always make the choice for you,' explains Mr Rudge. 'Deciding

between them is a nightmare. It has got more difficult since the principles which formerly dictated dis- tribution were abandoned.' It used to be the case, for instance, that younger patients automatically had priority over older ones. That has changed over the last ten years. Why? The surgeons themselves have got older,' suggested Mr Rudge. 'It may make us not quite so keen on an inflexible age cut-off.'

Other kidney surgeons, however, are utterly opposed to that idea. 'Of course we need more live donors,' Mr Christopher Rudge, a London surgeon told me, 'but they must be genuine donors, not people coerced into the operation. The worst thing we could do for voluntary donation is to associate with criminal bargains.' Like all other renal surgeons (including Mr Bewick), Mr Rudge is required by law to go to enormous lengths to ensure that fam- ilies of individuals who need a new kidney do not feel bullied or pressured into giving. Kidney surgeons become expert at detect- ing family coercion. 'It can happen in all kinds of ways,' says Mr Rudge. 'If we iden- tify it, we have to cancel the operation.' A genetically unrelated donor — a husband, for example, wishing to donate to a wife can only give up his kidney after the case has been carefully vetted by a government committee, a bureaucratic process which can take anything up to two months.

The operation itself is not without risks. The surgeon and anaesthetist who remove your kidney have about one chance in 2,500 of killing you. That may be what puts people off — but there is no reason why it should. In Norway, for instance, nearly half of transplanted kidneys are donated from living relatives, which is over five times the rate of live organ donation in the United Kingdom. The low figure is partly a testa- ment to the reluctance of many transplant units to inform family members that dona- tion is a solution, for fear of being seen to pressure reluctant brothers, sisters, parents or children into an operation they don't want.

A campaign to increase live donors might help to reduce the waiting-lists for kidneys, but without the introduction of financial incentives it won't eliminate them; and it cannot touch the shortage of other organs. The waiting-lists, therefore, are here to stay. And so are the waiting-list deaths.

The shortage leaves surgeons with the decision of who to treat. 'You can have a kidney which will fit either a man in his for- ties with a job and three children, or a retired single woman in her sixties without dependents. Strict medical criteria won't

There are no official guidelines about how doctors should decide who shall live and who shall die, granted the suitability of a given organ for more than one patient. A nationally organised institution, the United Kingdom Transplant Association, acts effi- ciently as a clearing house for organs, help- ing to ensure that all that become available are effectively used. But surgeons have the final say on what they transplant to whom. `There isn't always an objective way of making the decision', says Mr Robert Sells, who runs the renal unit in Liverpool. In the last analysis, he says, common sense is the best and only guide. But Mr Sells, like every other transplant surgeon, is unhappy with a situation in which it is not always possible to demonstrate clearly that scarce organs have been allocated fairly, or to jus- tify decisions to those who lose from them.

lit this point Lionel Blue will tell a couple of jokes.' Alasdair Palmer is home affairs editor of The Spectator.

Mind your language

MORE might mean worse, but less can mean better, as my friend Dr Christy Campbell, a lecturer at one of those new universities that we used to call polytechnics (a term originating from the Ecole Polytechnique, devoted in 1795 to the training of civil and military engineers in Paris. The Polytechnic Institution in London was open between 1838 and 1881 for the exhibition of things to do with industry).

Anyway, Dr Campbell was sleepless one night and instead of counting sheep counted those 'less' words that denote improvement, starting with horseless car- riage. Then there are boneless corsets, smokeless coal and so on. The list is long if not endless and he soon fell into a dreamless sleep.

Of course, the -less formation to mean improvement over previous arrangements where one had all the nuisance of horses, or bones, or smoke is a natural development of the Old English formation, an example of which is firena leas (`free from crimes'); soon the less element got tacked on to the noun to give countless adjectives.

More recently the suffix has given way to another one: free, as in 'nuclear-free zone' or 'cyclamate-free soft drink'. Then there is a prefix which some find ugly: non. But what we do without 'non- stick frying pans' and 'nuclear non-pro- liferation'? Or do you prefer the odourless atmosphere of a smokeless horseless carriage?

