HTHSCI 3DT3 - Donation and Transplantation
HTHSCI 3DT3 is a third-year undergraduate course in the McMaster University Honours Health Sciences program. It uses organ donation and transplantation as a real-world system in which biomedical science, ethics, law, media, public trust, and clinical practice intersect—often under conditions of urgency, disagreement, and uncertainty.
This course is not designed to deliver tidy conclusions.
It is designed to help students learn how to diagnose complex problems, remain present when values collide, and understand what responsible leadership requires when there is no single correct answer.
The course has run twice. The next offering is planned for Fall 2026.
Why this course exists
Organ donation and transplantation is a domain where decisions are rarely technical alone. Questions of death determination, consent, family disagreement, innovation, equity, and public trust involve competing values, real loss, and incomplete information.
These conditions make it an unusually powerful setting for learning adaptive problem analysis, drawing on the work of Ronald Heifetz and others.
Many students arrive expecting a course that clarifies how the system should work. Instead, they encounter a system that is morally serious, scientifically sophisticated, and often unresolved.
One student captured this shift clearly:
“At the start of the semester, I believed I already understood how to think critically. But through our work together I learned how to slow down, diagnose problems as adaptive challenges, and consider how to meaningfully involve stakeholders before moving toward solutions.”
The course exists because learning how to stay with complexity is itself a core professional skill.
Why this course exists
The course is taught almost entirely without slides.
After a brief grounding in core ideas, learning unfolds through: sustained case-based discussion, iterative problem diagnosis, large-group dialogue, student-led facilitation and presentation, and deliberate use of silence and pause.
Rather than transferring content, the course focuses on how students think while they are thinking.
Students repeatedly return to the same problems from different angles, refining rather than resolving them. The classroom itself becomes part of the learning environment.
As one student wrote:
“This class was unlike anything I’ve experienced before. I’m used to solving clearly defined problems. I’ve never been asked to sit with uncertainty like this.”
Discomfort is not an accident. It is treated as information.
Guest speakers and lived experience
A defining feature of HTHSCI 3DT3 is the presence of guest speakers who speak directly from lived experience within the donation and transplant system. These include donor family members, transplant recipients, clinicians, coordinators, and system leaders.
Students are asked not to take notes during these sessions. Instead, they are expected to listen fully and reflect afterward.
Donor families, recipients, coordinators, and clinicians are invited into the classroom not to illustrate a point, but to place lived experience at the centre of the work. Students are asked to listen without taking notes, remain fully present, and resist the urge to immediately analyze or resolve what they hear.
Students frequently describe these sessions as among the most challenging and meaningful moments of the term.
“This was the first time I realized how abstract policy discussions can feel when you are not the one living with the consequences.”
“I thought I understood the donation system from readings and cases, but hearing directly from a donor family changed how I understood responsibility.”
Many reflections describe the discomfort of listening without the usual academic defences.
“Not being allowed to take notes forced me to actually listen. I couldn’t hide behind writing. I had to sit with what was being said.”
“I felt uneasy not knowing what I was supposed to write down or remember, but that made me realize how often I use note-taking to distance myself from hard material.”
Rather than clarifying positions, these sessions often complicate them.
“I came in with strong opinions about family veto. After hearing a donor family speak, I realized how incomplete my thinking had been.”
“I found myself questioning assumptions I didn’t even know I was carrying.”
Students also describe how silence became part of the learning, especially in the moments immediately following a speaker’s story.
“The silence after the speaker spoke felt heavy, but it was also necessary.”
“I kept waiting for someone to explain what we were supposed to take away, but sitting in the silence forced me to confront my own discomfort.”
The discussions that follow guest speaker sessions are often markedly different from typical classroom debate.
“People spoke more carefully. There was less arguing and more listening.”
“It stopped feeling like a theoretical discussion and started feeling like real people making impossible decisions.”
Across reflections, students note a shift away from searching for the right answer and toward understanding the human cost of systems, policies, and professional choices.
“These sessions didn’t make things easier to understand. They made them more real.”
“I realized that being a good professional isn’t about having the right answer, but about staying present when there isn’t one.”
These sessions intentionally raise the level of tension in the room, not to provoke emotion for its own sake, but to create the conditions for learning. By limiting familiar academic protections and slowing the pace of response, the classroom becomes a holding environment where students can remain present with discomfort long enough to notice what they are learning about themselves, the system, and their assumptions. For many, this is their first sustained experience of productive disequilibrium in an educational setting.
