At germanium/high-k interfaces cations and oxygen interstitials can diffuse into the germanium substrate. Here we employ density functional theory calculations to investigate the interaction of a range of such cations (Al, Y, Zr, Nb, La, and Hf) with intrinsic defects and oxygen in germanium. It is predicted that high-k cations strongly bind with lattice vacancies, oxygen interstitials, and A-centers. The implications for microelectronic device performance are discussed. (C) 2012 American Institute of Physics.