Critical analysis of the allocation policy for liver transplantation in Brazil

Liver transplantation is now the standard treatment for end-stage liver disease. Given the shortage of liver donors and the progressively higher number of patients waiting for transplantation, improvements in patient selection and optimization of timing for transplantation are needed. Several solutions have been suggested, including increasing the donor pool; a fair policy for allocation, not permitting variables such as age, gender, and race, or third-party payer status to play any role; and knowledge of the natural history of each liver disease for which transplantation is offered. To observe ethical rules and distributive justice (guarantee to every citizen the same opportunity to get an organ), the "sickest first" policy must be used. Studies have demonstrated that death has no relationship with waiting time, but rather with the severity of liver disease at the time of inclusion. Thus, waiting time is no longer part of the United Network for Organ Sharing distribution criteria. Waiting time only differentiates between equally severely diseased patients. The authors have analyzed the waiting list mortality and 1-year survival for patients of the State of São Paulo, from July 1997 through January 2001. Only the chronological criterion was used. According to "Secretaria de Estado da Saúde de São Paulo" data, among all waiting list deaths, 82.2% occurred within the first year, and 37.6% within the first 3 months following inclusion. The allocation of livers based on waiting time is neither fair nor ethical, impairs distributive justice and human rights, and does not occur in any other part of the world.

Políticas Sociais: focalização ou universalização?

Public debate on social policies in Brazil has focused on the choice between targeted and universal programs. The article argues that the choice is unclear and misleading unless a previous decision is taken concerning principles of social justice. After distinguishing three different connotations of targeting - as residualism, conditionality or retification - and noting that universal programs may be compatible with minimalist social policy, the article goes on to make explicit a number of neglected options.

Modelos de crescimento kaleckianos: uma apreciação

The purpose of this article is to survey the main papers that founded a kaleckian approach of the economic growth. It presents a certain moment of the historical evolution of the non-neoclassical macrodynamics. This analysis can be understood under the political economy tradition in putting together social classes (capitalists and workers), distributive conflict and the relationship between distribution and accumulation.

A persistência da indexação no Brasil pós-Real

The paper analyzes the shortcomings of the Real Plan combining political science and economics, considering evidences on difficulties in implementing a complete plan of deindexation, namely: the distributional conflict, the corporatist relations between the State and society and the bureaucratic isolation of a highly specialized technocracy. The announcement of the plan triggered defensive reactions, fueling distributive tensions during the URV period, forcing the economic team to take measures that contradicted the overall guidelines followed. The persistence of indexation mechanisms indicate the resulting obstacles in seeking a reform of the State through a stabilization plan, even though the latter has the former as a precondition.