[Re-thinking Organ Donation: Structural development, Multiprofessional Collaboration, and Data-Driven Research]

The number of organ donations in Germany still does not meet the actual demand of patients on waiting lists, although there has been an increase in the first quarter of 2026 compared to the previous year. An effective and streamlined design of the overall process facilitating to organ donation after brain death is therefore mandatory. In addition to medical aspects, the establishment of adequate structural units and teams as well as mechanisms for quality assurance play a crucial role in achieving a coherent process organization with the best possible outcome, i.e. a high number of transplantable organs of excellent quality. Despite several efforts and improvements over the last couple of years, the overall goal to establish an integrated, data-based organ donation and transplantation system in Germany could not be achieved so far. However, examples from other European countries demonstrate successful improvements in structural conditions and process concepts leading to higher numbers and therefore better outcomes and might therefore also be useful for future improvement efforts in Germany. It will also be essential in the future to generate evidence for the various therapeutic approaches within the different stages of organ donation by conducting focused and meaningful research in transplantation medicine in general, but especially in organ donation. This is particularly necessary in light of the already mentioned shortage of donated organs. This review article therefore briefly examines existing structures in the European country with the highest number of organ donations per inhabitant (Spain), as well as the already partly successful establishment of similar institutions and organizational units in Germany. In addition, by introducing the German Transplantation Registry (TxR), this article aims to highlight a resource for research in the field of organ donation that has not yet been fully utilized.