It is a scenario no one wants to contemplate, particularly before going on vacation -- the possibility of a serious accident, leading to death. Yet most people are unaware that in some countries, such as Austria, France, Italy and Spain, doctors are allowed to remove human organs without consent to save the lives of others. That doesn't exclude foreign tourists.

"After brain death has been confirmed, the victim may -- without consulting relatives -- be deboned, be exploited," said Dresden-based attorney Heinrich Meyer-Götz. "That means kidneys, liver, lungs, all the cartilage, corneas, veins -- today they can make use of almost everything. And the relatives have no opportunity to file a protest. I think that's bad."

The summer vacation period has just begun in Europe, when most Germans go on holiday. But few travelers realize that transplant regulations vary from country to country. There are no warnings, because the organizations and politicians concerned with the issue support these more permissible laws -- for everyone.

"Of course the Austrians will say 'these particular regulations are valid here, and (ask) would you consent to the removal of organs?'" said Claus Wesslau of the German Foundation for Organ Transplantation. "You must expect that if you travel abroad. On the other hand, if a recipient is given a heart from England, and this results in a life-saving operation to save his life, he's not going to ask whether the heart was removed according to valid German law or English law."

Doctors say no need for concern

Doctors in Germany know the regulations better than their patients. Peter Neuhaus is one of the country's leading transplant surgeons. He says people shouldn't be too concerned about the issue.

"Our colleagues in Austria are very sensitive," said Neuhaus, director of the transplant center at Berlin's Charité hospital. "In Austria, too, they always ask the spouse, the parents or the relatives of the deceased. And if they say that they don't want to donate organs, their wish is always respected."

But if they're unable to contact a relative, doctors are allowed to remove organs without permission, according to what is known as the 'refusal regulation.'

Lawyer Meyer-Götz provides his clients with protection from having their organs removed without consent. They can apply for an extension to their passports that declares that the holder is unwilling to donate his or her organs. The information is also entered into an international refusal register.

Too few donors

But some doctors see the Austrian law as a model other countries should consider emulating to help make up for the lack of organs for patients in need.

"I think that the Austrian solution, which is also customary in Belgium and Spain, really is the right solution," said Dr. Neuhaus. "Unfortunately, we're unable to push it through because of attitudes on ethical and moral grounds. Look at the German attitude towards embryonic stem cells and other debates. We are always a little more perfect than everyone else and are constantly afraid that our individual freedom is no longer being safeguarded somewhere."

In Germany, organs can only be removed with the explicit permission of the deceased. This hurdle makes organ transplants considerably more difficult than in countries that have a refusal regulation. The result is that Germany has an acute shortage of organs.

"A thousand patients on the waiting list die in Germany every year," said Wesslau. "A patient waiting for a kidney must wait on average, four to six years. And for the patient, this is just not acceptable -- not just the dying, but this long waiting period as well."

No change likely

Though opponents of the refusal regulation accept that changing the law could save lives, say the right to decide for oneself is more important. "I can decide whether my organ should be removed for another person; it's not up to doctors to decide that they want to use it," Meyer-Götz said.

Neither the government nor the opposition foresee an imminent change in German transplant law since Germans continue to have too many reservations.

"I could imagine that many people would have doubts about whether they would more or less have to be organ donors, depending on the situation, even if they didn't want it," said Julia Klöckner, an opposition Christian Democratic party parliamentarian and member of the Bundestag's Committee of Enquiry into Transplant Law.

The upshot is that Germans suffering organ failure could find themselves better cared for on vacation than at home.