Organ Donation Rates Across the EU

Key Takeaways

• Spain recorded 53.9 deceased organ donors per million people in 2024. That is the highest deceased organ donor rate among the EU’s 27 countries.
• Bulgaria recorded the EU’s lowest deceased organ donor rate in 2024. It reported 2.4 donors per million.
• Czechia (34.3 per million) and Croatia (30.3) both post higher deceased organ donor rates than Germany despite having smaller economies. 
• Spain’s lead in deceased organ donor rate comes mainly from its network of hospital transplant coordinators and its focus on organ donation after circulatory death.
• Spain’s organ donation law makes adults donors by default unless they register to opt out. Most EU countries share this same law despite showing very different deceased organ donor rates.
• Across the EU, how well hospitals identify and report potential organ donors explains a country’s deceased organ donor rate better than its wealth or consent law.

Deceased Organ Donor Rates Across the EU

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Learn something new about Germany every week and make informed decisions with confidence.

Spain’s Deceased Organ Donor Rate Leads the EU Because of Its Transplant Coordinators

Spain recorded 53.9 deceased organ donors per million people in 2024. That is the highest deceased organ donor rate among the EU’s 27 countries.

Spain’s organ donation law makes adults donors by default unless they register to opt out. This is the reverse of opt-in systems, where nothing happens unless someone actively signs up to become a donor.

However, Spain’s opt-out law does not explain differences in donation rates between countries.

Spain’s deceased organ donor rate is more than double the EU-27 average of 24.2 per million. That lead traces mainly to its network of hospital transplant coordinators.

Intensive care specialists in every hospital are trained to identify potential deceased organ donors and manage the organ donation process.

Spain also prioritizes organ donation after circulatory death. That method recovers organs after a patient’s heart stops, rather than only after brain death is confirmed.

More patients die by circulatory death than by brain death, which expands the pool of potential donors.

Spain recorded 1,316 organ donors after circulatory death in 2024. That single country accounted for half of all such organ donors across the EU in 2024.

Spain’s large share of the EU’s organ donors after circulatory death partly reflects how few EU countries actively practice this method of donation.

Germany, for example, does not legally recognize circulatory death as grounds for organ donation. It contributes no organ donors after circulatory death to that total as a result.

Germany’s Deceased Organ Donor Rate Is Low Because Hospitals Don’t Report Donors

Germany is the EU’s largest and wealthiest member state. Its deceased organ donor rate ranks only 22nd of 27 EU countries. That rate was just 11.4 per million in 2024, less than half the EU-27 average.

Public opinion is not the cause of Germany’s low deceased organ donor rate. The share of Germans carrying an organ donor card stood at 17% in 2010. By 2015, it had climbed to 36%.

The real problem with Germany’s low deceased organ donor rate lies with hospitals. Many fail to identify potential deceased organ donors or report them to Germany’s transplant network.

Germany’s hospital reporting rate to the transplant network stood at 11.4% in 2010. It had fallen to 8.2% by 2015.

The decline in Germany’s hospital reporting rate also lines up with a 2012 scandal at German transplant centers. Several centers were caught manipulating patient waiting-list data that year.

Doctors likely grew more cautious about reporting potential deceased organ donors after the scandal broke.

Wealth Doesn’t Predict a Country’s Deceased Organ Donor Rate in the EU

Two much smaller, less wealthy EU countries post higher deceased organ donor rates than Germany:

• Czechia: 34.3 per million (3rd highest in the EU)
• Croatia: 30.3 per million (6th highest in the EU)

Czechia and Croatia both have far smaller economies than Germany. Neither ranks among the EU’s wealthiest member states.

Croatia’s rise traces mainly to an empowered national transplant coordinator role created in 1999. Hospitals across the country also employ their own trained coordinators. That mirrors the model behind Spain’s own lead.

Bulgaria and Romania recorded the two lowest deceased organ donor rates in the EU:

• Bulgaria: 2.4 deceased organ donors per million
• Romania: 3.7 deceased organ donors per million

Bulgaria’s low rate traces mainly to a collapse in public trust in the health system. Frequent leadership turnover at the national transplant agency and unproven organ-trafficking allegations against a hospital both eroded that confidence.

Meanwhile, Romania’s shortfall stems mainly from public mistrust of the healthcare system, outdated hospital equipment, and slow, bureaucratic donation procedures.

Wealth and consent laws matter less than how well a health system finds and reports potential organ donors. 

Spain shows that a dedicated coordinator network can push a country’s deceased organ donor rate far above the regional average. Germany shows that even the EU’s wealthiest country can fall behind without that same organizational effort.