Due to a persistent shortage of organ donations, the ‘opt-out’ system is once again being debated in Germany. In their article in the Frankfurter Allgemeine Zeitung, Alex Chan and Axel Ockenfels point out that empirical findings are not being sufficiently taken into account in the discussion. Studies show that, whilst the switch from an opt-in to an opt-out system leads to an increase in the number of registered donors, it results in only a minimal rise in actual donations, as families can refuse donation retrospectively. The authors therefore propose, as an alternative solution, a mandatory enquiry into attitudes towards organ donation, to be carried out when dealing with the authorities, which would include the option of not making a decision. Furthermore, they point out that improvements to the hospital system and to legislation on living donation offer considerable potential for reducing the shortage of donors.