The Formation of Organ Donation Policy in Germany: Evidence, Politics and Public Opinion

David Wainwright,Anne Christine Hanser

doi:10.13189/ujph.2014.020501

Abstract

The gap between the demand and supply of organs for transplantation is a worldwide phenomenon that continues to tax policy-makers. We consider recent policy reforms in Germany, drawing on evidence from Spain and Austria for comparison. Our analysis adopts Kingdon's multiple streams model which suggests that windows of opportunity for policy change open when an issue of public concern combines with a plausible solution and favorable political circumstances. Evidence is central to this process, but the type of evidence and the ways it is used, differ from technocratic formulations of evidence based policy-making. Scientific evidence may contribute to the rational appraisal of options, but this and other forms of evidence are also used rhetorically to generate political will and public support for change. We conclude by considering what the formation of organ donation policy in Germany reveals about the processes of policy-making under the competing imperatives of rationalism and democracy.

Highlights

In August 2010, Frank-Walter Steinmeier, leader of the opposition SPD in the Bundestag, donated a kidney to his sick wife [1]
The Steinmeier donation sparked a national debate about organ donation policy, which coincided with a European Commission action plan on organ donation and transplantation that combined greater cooperation between member states with a requirement for national policy reform, [3], including a deadline for the reform of member states’ national transplantation laws by summer 2012
The comparative evidence of relatively poor donation indicators in Germany, the impetus given by the Steinmeier donation, the widely recognized ‘solution’ of presumed consent, coupled with the deadline for action set by the EU directive, combined to open the policy window and drive through reform

Summary

Introduction

In August 2010, Frank-Walter Steinmeier, leader of the opposition SPD in the Bundestag, (the German parliament), donated a kidney to his sick wife [1]. The problem stream refers to the process by which issues are articulated and placed on the decision-making agenda. The policy process requires clearly articulated plans for action from which politicians and policy-makers can select a solution. Policy change is likely to occur when there is a conjuncture between the three streams, that is, when recognizable problems coincide with feasible solutions and a favorable political climate. At such times a policy window opens allowing policy change to occur, and policy entrepreneurs (people who favor a particular solution) become active in the problem and policy streams, jockeying to promote their favored solution. The policy window may not stay open for long and if the opportunity is missed policy entrepreneurs may have a lengthy wait before policy change becomes viable again

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