Fall Study Group: How Should Democracies Govern Scarce, Life-Saving Resources? The Case of Organ Transplantation
This in-person study group led by Aditya Pawar, Ash Center Democracy Visiting Fellow, and Santiago Creuheras, Ash Center Democracy Fellow, will take place throughout six sessions. Applications are necessary.
In-Person Event
Harvard Kennedy School
2:00 pm – 3:00 pm EDT
Nearly 110,000 people are currently on the U.S. transplant waiting list, and about 12 people die each day while waiting for an organ. Although a donated organ can save a life, not everyone who needs a transplant can receive one. This study group will examine transplantation as a governance and democracy issue, asking how institutions allocate scarce resources, who has a voice and what makes the process legitimate.
Participants will explore how biological scarcity is shaped by unequal access to referrals, insurance, transportation, infrastructure and care. Using transplantation as a case study, they will apply concepts including legitimacy, accountability, transparency, representation, participation and fair process. Sessions will examine the patient journey, compare allocation systems across countries and consider organ markets, donor compensation, trafficking, transplant tourism and emerging technologies. Participants will evaluate utility, urgency and equity, then develop a reform proposal integrating ethics, evidence, implementation and effective democratic governance.
Full syllabus can be found here.
Dates:
October 14 - How Transplantation Works: Current Challenges of Scarcity and Unequal Access
Why do organ shortages persist, and why do their burdens fall unevenly?
Map two patient journeys – one in a well-resourced system and one in a resource-constrained setting – and identify where scarcity is biological, institutional, or distributive.
Reading: They decide who lives, who dies Life Magazine November 1962 (p102-127)
Documentary: Who shall live?
October 21 - Donation Systems Around the World
How do law, culture, trust, organization, and health-system capacity affect donation? This session compares donation systems across the world.
Optional – Teams conduct a structured comparison of two countries and recommend one context-sensitive reform.
Reading: The Nicholas effect
October 28 - Organ Markets, Compensation, Innovation and the Future of Organ Supply
Can technology relieve scarcity without reproducing or deepening inequality?
Emerging technologies may expand the pool of usable organs, but innovation also creates questions about risk, ownership, affordability, regulation, and public consent.
Optional – A technology assessment panel recommends whether and how to introduce one innovation, including safety, equity, oversight, and post-market learning requirements.
Reading: This pig could save your life
November 4 - Voice, Transparency, and Trust in Transplant Decisions
Who gets to see, question, or influence decisions made by transplant institutions? Explore transplant selection committees, with explicit roles, boundaries, safeguards, and a method for appeal and revision.
Reading: Organ Transplant System ‘in Chaos’ as Waiting Lists Are Ignored
November 18 - Democracy and Scarcity (Part 1)
What can democracy teach transplantation, and what can transplantation teach democracy about governing scarcity?
The final two session brings together allocation, comparative policy, markets, innovation, equity, and patient voice. Participants explore reform proposals against both substantive outcomes and the quality of the decision-making process.
Optional – Sharing write up and identify one failure point from Session 1 and create a reform with a target population, responsible institution, implementation pathway and measurable outcome.
Reading: The 25th Anniversary of a Nearly Unknown Health Policy Turning Point
December 2 - Democracy and Scarcity (Part 2)
What can democracy teach transplantation, and what can transplantation teach democracy about governing scarcity?
The final two session brings together allocation, comparative policy, markets, innovation, equity, and patient voice. Participants explore reform proposals against both substantive outcomes and the quality of the decision-making process.
Optional – Sharing write up and identify one failure point from Session 1 and create a reform with a target population, responsible institution, implementation pathway and measurable outcome.
Reading: The 25th Anniversary of a Nearly Unknown Health Policy Turning Point
Facilitator Biographies
- Aditya Pawar, Democracy Visiting Fellow, is a physician specializing in the care of patients with advanced kidney disease and those undergoing kidney transplantation. His clinical and research interests lie at the intersection of healthcare and democratic governance, applying democratic principles to the distribution of scarce medical resources. At the Ash Center, his work focuses on exploring the role of patients in medical decision-making and its impact on the legitimacy, trustworthiness and accountability of healthcare decisions and decision-making structures. On a broader, community level, his work applies democratic-governance principles to theorize how citizens might shape healthcare through electoral engagement and policy processes.
- Santiago Creuheras, Ash Center Democracy Visiting Fellow, is a distinguished expert and scholar in public policy and sustainable development whose career has advanced democratic governance through institution-building, citizen participation and strategic policymaking. With a strong academic foundation and extensive experience in both national and international contexts, he has supported democratic transitions by advising governments on reforms that strengthen transparency, accountability and inclusive decision-making. His current work evaluates the state of democracy and sustainable development in the region a quarter century later. By examining the endurance and evolution of democratic institutions in Mexico, he seeks to assess the broader challenges facing Latin American democracies today, including political backsliding, polarization, institutional fragility, economic inequality and the erosion of civil liberties.
Registration Information
This Study Group is open to HUID holders only. Please apply here. Approved attendees will be informed via Harvard email on October 13. If capacity is reached, we will notify students if they have been accepted or assigned to the waitlist. We will also include the HKS room location at that time.
Note: It is strongly recommended that interested students are able attend all sessions.