Journal of Public Health

, Volume 25, Issue 3, pp 249–256 | Cite as

Attitudes towards brain death and conceptions of the body in relation to willingness or reluctance to donate: results of a student survey before and after the German transplantation scandals and legal changes

  • Silke SchicktanzEmail author
  • Larissa Pfaller
  • Solveig Lena Hansen
  • Moritz Boos
Original Article



In Germany, two events regarding organ donation in 2012 happened: media reported about allocation scandals and regulations concerning regular public information were implemented. Public mistrust as a result of the scandals was repeatedly utilized to explain the current decrease in donation rates.


To test for public attitudes towards organ donation, a comprehensive survey with 55 sets of closed questions was conducted twice (2008/09 and 2014/15) with students of medicine and economics (total n = 1403) at the University of Göttingen. Statistical analysis involved a multivariate regression using R 3.2 and focused on potential pre/post-shifts in willingness and on social or attitudinal factors linked with reluctance to donate.


The survey revealed that donation willingness increased (58–75%); in 2014 twice as many held a donor card (24–52%). The majority in both periods agreed that there is a problem of fair allocation (64–74%). Only a small minority considered transplantation well regulated pre- (15%) and post-scandal (11%; p < 0.05 sig.). Analysis of attitudes for reluctance identified non-acceptance of the brain death criterion and sharing a holistic conception of the body linking the human body to personal identity.


Reluctance to donate seems to be linked to deeper cultural attitudes.


Survey Attitudes Organ donation Brain death Germany Scandals 



We would like to thank Gitit Bar-On, Klaus Hoeyer, Myfanwy Morgan and Jochem Rieger for comments on an earlier version.


Silke Schicktanz was responsible for planning of the study, conception of survey and analysis, figures, manuscript preparation and finalization. Larissa Pfaller took care of statistical analysis, manuscript preparation and figures, and Solveig L. Hansen was in charge of background analysis of current state of the art technologies, data collection and manuscript preparation. Moritz Boos contributed to statistical analysis and figures.

Compliance with ethical standards

Conflict of interest

All authors state that they do not have any conflict of interest.


This study is part of the research project GZ SCHI 631/7-1 funded by the German Research Foundation.