Dot Wordsworth

Bonn IF THE PAST weekend for Helmut Kohl was not altogether typical, it was none the less characteristic. By Saturday, Kohl had managed to isolate John Major at the negotiating table at Corfu, although the feelings of protest against Mr Kohl's choice of Jean-Luc Dehaene for the Com- mission's presidency were rather more widespread than Mr Major's lonely defi- ance might indicate. By Sunday, Kohl had carried the incumbent Christian Democrats to election victory in the east German state of Saxony-Anhalt, despite the press discovering a scale of corruption practised by the local party there sugges- tive of conditions in a ramshackle equa- torial republic.

In general these days, Helmut Kohl appears like a kind of human bulwark. As the defender of Maastricht, he points the way to European integration (all the more so from the beginning of this month, when the German Chancellor assumes the year- long presidency of the European Council); as the defender of German democracy, he takes almost all the votes right of centre in his own country.

Kohl's political longevity springs from his ability to offer identity to the German people and from his ruthlessness in the management of Germany's ruling party. Although he is not a German nationalist, he is the embodiment of the German nation, and especially of its petty bour- geoisie. With a — literally — huge pres- ence, there is nothing merely official about his authority; out of an election campaign he can enact a topsy-turvy world of carni- val in which he is the king of revelries. He delighted the nation recently with a sur- prise helicopter stop to an east German village, where he embraced machinists and handed out beers even before they had time to wash their hands.

In Britain, the politician Helmut Kohl is something of a mystery, to judge by John Simpson's recent comments in The Specta- tor ('We are all sceptics now', 4 June). Kohl's voice belongs to a traditional cul- ture which his nation has lost and misses. With a rhetoric full of farmers' proverbs, he talks of the fat times of the

LIKE BISMARCK, ONLY BIGGER

Anjana Shrivastava examines the political bulk

and longevity of Helmut Kohl, as Germany assumes the presidency of the EC

Wirtschaftswunder, and of leaner times like these when his nation will have to tighten its belt before it will again be rewarded with wealth. On successful election nights, Kohl's favourite saying is: `Wer schaffi, kann feiern; wer nicht feiern kann, kann nicht schaffen' (he who get things done can celebrate, and he who can't celebrate can't get things done). Carnival and Lent, that is Helmut Kohl's message.

His second strength is an unfailing realpolitik, and here his instinct is as remi- has an uncanny sense of how to play his cards in Europe, and thereby has ensured that no European partner can act against the central European power.

And yet Bismarck, by placing himself, at the centre of virtually every political pro- cess, by manipulating but never resolving social and political conflicts, left in his wake a domestic and diplomatic mess. Hel- mut Kohl is setting about doing the same, both in Germany, with its unification fund- ed by massive debt, and in the European Union, where contradictory promises will be made without a fundamental building plan. Bismarck realised that he was just a rider of huge events in the 19th century, and, as the best horseman of the Hohen- zollern crown, he did so gracefully. Kohl, on the other hand, is tied to the Christian Democratic Party with all its peculiar social and political commitments. And as might be expected of so bulky a figure, he will ride the great movements of Europe as one rides a bull: when leading the charge to unity in 1998, neither will he be thrown off, nor will he cover much ground.

Kohl, unlike Conservative counterparts such as Margaret Thatcher, has executed no significant reforms in his 12 years of power. But the German system is in need of reform. From its stagnant political par- ties to its rigid corporate hierarchies, Ger- man society has been surprisingly inert, even during the events surrounding unifica- tion.

For the past five years, instead of domes- tic reform, all political energies have been devoted to the development of east Ger- many, an effort financed by massive trans- fer payments of the order of 150 billion deutschmarks per year. Far too much of this 'shock therapy without the shock' has gone into consumption and into the pock- ets of the individual profiteers of unifica- tion rather than into needed investment. While east German growth rates look good, they do not look as good as those of the Czech Republic where much more carefully invested private German money flows. Mr Kohl acts as if this balance of west and east German accounts can contin- ue indefinitely, but it is clear that it cannot. This past Sunday the Christian Democrats emerged victorious once again in Saxony- Anhalt, despite the fact that carpetbagging ministers from the west German CDU were recently found to have embezzled 1 million marks from the meagre funds of the industrially devastated eastern state. This is the kind of electoral miracle which Helmut Kohl's policy of subsidised opti- mism can produce.

