The German Medical Association (Bundesärztekammer) is the joint association of the 17 state chambers of physicians and hence a union of public corporations. In the transplantation system, the German Medical Association carries out two central tasks. Firstly, it is legally commissioned to determine the level of knowledge of medical science and transforms it into guidelines. Secondly, it belongs to the circle of contracting entities of coordination and exchange authority and therefore belongs to the independent testing and surveillance commission which monitors the compliance with the guidelines. The core principle of the German transplantation organizational law is thus the idea of “regulated self-regulation”.

In the course of the violations that took place within the frame of organ donation which got released to the public in 2012, the patient protection organization demands the establishment of a governmental system of organ donation and distribution with the argument that the current practice grants neither a constitutional control nor a possibility of a legal protection. The politics currently rejects giving the transplantation system to the hands of the state. The guidelines according to which hearts, lungs, livers, kidneys or pancreases are donated must be approved by the ministry of health. Furthermore, the independent confidentiality office “transplantation medicine” was established by the German Medical association. Its task is to receive and clarify confidential indications regarding irregularities and peculiarities in the domain of organ donation and transplantation. The confidentiality office is independent of the prosecution authorities.

The Bundesärztekammer has established Guidelines for inclusion in the waiting list for donor organs. These Guidelines stipulate that a patient may only be included in the waiting list if

1. no other treatment is likely to be effective,
2. the disease of the patient’s organ is certain to induce serious, life-threatening illness, or if such a stage of disease has already been reached, and
3. if there is a substantial likelihood of the patient having a longer and better life after successful transplantation than without this intervention.

Arguments against waiting list inclusion include several diseases that are likely to negatively affect the short- or long-term success of transplantation, such as malignant diseases which have not been cured, clinically manifest infectious diseases, HIV infections, and serious diseases of other organs. Other possible contraindications for waiting list inclusion include heavy consumption of nicotine, alcohol or other drugs; still, the physical and mental condition of each patient must be appreciated and assessed as a whole. Another prerequisite for the allocation of a donor organ is that the recipient’s general state of health must be stable enough for an operation and that he/she has consented to undergo long-term follow-up drug therapy (compliance). Especially the latter is subject to controversy in an ethical context: Although it is undisputed that the regular intake of immunosuppressants following organ transplantation is a prerequisite for long-term success of the intervention, it could be considered disproportionate, from an ethical point of view, to classify non-compliance as a contraindication.
Pursuant to § 16 TPG physicians have a duty to observe the Guidelines of the Bundesärztekammer on the administration of waiting lists and organ allocation.