Germany is the only European country with the decision solution. The decision solution is a variant of the (extended) consent solution, which is in force in Denmark, Georgia, Greece, Ireland, Lithuania, Malta, Montenegro, North Macedonia, Romania, Switzerland, Turkey, United Kingdom (Northern Ireland), Cyprus. A mixed system applies in Moldova, Slovenia and Sweden. In all other European countries the dissent solution is in place.

The Federal Centre for Health Education (BZgA), a federal agency which is part of the Federal Ministry of Health (BMG), defines the different forms of regulations of organ donation in the following way:

• Consent solution: According to the consent solution organs and tissue can only be removed if the deceased person has explicitly consented to organ donation during their lifetime. If there is no consent then it is impermissible to remove organs or tissue. No one is forced to make a decision. Among members of Eurotransplant there is no strict consent solution but rather an extended consent solution. This means that if the deceased person did not document their decision on organ donation, then the next of kin or other legal representatives are asked to decide on behalf of the deceased person on organ and tissue donation.
• Decision solution: This is a variant of the extended consent solution. Citizens are given neutral information on a regular basis so that they can make a safe decision for or against organ and tissue donation.
• Dissent solution: If the deceased person did not explicity object to organ donation during their lifetime, e.g. by documenting the objection in an opt-out registry, then organs can be removed for transplantation. In some countries the next of kin have the right to object to organ removal if there is no documentation of the decision of the deceased person.