Organ donation reform: a matter of the heart

The Bundestag passes a moderate reform of organ donation and rejects the contradiction solution. The debate is thoughtful and emotional.

The factional constraint was – as usual with conscience decisions – lifted Photo: reuters

It is about Lilli, for example. Lilli, a nine-year-old girl, is waiting for a donor heart in a clinic in Hamburg. For 19 months, day after day, she and her parents have been hoping for the redeeming call that an organ is ready for transplantation. Lilli, tells SPD member Matthias Bartke, standing at the lectern, told him, "When you’re dead, you don’t need your organs anymore." She was right.

Sometimes the Bundestag has to decide on matters of life and death. The one about how lawmakers feel about organ donation is one of those. It was discussed in the plenum on Thursday. It was thoughtful, but also emotional. The factional constraint was lifted – as is usual for decisions of conscience. The question is: May the state automatically consider its citizens as organ donors if they do not explicitly object?

Such a "double contradiction solution" is being demanded by a group of members of parliament led by CDU Health Minister Jens Spahn and SPD health expert Karl Lauterbach. Lauterbach cites dramatic figures in his speech. In Germany, more than 1,000 people die each year on the waiting list for an organ. In neighboring countries, two to three times as many organs are donated, he stresses. "We are bringing up the rear in Europe."

Yet the willingness to donate is high, Lauterbach says, adding that 85 percent of Germans are positive about organ donation. Unfortunately, there is a gap between this attitude and actual practice. Only 39 percent of Germans have documented their yes to donation on an organ donor card or in a living will. Lauterbach wants to close the gap. He speaks forcefully, without pauses between sentences, clinging to the lectern.

"There is a lack of simple, unbureaucratic regulations on how to become a donor." And, he said, there is no obligation to donate. But it is unethical, he said, to want to claim an organ for yourself in the event of a serious illness, but not even be willing to say no yourself if you don’t want to donate.

The proposal put forward by Lauterbach, Spahn and others would be a paradigm shift: anyone who wants to donate an organ in the event of brain death must, until now, have given their consent during their lifetime. Spahn’s and Lauterbach’s objection solution reverses this logic. Everyone would be a potential organ donor unless he or she objects. The no vote can be given without any justification – and can be revised. Gradations, for example according to individual organs, would also be possible.

Culture of organ donation

After Lauterbach, 23 other speakers are given the floor. Each has five minutes; the debate is scheduled to last two hours. Spahn listens in the ranks of the CDU/CSU parliamentary group; he introduced the motion as a parliamentarian, not as a minister. He is the last to move forward with quick steps.

The contradiction solution is "not a panacea, not a magic bullet," he says. But it meant that society would make it clear: "Yes, we want a culture of organ donation." Spahn points to patients and children, some of whom have lived for years in hospital rooms with large machines because there are no donor organs. In no other area is such suffering and such a disastrous supply situation accepted.

Spahn looks around the table. Was it an imposition, he said, that people who didn’t want to donate would have to object? "Yes, but one that saves lives." At the end, he warns that the other group of deputies’ bill won’t change the current situation. That’s a nasty accusation, because the status quo, far too few donor organs for too many terminally ill people, is terrible.

The second bill has been formulated by the Green Party’s Annalena Baerbock, the Left Party’s Katja Kipping and others. They propose a "consent solution," a moderate improvement to the current law. Citizens should be regularly informed about organ donation, for example by family doctors or when they apply for an ID card at the citizens’ registration office, and encouraged to do so. The entry is to be made easily via an online register.

In a third motion, the AfD parliamentary group advocates transferring the procurement and control of organ donations to an independent institution under public law. But he has no chance.

Who does the human being belong to?

The main problem is that too little is reported and too few transplants are performed, says Baerbock. The online register changes the reality, she says, because doctors in the hospital can access it immediately instead of first having to look for the organ donor card or ask relatives. Baerbock makes it clear that it is also about the ethical question "To whom does the human being belong?" She exclaims, "In our eyes, he does not belong to the state, not to society. He belongs to himself, unasked, without contradiction."

Usual reflexes are omitted. Most speakers save polemical attacks on opponents

Concerns about state paternalism are high in parliament. Several opponents of the contradiction solution point to people who would not be able to articulate themselves. What about the homeless, the depressed or the illiterate? Will the contradiction solution result in organs being removed from the weakest against their will?

The debate is interesting above all because the usual reflexes are absent. Most speakers spared polemical attacks on their opponents. The AfD parliamentary group applauds the left-wing Social Democrat Hilde Mattheis because she is also against the contradiction solution. Liberal Hermann Otto Solms wisely argues in favor of the contradiction solution, even though it gives the state more power. His parliamentary group colleague Otto Fricke later countered no less cleverly.

In the end, those who want to continue to rely on voluntary consent win. The majority votes against Spahn’s and Lauterbach’s contradiction solution – and for Baerbock’s moderate reform.

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