But Kohl has at least tried to deal with the problems of unification; other struc- tural problems he has chosen completely to ignore over the period of his administra- tion. Living off his nation's substance, Kohl has never paid serious attention to lagging research and development, to the unman- aged integration of a growing foreign pop- ulation, to high unemployment which now affects 6 million Germans, or, above all, to a crumbling social security system based on 19th-century Bismarckian models.

A child of the second world war, Kohl looks at such problems as one of the gen- eration which suffered early horrors but went on to build and enjoy the Wirtschaftswun-der. In his boyhood in Lud- wigshafen, he had to dig up corpses after bombing raids and lost his older brother at the front. But his first job was in the chem- ical industry, and at an early age he threw himself into building a democratic frame- work with the Christian Democrats for booming companies like Ludwigshafen's BASF. With this past, he is convinced that all difficulties can be surmounted by moral steadfastness.

`The war ended my childhood abruptly and without mercy,' Kohl has written, tut in my parents' house the sense of orienta- tion was never for a moment lost.' And so when 30 years after the war's end he first campaigned for the chancellorship, he was moved in a speech before a group of holi- daymakers at the Baltic seaside to say, `Holidays give us a chance to think about our private life, our families and also about what we want for our communities and for our fatherland. And in this regard we should think about whether the old virtues like loyalty, thrift and diligence shouldn't again play a bigger role.' It was `Treue, Sparsamkeit and Fleiss' which Kohl called to govern in 1982, and they are again his muses in the campaign of 1994 although 'punctuality' and 'tolerance' have also been added to the back-to-basics brew. But while his paterfamilias act, his sense of orientation, creates a pleasing contrast to much needless pessimism in Germany, his solutions are rather home- spun for such problems as a national debt of 2,000 billion marks. Mr Kohl's `Sparsarnkeie evidently does not cover the small matter of the nation's public finances.

Just as Bismarck never resolved the con- tradictions between the traditional aristo- cratic state and the new industrial society of his century, Kohl has failed in the small- er task of leading the Germany of the Wirtschaftswunder into a new era of global competition. But when the savings of decades are spent on debt payments, and when the contradictions between an ineffi- cient bureaucracy, a sluggish industry and a population with growing expectations come to a head, future politicians will have to tackle the backlog of structural reforms.

But for the time being, as it seems likely that Helmut Kohl will continue to play a pre-eminent role for the rest of the centu- ry, it is necessary to speculate about what kind of Europe he will build with the help of men like his protégé, the Belgian Prime Minister, Jean-Luc Dehaene. One suspects that power will be skilfully played towards the Christian Democrats at the centre of the continent, after the manner in which M. Dehaene negotiated the placement of the European central bank in Frankfurt. But more fundamental issues, such as the massive and unsustainable subsidies of the Common Agricultural Policy, will be deferred by means of rubrics such as that of a `multispeed' Europe.

Kohl is without doubt a true European; as a student he knocked down border posts between France and Germany with élan. But he has, as well, a healthy dose of nationalism; in 1947 he organised opposi- tion to French plans to annex disputed parts of his home state, Rheinland-Palati- nate. A lone voice in the early Seventies, he rightly predicted that within a decade questions of German identity would loom large in the minds of his fellow country- men.

While Kohl was the main German force behind the axis built between Paris and Bonn in the Eighties, and while his Rhineland roots naturally orientated him towards France, he has reacted intelligent- ly to French signs of discontent since 1989. When France tried at times to make com- mon cause with Russia, and more lately with Britain, Kohl moved quickly to pre- vent such demi-alliances by temporarily pressing all the attentions of a 'special relationship' on Mr Major and Mr Yeltsin. But the German view of Britain has never been as high as Downing Street believes, and Mr Major's insurrection at Corfu will not be forgiven, let alone forgotten. Mr Yeltsin for his part has been asked to undergo humiliating historical rituals which compare Stalinism to National Socialism when his troops leave Germany under the eyes of his 'special friend Hel- mut'. The great respect of the new, ner- vous Washington for the strong man in Bonn makes it hard for either London or Moscow to question Mr Kohl's words of support.

But the Chancellor's aim is not to build solid bilateral alliances, as much as it is to follow, to the letter it would seem, the advice of the master statesman Bismarck, who described his own diplomatic goals in the following way in 1877: 'to create a situ- ation in which all powers other than France need us, and are prevented as much as possible from building coalitions against us because of their relationships to one another'.

0 Ermenegildo Zegna

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