  1. Amber R, McDaid C, Suekarran S, Myers L, Sowden A (2009) Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 338:a3162. doi: 10.1136/bmj.a3162 CrossRefGoogle Scholar
  2. Banas B, Beyer B, Eckert M, Gruber H, Pfirstinger J, Schaller O, Dietl B (2013) Informationsstand von Regensburger Studierenden zu Organspende und Transplantation: informierte oder nicht informierte Zustimmung zur Organspende? DMW 138:775–780. doi: 10.1055/s-0032-1332960 CrossRefGoogle Scholar
  3. Berndt C. (2012) Geld oder Leber. Süddeutsche Zeitung June 16:24Google Scholar
  4. Deutsche Stiftung Organtransplantation (2016) Statistiken. Accessed 10 March 2016
  5. European Commission (2014) Journalist workshop on organ donation and transplantation. Recent facts and figures. Accessed 10 December 2015
  6. Federal Centre for Health Education (BZgA) (2009) Organ- und Gewebespende. BZgA, Cologne, Germany Accessed 17 April 2015
  7. Federal Centre for Health Education (BZgA) (2015) Report on the 2014 Representative Survey “Knowledge, Attitude and Behaviour of the General P.ublic Regarding Organ and Tissue Donation”. Accessed 17 April 2015
  8. Guttmann N, Ressler WH (2001) On being responsible: ethical issues in appeals to personal responsibility in health campaigns. J Health Communication 6:117–136CrossRefGoogle Scholar
  9. Heuer M, Radunz S, von Hugo F, Kirchner C, Wittenburg N, Stammen KH, Paul A, Kaiser G (2014) Online intervention study: willingness to donate organs among the employees of a German university. Eur J Med Res 19:1–6. doi: 10.1186/s40001-014-0043-y CrossRefGoogle Scholar
  10. Hoeyer K, Jensen AMB, Olejaz M (2015) Transplantation as an abstract good: practising deliberate ignorance in deceased organ donation in Denmark. Sociol Health Illn 37:578–593. doi: 10.1111/1467-9566.12211 CrossRefPubMedGoogle Scholar
  11. Hyde R (2012) German doctors call for reform after organ scandal. Lancet 380:1135. doi: 10.1016/S0140-6736(12)61650-X CrossRefPubMedGoogle Scholar
  12. Inthorn J, Wöhlke S, Schmidt F, Schicktanz S (2014) Impact of gender and professional education on attitudes towards financial incentives for organ donation: results of a survey among 755 students of medicine and economics in Germany. BMC Med Ethics 15:1–8. doi: 10.1186/1472-6939-15-56 CrossRefGoogle Scholar
  13. Morgan M, Kenten C, Deedat S (2013) Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the UK: a synthesis of quantitative and qualitative research. Ethn Health 18:367–390. doi: 10.1080/13557858.2012.752073 CrossRefPubMedGoogle Scholar
  14. Neuberger J, Murphy P (2013) Comment on ‘Lessons from the German Organ Donation Scandal’. JICS 14:201–203Google Scholar
  15. Newton JD (2011) How does the general public view posthumous organ donation? A meta-synthesis of the qualitative literature. BMC Public Health 11:1–11. doi: 10.1186/1471-2458-11-791 CrossRefGoogle Scholar
  16. Pondrom S (2013) Trust is everything. Am J Transplant 13:1115–1116. doi: 10.1111/ajt.12277 CrossRefPubMedGoogle Scholar
  17. R Development Core Team (2012) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Accessed 20 June 2016
  18. Radunz S, Benkö T, Stern S, Saner FH, Paul A, Kaiser GM (2015) Medical students’ education on organ donation and its evaluation during six consecutive years: results of a voluntary, anonymous educational intervention study. Eur J Med Res 20:1–5. doi: 10.1186/s40001-015-0116-6 CrossRefGoogle Scholar
  19. Repräsentative Befragung der Allgemeinbevölkerung Zusammenfassung. . Accessed 17 April 2015Google Scholar
  20. Sahin H, Abbasoglu O (2015) Attitudes of medical students from different countries about organ donation. Exp Clin Transplant. doi: 10.6002/ect.2014.0228 Google Scholar
  21. Shaw D (2013) Lessons from the German organ donation scandal. JICS 14:200–201. doi: 10.1177/175114371301400304 Google Scholar
  22. Schweda M, Schicktanz S (2009) The “spare parts person”? Conceptions of the human body and their implications for public attitudes towards organ donation and organ sale. Philos Ethics Humanit Med 4:1–10. doi: 10.1186/1747-5341-4-4 CrossRefGoogle Scholar
  23. Schwettmann L (2015) Decision solution, data manipulation and trust: the (un-)willingness to donate organs in Germany in critical times. Health Policy 119:980–989. doi: 10.1016/j.healthpol.2015.01.017 CrossRefPubMedGoogle Scholar
  24. Siegmund-Schultze N (2014) Organ donation in Germany: getting out of a tense situation. Accessed 10 December 2015 (English translation of author’s article: (2013) Organspende in Deutschland: Wege aus einer angespannten Situation. Deutsches Ärzteblatt 110:A–2118/B–1872/C–1826)
  25. Venables WN, Ripley BD (2002) Modern applied statistics with S, 4th edn. Springer, New YorkCrossRefGoogle Scholar
  26. Wöhlke S, Inthorn J, Schicktanz S (2016) The role of body concepts for donation willingness: insights from a survey with German medical and economics students. In: Jox RJ, Assadi G, Marckmann G (eds) Organ transplantation in times of donor shortage: challenges and solutions. Springer, Heidelberg, Germany, pp 27–49Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Silke Schicktanz
    • 1
    Email author
  • Larissa Pfaller
    • 2
  • Solveig Lena Hansen
    • 1
  • Moritz Boos
    • 3
  1. 1.Department of Medical Ethics and the History of MedicineUniversity Medical CenterGöttingenGermany
  2. 2.Institute of SociologyFriedrich-Alexander-UniversityErlangen-NürnbergGermany
  3. 3.Department of Applied Neurocognitive PsychologyCarl von Ossietzky UniversityOldenburgGermany

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