The Evolution of Legislative Power-Sharing in the EU Multilevel System

While governance in multilevel systems involves many processes, legislation at the upper jurisdictional level is at its core. The lower levels of jurisdiction are represented at the upper level through a second legislative chamber. The exact competences of the second versus the first chamber are indicative of the degree of integration of a multilevel system. This chapter explores the evolution of the relationship of the two chambers in the European Union: the Council of Ministers and the European Parliament. The authors develop an empirical approach to evaluate the gradual change of their relative legislative influence. The Consultation, Cooperation and Codecision II procedures are analysed for the period from 1976–2009, covering the most important changes. Parliament has clearly gained influence on legislation through Cooperation and, most prominently, Codecision II. Whereas a unanimous Council could mostly have its will in Consultation, Parliament and Council are on equal footing in Codecision II.publishe

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

Extended-criteria donors (ECDs) have an impact on early allograft dysfunction (EAD), biliary complications, relapse of hepatitis C virus (HCV), and survivals. Early allograft dysfunction was frequently seen in grafts with moderate and severe steatosis. Donors after cardiac death (DCD) have been associated with higher rates of graft failure and biliary complications compared to donors after brain death. Extended warm ischemia, reperfusion injury and endothelial activation trigger a cascade, leading to microvascular thrombosis, resulting in biliary necrosis, cholangitis, and graft failure. The risk of HCV recurrence increased by donor age, and associated with usingmoderately and severely steatotic grafts. With the administration of protease inhibitors sustained virological response was achieved in majority of the patients. Donor risk index and EC donor scores (DS) are reported to be useful, to assess the outcome. The 1-year survival rates were 87% and 40% respectively, for donors with a DS of 0 and 3. Graft survival was excellent up to a DS of 2, however a DS > 2 should be avoided in higher-risk recipients. The 1, 3 and 5-year survival of DCD recipients was comparable to optimal donors. However ECDs had minor survival means of 85%, 78.6%, and 72.3%. The graft survival of split liver transplantation (SLT) was comparable to that of whole liver orthotopic liver transplantation. SLT was not regarded as an ECD factor in the MELD era any more. Full-right-full-left split liver transplantation has a significant advantage to extend the high quality donor pool. Hypothermic oxygenated machine perfusion can be applied clinically in DCD liver grafts. Feasibility and safety were confirmed. Reperfusion injury was also rare in machine perfused DCD livers