Transplantation medicine assumes and calls for the availability of donor organs. The Federal Republic of Germany as well as seven other countries¹ have joined the Eurotransplant procuration organization in Leiden, Netherlands, in order to increase a chronically ill and waiting patient’s chances of receiving a donor organ, for him to receive the most immunologically suitable organ, or to transplant this organ as quickly as possible in acute life-threatening situations by implementing a collective donor-alert system.

As of January 1, 2013, there were 11,233 patients on the main Eurotransplant wait list, 6713 of which had just recently registered in 2012. In 2012, the small sum of 4042 procurable organs from deceased donors were actually transplanted.² Thus, this process of procuring donor organs represents the distribution of scarce goods among numerous interested parties. This is an ethical and legal challenge, in that one donor organ has many chronically ill potential takers, who either receive a new chance at life through the allocation of this organ or whose body will fail in the case of non-consideration.

Organ transplantation is not immune from German law, but instead falls under the realm of the transplantation law (TPG), which has been in place since December 1, 1997³ and which was significantly amended and has recently been reformed on July 12, 2012⁴ and July 21, 2012⁵. The law explicates the medical and legal premises for organ donation and controls the coordination of the extraction of the organ or tissue from the donor and the transfer of procurable organs to a specific recipient. It provides the basis for the organization of the organ transplantation, separating the responsibilities for the extraction of organs and tissues (§ 11 TPG), and getting the procurable, eligible organs to the potential recipient (§ 12 TPG). The institution that holds the position that is responsible for organretrieval and procurement preparation is reserved for a so-called coordinating center (§ 11 Paragraph 1 TPG), which in Germany is the German Organ Transplantation Foundation (German: Deutsche Stiftung Organtransplantation (DSO)). The procurement itself is carried out by a medical board, health insurance providers, and a financially and organizationally independent procurement committee within each respective hospital (§ 12 Paragraph 1 TPG). The procurement agency responsible for the German transplantation centers (German: Transplantationszentren (TPZ)) is, as mentioned above, Eurotransplant . They are responsible for procuring the organs to a proper recipient by following a set of rules, which adhere to contemporary findings in the medical sciences and which adequately ensure that the transplantation is for the benefit of the patient and takes the urgency of the need for an organ transplant into consideration (§ 12 Paragraph 3 Sentence 1 TPG).

The transplantation law requires that all the wait lists from various transplantation centers be treated as one collective wait list (§ 12 Paragraph 3 Sentence 2 TPG). The regulation stating that patients from each individual transplant center register collectively on one wait list guarantees that patients registered in Germany all have an equal chance of getting a donor organ. In general, standard procedure requires that an organ be allocated to one specific patient as opposed to allocating or offering it to a transplant center. However, there are exceptions (for example, resource allocations), which have certain guidelines regarding their prerequisites, which will not be elaborated on here.