This paper concerns the structural development of German transplantation medicine and the organ allocation system in the interest of all those involved, especially patients waiting for transplants. The central issues are:

• The democratic legitimation of basic normative allocation criteria by parliament
• An effective legal protection framework for patients
• An independent organisational structure that avoids intertwining between specific institutions and practitioners and which facilitates clear accountability
• The further development of transplant centres, which are assessed for the quality of their processes, structures and results, and which conduct transplant research
• Comprehensive transparency at every level

The following considerations should serve as a springboard for the necessary discussions to further develop transplantation medicine. Whilst the standard of transplantation medicine in Germany is admittedly high, it urgently requires better and more effective structures.