Bundesrat, which likewise calls for the introduction of an opt-out system. A second group of 58 lawmakers from the CDU/CSU, SPD, Greens and Left Party is instead calling for voluntary consent to remain the basis of organ donation.
As is often the case with medical ethics issues, many lawmakers shared their personal views during the debate and spoke unusually openly about their own experiences. Green Party lawmaker Michael Kellner, arguing in favour of the opt-out system, described the fate of a friend whose donor liver had given her "17 good years". He said he himself had "needed this impetus" to make a decision.
The opt-out system is the solution in the vast majority of European countries, Kellner said. Germany was taking a different path, while benefiting disproportionately from organ donations from abroad. "For me, that is ethically difficult to justify."
Bodo Ramelow of the Left Party spoke "as a father" to the lawmakers and described the fate of his daughter, for whom he himself had donated bone marrow. Ramelow, who supports the opt-out system, appealed to citizens to make a conscious decision on organ donation. At the same time, he rejected concerns that an opt-out system would put pressure on groups of people who were unable to make the decision themselves.
"We are not creating an obligation to donate organs," SPD lawmaker Sabine Dittmar also stressed. Relatives would remain closely involved under the opt-out system. "But we are no longer placing on them a decision that every person can make for themselves during their lifetime."
CSU politician Hans Theiss cited international studies that showed "the clear effect of the opt-out system". Together with other measures "such as intensive public information, optimisation of hospital structures and good transplant coordination", he said the opt-out system was "the decisive piece of the puzzle that is still missing in our country when it comes to organ transplantation".
North Rhine-Westphalia Social Affairs Minister Karl-Josef Laumann (CDU), speaking as a representative of the Bundesrat, pointed out that more than 600 people had died last year because no donor organ was available for them. In a situation "where a person is in the process of dying", it should not be left to chance, Laumann said, "that others decide for you".
CDU politician Michael Brand also appealed to people to make an active decision. However, he said the opt-out system was "no magic switch" when it came to increasing the number of organ donors.
Instead, he argued, the focus should be on better communication, including "a sensible online campaign" and easier access to the online organ donation register. The state should not "automatically make everyone an organ donor who does not object". With the voluntary system, he said, "people are worked with", rather than against them.
Green Party lawmaker Sven Lehmann also referred to the fate of his mother, for whom a donor liver was found. However, he said a person should "actively affirm" the decision to donate an organ. The opt-out system, Lehmann argued, meant "at its core nothing other than the socialisation of the body". AfD lawmakers Christina Baum and Martin Siechert likewise expressed concern about excessive state interference in citizens' rights to self-determination.
"With the opt-out system, the state initially declares everyone an organ donor," Siechert said. The opt-out system was "simply unconstitutional". Organ donation would become "organ allocation", he said.
AfD lawmaker Alexis Giersch, however, spoke in favour of the opt-out system. "The current legal situation means that organs are not available simply because too few people have documented this life-saving decision," he said.
The bills and motions discussed were referred to the Health Committee for further consideration. A final vote could then take place in the plenary chamber in a few weeks.
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