What students are asked to do
The assignments in this course are designed to slow thinking down rather than speed it up. They ask students to spend disciplined time with uncertainty, to diagnose problems before proposing solutions, and to notice how values, identities, and losses shape decision-making in complex systems.
Most students find this challenging at first. Many arrive expecting clear answers, definitive ethical positions, or mastery of technical content. Instead, the assignments repeatedly return them to the work of problem definition: What is actually happening here? Who is affected? What is at stake? What losses are being protected against? What cannot be solved by expertise alone?
Writing is a central part of the course. Students often underestimate the amount of writing required and the effort involved. This is intentional. Writing becomes a tool for thinking, not a demonstration of knowledge already held.
Across the term, students complete several distinct types of assignments, each serving a different learning purpose.
Case Reflection and Problem Refinement
These assignments form the backbone of the course. Students work with real cases drawn from organ donation, transplantation, death determination, media, and public trust. Rather than arguing for a position, students are asked to refine the problem itself. Strong submissions resist premature judgment and instead show increasing clarity about tensions, stakeholders, values in conflict, and sources of resistance.
Students often find this work frustrating. Many want to “get to the answer.” Over time, most begin to see that the quality of the diagnosis determines the quality of any future action.
“I kept wanting to fix the problem. This course taught me how much work comes before that.”
Critical Connections
In these assignments, students are asked to connect course cases with external material—academic literature, media reporting, policy documents, or public debate. The goal is not summary but integration. Students learn to trace how narratives, institutional structures, and public discourse shape what becomes possible in practice.
This work often reveals how technical arguments mask adaptive challenges, and how policy debates can obscure underlying human concerns.
Guest Speaker Reflections
Guest speakers—including donor families, transplant recipients, coordinators, nurses, and physicians—are central to the course. Students are not permitted to take notes during these sessions. Instead, they are asked to be fully present.
Reflections written afterward consistently describe these sessions as among the most impactful elements of the course. Students grapple with grief, gratitude, moral ambiguity, professional responsibility, and the emotional weight of real decisions. Many note how difficult it is to reconcile lived experience with policy language or clinical frameworks.
These reflections often mark a turning point in the course, where abstract concepts become personal and irreversible.
Group Work and Teaching Others
At various points, students work together to teach aspects of a case or issue to their peers. This requires coordination, negotiation of differing viewpoints, and shared responsibility for learning. Students frequently report that disagreement within groups becomes one of the most important sources of insight.
Facilitating learning for others forces students to confront what they truly understand—and what they do not.
Final Interview / Oral Examination / Integrative Reflection
The course concludes with an individual interview rather than a traditional exam. Students are invited to reflect on how their thinking has changed, what tensions they now see more clearly, and where uncertainty remains.
Success in this course is not measured by arriving at the “right” answer. It is measured by increased capacity to stay with complexity, to think relationally, and to approach difficult problems with humility and care.
Representative case work
Several cases anchor the course. One of the most demanding is Normothermic Regional Perfusion (NRP)—a case that brings together cutting-edge biomedical science, ethics, law, media scrutiny, and public trust.
Students engage with scientific uncertainty, ethical disagreement, institutional roles and authority, public perception and risk, and the emotional realities faced by families and clinicians.
There is no consensus position offered.
“This case made me realize that disagreement doesn’t mean failure—it means the problem is real.”
Additional cases explore family veto, deemed consent, media narratives, and decision-making under pressure.
Student writing: representative excepts
Student writing is one of the strongest indicators of learning in this course. Below are anonymized excerpts that reflect recurring themes across submissions.
In response to a guest speaker:
“What stayed with me wasn’t a fact or a policy, but the quiet way she described waiting. Waiting to be called. Waiting to decide. Waiting to live with what came next. I realized how little our frameworks account for that kind of time.”
On problem definition:
“I used to think defining the problem was the easy part. Now I see it’s the work. Every time I thought I understood it, another layer appeared—another stakeholder, another loss.”
On personal implication:
“I entered this course believing I was fair and open-minded. I’m leaving with a deeper awareness of how my instincts are shaped by comfort, distance, and privilege.”
These excerpts reflect what many students describe as a shift from certainty to responsibility.
Representative student work and writing excerpts can be found here.
