Germany legalizes kidney exchange: A major step forward for organ transplantation – with contributions from Axel Ockenfels

On 26 March 2026, the German Bundestag adopted a landmark reform of the Transplantation Act, expanding the framework for living organ donation in Germany. For the first time, the law enables kidney exchange programs, allowing “crossover” donations between incompatible donor–recipient pairs.

Under the new rules, pairs who are willing but biologically incompatible can exchange donors with other pairs in similar situations. This mechanism, long established in countries such as Spain and United Kingdom, increases the number of feasible transplants and improves matching quality.

The work in market design and matching theory by Axel Ockenfels, Director at the Max Planck Institute for Behavioral Economics, as well as his policy advice, helped shape the legislative process and the design of kidney exchange systems.

While welcoming the reform as a major step forward, Ockenfels also highlights important limitations. The current law excludes biologically compatible donor–recipient pairs from participating in exchanges. However, compatibility does not necessarily imply the best possible match: allowing such pairs to participate could lead to better matches, reduce the risk of organ rejection, and increase the total number of transplants—benefiting all patients on the waiting list.

He also criticizes the planned implementation timeline. The system is expected to become operational only after a transition period of up to three years, intended to allow the development of the necessary infrastructure. Given that effective kidney exchange systems and reliable matching software already exist in several European countries, this delay is difficult to justify in light of the urgent needs of patients.

The reform nevertheless marks a decisive breakthrough. By introducing kidney exchange into German law, it aligns the country more closely with international best practices and opens new possibilities to save lives through improved organ allocation.