The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations

Background. The degree of involvement by the next-of-kin in deceased organ procurement worldwide is unclear. We investigated the next-of-kin’s authority in the procure-ment process in nations with either explicit or presumed consent. Methods. We collected data from 54 nations, 25 with presumed consent and 29 with explicit consent. We char-acterized the authority of the next-of-kin in the decision to donate deceased organs. Specifically, we examined whether the next-of-kin’s consent to procure organs was always required and whether the next-of-kin were able to veto procurement when the deceased had expressed a wish to donate. Results. The next-of-kin are involved in the organ procure-ment process in most nations regardless of the consent principle and whether the wishes of the deceased to be a donor were expressed or unknown. Nineteen of the 25 nations with presumed consent provide a method for individuals to express a wish to be a donor. However, health professionals in only four of these nations responded that they do not override a deceased’s expressed wish because of a family’s objection. Similarly, health profes-sionals in only four of the 29 nations with explicit consent proceed with a deceased’s pre-existing wish to be a donor and do not require next-of-kin’s consent, but caveats still remain for when this is done. Conclusions. The next-of-kin have a considerable influ-ence on the organ procurement process in both presumed and explicit consent nations

Retrenchment, reproduction, modernization: pension politics and the decline of the German breadwinner model

The German welfare state in gendered welfare state analyses is widely recognized as a strong male breadwinner model: its institutions support the traditional division of labour and low female labour force participation. This article seeks to show that due to diminishing political support this model is eroding. The article starts from the assumption that the welfare state is a mediator between dynamic social and economic requirements. Therefore social policy regulations need to be adjusted continuously. This need has intensified over the last decade because of growing global economic competition and the collapse of the East German economy. The way social policymakers reacted to this pressure for reform shows no active support for the policies that help to maintain women's economic dependency on 'breadwinners'. This will be demonstrated by an analysis of the positions of the political actors involved in two major pension reforms, one in 1989 and one in 1997. According to their public statements these actors were motivated by three factors: firstly, they agreed that retrenchment measures were necessary; secondly, the intention to secure generational reproduction by improving carers' independent rights was dominant; thirdly, reforms were motivated by the intention to make the pension system more just. The direction of the reforms is to reduce the economic attractiveness of marriage and to create stronger incentives to be employed