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The right to self-determination

Sometimes patients are no longer able to make their own decisions. That is why Germany has advance healthcare directives and organ donor cards.

Kim Berg, 23.05.2020
There were 740,000 applications for organ donor cards in January 2020.
There were 740,000 applications for organ donor cards in January 2020. © picture alliance / Geisler-Fotopress

What treatments would you want to receive if you became seriously or even incurably ill? Would you want to donate your organs in the event of your death? The German healthcare system gives people the chance to make their own decisions. Whether it is with an advance healthcare directive or an organ donor card, people in Germany can decide for themselves how they want to be treated.

Organ donor card

An organ donor card (Organspendeausweis) determines whether doctors are allowed to remove organs or tissue after someone’s death. In 2019, according to a survey by the Federal Centre for Health Education (BZgA), 36% of Germans had one of these cards. In other words, organ donations in Germany are subject to an opt-in system. If you want to donate your organs after your death, you have to actively decide in favour of doing so. In 2019, 932 people in Germany donated their organs after their death. On average, one donor saved the lives of three severely ill patients. Unfortunately, that is still not enough. Over 9,000 people in Germany are currently waiting for a donated organ.

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As a result, in 2019 Federal Health Minister Jens Spahn floated the idea of an opt-out solution. This would make everyone a potential organ donor unless they expressed their opposition to the idea while still alive. However, the Bundestag rejected this solution in January 2020. It is now relying on better public education to achieve this goal. Initial successes were already seen in January 2020: 740,000 people requested an organ donor card – more than double the monthly average in 2019.

Advance healthcare directive

It is one of the most difficult questions in life: what kind of treatment do I want if I become incurably ill or suffer a severe injury? Often patients are then no longer able to express their wishes. For that eventuality in Germany there is the advance healthcare directive (Patientenverfügung). It enables people to define precise treatment wishes, which can then be realised by their doctors. Would I like, for example, to receive life-supporting measures during the dying process? And where would I like to die?

Since the beginning of the corona crisis there has been an addition to the conventional advance healthcare directive. It enables people to determine which measures should be taken in the event of them suffering a severe case of COVID-19.


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