Organ transplantations are not only a highly complex and challenging matter from a medical point of view; they also raise extensive ethical questions. This has to do with the fact that the procedure of transplanting organs between individuals requires two separate processes—donating and receiving –, which both have to be arranged by the institutions that are responsible for each respective process. In other words, curing or relieving one human being’s suffering depends on another human being giving up a part of his body and donating it to the recipient (directly in the case of a living donation , and anonymously in the case of a post mortem donation). This raises such questions as to what extent the body is a part of our ego (self) or also then becomes the ego of the other person. In addition, the question is raised whom our body belongs to and what we can accept and also expect from others. In conclusion, how should we handle the transplanted part that belonged to a stranger so that it becomes a part of us and that we can then consider our own? These are all questions that mainly concern the recipient.

A second round of ethical discussion concerns the donor: In contrast to other medical interventions, the removal of an organ is not a curative procedure. Thus, removing an organ from a living person contradicts the principle that an intervention should only be permitted if it serves the benefit of those involved. In the case of a deceased individual, it contradicts the principle of deference. Under what circumstances can the benefit of the recipient, which is undoubtedly a given fact, outweigh the principles of these fundamental rules? What role does respecting the autonomy of the donor play or what role should it have to play? How can the risk and damage for the donor be reduced?

In the end, there is a discrepancy between the demand and need for transplant goods and the available supply of donor organs. However, when a commodity is sacre the question is raised of whether this scarcity can be remedied by increasing the amount of supply. If this is not possible then the question of the distributive equity of the scarce good arises. This is the third ethical round of discussion: What criteria does the distribution of organs have to follow in order to comply with the fundamental principle of fairness ?

These are the three ethical rounds of discussion that serve as the categories that questions from contemporary dialogs on organ transplantation can be placed in.

It is a known fact that the organ transplantation system in Germany has been subject to criticism for quite some time.

It started with a few federal German states that advanced a legal reform in May 2011 concerning organ donation. The aim behind this initiative was to increase the provision of donor organs. The facts that led to the launch of this reform were the statistics showing that Germany ranked quite poorly in the overall comparison of organ donors in European countries. Among the approximately 12,500 registered recipients who are waiting on a donor organ, one out of every three—which amounts to approximately 1000 people per year—die before they are able to receive the life-saving transplant. These are just numbers, but these numbers also signify the fate of individuals including young people and children, who have to live their lives under restricted conditions on a daily basis, which most of us cannot even begin to fathom. Part of the blame needs to be placed on the mandatory consent(opt-in) law, which has been in place in Germany since 1997 (Transplantationsgesetz) and relies solely on the moral plea to all German citizens to fill out and carry a donor card with them at all times. The indication that one of the reasons behind organ scarcity lies in the “non-exploitation of donor potential” was mentioned in a statement made by the National Ethics Council in 2007 (Nationaler Ethikrat 2007, p. 18). A political effort to increase the number of organ donations led to a cross-party decision in the German Federal Parliament in May 2012, amending the German transplant law in the sense that all German citizens over the age of 16 are prompted by their health insurance provider every two years to declare their willingness to be a registered organ donor (cf. Gesetz). To what extent this so-called “declaration law” serves as an adequate instrument in resolving the problem of organ donor scarcity or at least abating it is yet to be determined.