What students say about the learning experience
Students consistently describe this course less as a traditional class and more as an experience that reshapes how they think, listen, and tolerate uncertainty.
Many arrive expecting answers—about ethics, policy, medicine, or right action. What they encounter instead is sustained attention to the problem itself, and to their own responses as learners within it.
“At the start of the semester, I believed I already understood how to think critically. But through our work together I learned how to slow down, diagnose problems as adaptive challenges, and consider how to meaningfully involve stakeholders before moving toward solutions.”
“I’m used to solving clearly defined problems—memorizing, calculating, getting the right answer. I’ve never been asked to sit with uncertainty, or to stay with a problem without fixing it. This course forced me to do that.”
The learning environment is frequently described as uncomfortable—but intentionally so.
Students name moments of silence, restraint, and emotional friction as pivotal, not incidental.
“When you announced that we would sit in silence, something in me tightened. I hated it—not out of defiance, but out of fear. I realized how quickly I reach for noise, explanation, or action to escape discomfort.”
“Instead of fixing or fighting what felt uncomfortable, I learned to understand it as part of a system. That shift—from curing to learning—changed how I approach problems in my own life.”
Several students describe a transition from individual blame toward structural and relational understanding.
“I started to see how easily we blame individuals for problems that are actually structural. This course taught me to look for patterns, relationships, and pressures instead of villains.”
“Conflicts that once felt like policy problems started to look like human problems. That changed how I listened.”
The work is often personal, sometimes unsettling.
Students are asked to examine their own values, instincts, and identities in relation to real cases with real consequences.
“This was the first time I felt uncomfortable in a way that forced me to confront who I am and the assumptions I carry.”
“I always thought of myself as a ‘good person,’ but this course made me question what that actually means when the stakes involve real people, real loss, and irreversible decisions.”
Despite the difficulty, students repeatedly describe the environment as careful, humane, and deeply supportive.
“I always left feeling challenged but also grateful.”
“The classroom felt safe enough to be honest, but not so comfortable that the work disappeared.”
Many describe the impact as extending well beyond the course itself.
“This framework has already changed how I write, how I think, and how I approach my future in health care.”
“This course has stayed with me more than any other during my undergraduate degree.”
Taken together, these reflections describe a classroom intentionally held in the zone of productive disequilibrium—warm enough to surface real learning, steady enough to prevent collapse into defensiveness or avoidance. It is an experience for everyone in the room; each time I teach this course, I learn something new about the work, the system, and myself.
You can find more feedback on my teaching here.
Where students often struggle
Students regularly report:
frustration with spending so much time defining problems
discomfort leaving questions unresolved
surprise at the volume of writing
uncertainty about whether they are “doing it right”
Over time, most describe a shift—from seeking answers to valuing better questions.
Who is the course for
HTHSCI 3DT3 is a third-year undergraduate course in Health Sciences, though students come from diverse academic backgrounds.
It assumes:
strong reading and writing skills
willingness to engage respectfully with disagreement
openness to uncertainty
readiness to take responsibility for one’s own learning
Enrollment is capped at approximately 50 students.
Ongoing learning and future iterations
Feedback from students continues to shape the course. Current reflections include:
distributing work more evenly across the term
providing more exemplars of student work
increasing the number of donor family and recipient voices
adding structured reflective writing time following guest speakers
deepening transplant-specific scientific content
refining assignment structure while avoiding increased writing volume
These reflections are part of the same adaptive process students are asked to practice.
My Reflections on 3DT3
HTHSCI 3DT3 is built on a simple but demanding premise: adaptive leadership is a skill that can be learned, practiced, and strengthened.
This course treats the classroom itself as a holding environment—a space where complexity is not avoided, disagreement is not rushed past, and learning is allowed to unfold at a human pace. Heat is generated deliberately, not to provoke for its own sake, but to make real learning possible. Loss is named. Responsibility is shared. Silence is used. Voices that are often held at the margins are brought into the centre of the work.
Students leave this course not with a single position on organ donation and transplantation, but with something more durable: an increased capacity to stay present in hard conversations, to diagnose before acting, and to engage problems that matter without needing them to resolve cleanly.
For many, this is the first time learning has felt this demanding—and this alive.
That is the point.
This course exists because the problems we face in health care and beyond will not be solved by better answers alone. They will require people who can hold complexity, mobilize others, and stay in the work when certainty is unavailable. HTHSCI 3DT3 is one place where that practice begins.