Debate about the dissent solution

Starting point of the debate about the so-called dissent solution is the lack of donor organs. In 2019, there were only 932 organ donors; roughly 3,800 organs were transplanted compared to roughly 9,000 people on the waiting list. In order to increase the number of organ donors, Health Minister Jens Spahn (CDU) and health expert Karl Lauterbach (SPD), in July 2019, introduced a bill in the German Bundestag (which, eventually, was rejected), according to which “every person is considered an organ or tissue donor, unless there is a declared objection to or a preference against the removal of the organ or tissue.” This is, in essence, the dissent solution. If the next of kin has a right to object to the organ donation then this is called an extended or double dissent solution (analogous to the extended or double consent solution).

The main argument of the proponents of the dissent solution is that it increases the number of organ donors. Furthermore, it is stated that according to a representative survey by the German Federal Centre for Health Education (BZgA) in 2018, even hough 84% of those questioned had a positive attitude toward organ donation, only 36%, however, were in possession of an organ donor card. Therefore, the current decision solution would reinforce the disparity between potential and actual organ donors. Finally, proponents often point out that the dissent solution takes emotional pressure off the next of kin because they do not have to deal with the question of organ donation if the will of the deceased is unknown to them.

The main objection raised by opponents is that the dissent solution would impermissibly interpret a non-declaration or the omission of an objection as consent. The dissent solution would, therefore, infringe on a fundamental principle of medical ethics, namely the informed consent of a patient which must always be based on a deliberate and free decision. Furthermore, the dissent solution would represent a violation of various fundamental rights and values, such as human dignity, personal rights, and religious freedom. Finally, opponents indicate that the dissent solution does not necessarily lead to a higher number of organ donors as this depends on various other factors.

Review article on the pros and cons of the dissent solution in "Der Tagesspiegel" Online Version (German)

EThe following journal articles offer a detailed discussion in favour of (Rosenau/Knorre) and against (Schockenhoff) the dissent solution:

Rosenau, H. / Knorre, J. (2019): Die rechtliche Zulässigkeit der erweiterten (doppelten) Widerspruchslösung in der Organtransplantation. In: Zeitschrift für medizinische Ethik 65, 45–60. doi: 10.14623/zfme.2019.1.45-60.  Online Version (German)

Schockenhoff, E. (2019): Paradigmenwechsel zur Widerspruchsregelung? In: Zeitschrift für medizinische Ethik 65, 19–33. doi: 10.14623/zfme.2019.1.19-33.  Online Version (German)


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