Suchergebnisse

Abstract
The Eurotransplant Kidney Allocation System (ETKAS) emerged from the XCOMB model by Wujciak and Opelz (1993a,b), who applied computer simulation studies to create an allocation algorithm. The present study investigated how experts would allocate a donated organ to patients on the waiting list with respect to the five allocation factors proposed in the ETKAS (number of mismatches, mismatch probability, waiting time, distance, international exchange balance). The experts' evaluations were compared to the ETKAS points as well as to factor weights established in mandatory allocation guidelines which are based on the German law for organ allocation (Transplantationsgesetz). The investigation was carried out using a conjoint analysis. Overall, the results indicate a fairly high degree of agreement between the experts' opinions and the existing allocation system ETKAS and even more so for the allocation guidelines, in particular, with respect to the factors Mismatches, Mismatch probability, and Waiting time.

Abstract
For patients suffering from renal failure, cadaveric donor kidneys are a scarce and valuable good. In 1996, the Eurotransplant International Foundation implemented a new kidney allocation. system. The aim of this paper is to identify and discuss issues of distributive justice in kidney allocation, with an emphasis on the basic features of the new Eurotransplant system. Particular consideration is given to waiting time and medical success.

Abstract
To facilitate access for the wider international audience interested in issues of organ allocation the texts in this volume are all in English. But in view of the fact that Analyse & Kritik, though an international journal, is published in Germany it seemed appropriate to provide a German introduction and overview. This overview outlines the background of organ donation and transplantation as seems useful for the 'uninitiated' reader and positions the papers of the volume on the intellectual map. In the end the articles of the volume speak for themselves while the comments that conclude it may be helpful as springboards for further critique.

Abstract
In a questionnaire study on organ allocation 348 students of medicine (102) and economics (246) at the universities of Halle (114 students) and Hannover (234 students) responded to questions concerning their basic attitudes toward alternative criteria of organ allocation. Medical criteria were widely accepted by the respondents. Considerations concerning the patient's value to society were seen as being of minor importance. With respect to reciprocity, we could detect a high share of respondents who would favor former living donors and discriminate against murderers. Among considerations of fairness, the criterion of waiting time gained the highest support. Furthermore, majorities favored the view that health-compromising behavior and differences in age should play a role. Economic considerations were strongly rejected as criteria of organ allocation.

Abstract
Experts in the field of organ transplantation had to rank order a set of 32 patients according to their priority in receiving a donated kidney. The patients were described by the five characteristics that are incorporated in the kidney allocation algorithm applied by Eurotransplant. The priority rankings as defined by the experts were analyzed and patterns of dedsion making identified in the rankings investigated in this study. All patterns could be explained by some type of lexicographical ranking. The larger group of experts preordered tissue compatibility or, more technically speaking, the criterion of HLA match, while the complementary group applied the criterion of the length of waiting time first. Analyzing the finer decision structures of expert rankings and com paring the method of pattern exploration with a conjoint measurement analysis led to two follow-up questions: First, how can the value judgments of the experts be described adequately? Second, which type of aggregated ordering derived from the individual rankings represents them 'best'?

Abstract
The benefits of a large organ pool accrue not only to the actual organ recipients themselves, but to others as well due to the insurance it provides against having to wait 'too long' for an organ transplant. We argue that this public good character of a large organ pool makes it economically and ethically justifiable to design a market mechanism that boosts the number of donors. Most importantly, such a mechanism has the potential to substantially alleviate the troubling equity and efficiency problems on the demand side while, at the same time, being entirely independent of the allocation algorithm used for the distribution of organs.

Abstract
The implementation of the Wujciak algorithm as a new rule for organ allocation by Eurotransplant is of considerable interest for the theorist of choice making. In the process reformers accepted the status quo in principle but expected that their potential opponents would be willing to make minimal or 'tolerable' concessions. Thereby the consensual introduction of new dimensions of value and reforms of allocation practices based thereupon became viable. The paper characterizes a decision procedure based on 'almost lexicographically pre-ordering established values and practices' in a stylized manner, presents a formal reconstruction of it and points out some of its potential implications for rule choices in general.

Abstract
In the Eurotransplant region transplantable kidneys from cadaveric donors are allocated according to the Wujciak-Opelz algorithm. This paper shows that the algorithm as it stands fulfils certain normative standards of a more formal nature while violating others. In view of these insights, it is explored how the algorithm could perhaps be improved. Even if issues of substantial rather than formal adequacy need to be addressed separately, analyses as presented in this paper can prepare the ground for a discussion of substantive normative issues. In any event, axiomatic accounts can tell us something about what we are in fact doing when using a procedure like the Wujciak-Opelz algorithm.

Abstract
The selection and balancing of values for the Eurotransplant kidney allocation algorithm poses both practical and ethical challenges. The paper argues that any allocation algorithm can only be justified by reference to some substantive conception of a good life that reflects our value preferences regarding the allocation of scarce donor kidneys. It is concluded that the criterion of HLA compatibility maximizes overall rather than individual utility. The paper emphasizes that good pragmatic arguments for maintaining the primacy of HLA matching can never replace a more systematic, independent ethical justification. As neither the selection nor the balancing of the different allocation criteria are based on an explicit ethical justification, the paper concludes that the choice of the Wujciak-algorithm was rather a product of pragmatic compromise than moral consensus.

Abstract
Every action decision made by an actor is preceded by a special definition of the situation that first structures the preferences and expectations from which the selection of an action proceeds in a second step. In a conception based on the 'subjective expected utility' (SEU) Esser 1996 modelled the definition of a situation as a dual structure comprising two stages of selection: the selection of the model and the selection of the mode of information processing. In this paper it is shown how a link to a threedimensional picture of the situation emerges from the formal assumptions of these two selection steps. Depending on the selected utility ratios this picture then represents the choice of the mode of information processing as a function of subjective probabilities.

Abstract
Whereas Eichenberger advocates better policies by deregulation of politics, politicians and political scientists in Western Europe are quite satisfied with Western democracies and their performance. This satisfaction is based on neglecting the insights from 'Public Choice' theorizing as well as on negating the coming pension crisis in ageing societies. Including Eichenberger's ideas there are now five schools of thought about how to improve Western democracies: more direct democracy, strengthening market-preserving federalism, less law and fewer lawyers, exploiting international rivalries for limiting government and, now, dismantling the protection from foreign competition which elected representatives enjoy almost everywhere in the West.

Abstract
Eichenberger's 'deregulation' concept is designed to make political competition as similar to market competition as possible. The aim is to replace the competition of encompassing programmes by the competition of issue specific policies. In my view this idea is mistaken. First, it is by no means clear how the proposed institutions might work, since no hint is given how issue specific policy supply and unspecific political demand are matched. Second, and more important, the conception is normatively unconvincing. It aims at dissolving the political decisions of a society into an aggregate of separate and mutually independent issue specific policy decisions - which would destroy the role politics has in a market society, namely, to provide market-complementary and not just market-analogous decisions.

Abstract
Deregulation of the political process could be an instrument to reduce the overwhelming power of specialised interest groups and tighten the links between voters and politicians. But deregulation causes serious problems. Reputation pooling by international political enterprises depends on a transnational public sphere which is quite unrealistic. And political enterprises are not capable of shaping candidates for public service. Putting political finance in the hands of voters simply moves lobbying activities to the level of voters and does not change the asymmetrical influence of interest groups. Above all, the idea that political enterprises exchange experts in parliament does not fit into the crucial principle of parliamentary government and political responsibility.

Abstract
This paper concerns Philippe Van Parijs's case for an unconditional basic income. It argues that given central egalitarian commitments-to wit, (i) equal concern and respect; (ii) endowment-insensitivity (which can be seen to include Van Parijs's project of maximizing or leximinning real freedom); (iii) ambition-sensitivity; and (iv) neutrality-endorsed by Van Parijs, a basic income does not appear to be a requirement of justice. The core claim defended is that there is a serious tension between (iii) and the idea of an unconditional basic income.

Abstract
Philippe Van Parijs's ethical justification of basic income is based on the argument that job resources must be shared equally. Underlying this idea are two important claims: (1) all individuals in society hold an ex. ante entitlement in job resources and (2) job resources are tradable: First, I present the real-libertarian argument for sharing job resources. Next, I identify and critically review three different objections against this view: the liability objection, the cooperation objection and the parasitism objection. I believe the parasitism objection poses a serious challenge to basic income, and argue that Van Parijs's most plausible response-based on the idea that job resources are socially owned-is flawed. I provide the outline of an alternative normative basis for grounding a person's ex ante entitlement to job resources using an institutionalist approach.