During and after the 2024 election, President Trump said he would lead a mass deportation of undocumented immigrants from the United States. The estimate for undocumented immigrants in the United States is approximately 11 million people. Their deportation, in addition to legal and humanitarian concerns, could destabilize the United States economy by causing a significant labor shortage, increasing food prices, construction, and other sectors that for years have relied heavily on labor of undocumented immigrants. This potentially pits Trump’s immigration policy against one of his other 2024 campaign promises, to reduce inflation.

The OPTN Board of Directors adopted strategies to build support and administrative capacity for implementing continuous distribution (CD). It also sequenced implementation of CD by organ to ensure adequate staff support for committees, learn from early implementations, and gain “small wins.” Implementation of CD began with lungs, because of the relative simplicity of the lung categorical allocation rules and the success of the lung committee in making substantial rule changes in the past. The lung proposal was completed, and its subsequent revisions indicated CD flexibility. CD implementation began for the more complex kidney and pancreas allocation prior to the finalization of lung CD. The kidney and pancreas CD proposals were near completion when the CD initiative was put on hold because of concern about the nonuse of donated organs. CD development was also under way for the more politically challenging liver allocation when CD was put on hold. The lung CD success serves as a proof of concept for CD. The kidney, pancreas, and liver efforts show the challenges encountered in making substantial planned organizational change.

The development of continuous distribution (CD) proposals for lungs, kidneys, pancreases, and livers display the interrelationship of values and evidence. CD involves identifying attributes that assess progress toward five goals: (1) prioritize sickest candidates first to reduce waitlist deaths; (2) improve long-term survival after transplant; (3) increase transplant opportunities for patients who are medically harder to match; (4) increase transplant opportunities for candidates with distinct characteristics, such as pediatric and prior living donor status; (5) promote efficient management of organ placement through consideration of geographic proximity between donor hospitals and patient transplant centers. Weights are then assigned to the attributes and goals to obtain a composite priority score. Both values and evidence influenced the choice of attributes and their functional forms. Rather than primarily statements of values, weights became design features in machine learning optimization exercises that allowed for the identification of alternatives that predicted the most favorable combinations of efficiency and equity outcomes.

Chapter 4 extends my exploration of time management by looking at Sheila Heti’s novel-from-life, Motherhood (2018), interrogating how Heti’s engagement with contrasting models of time management allows her to consider questions of everyday time use within broader negotiations of socially normative lifecycles and the ‘infinity’ time she associates with art-making. Through close readings of Heti’s texts alongside self-help works by David Allen, Stephen Covey, and Mihaly Csikszentmihalyi, it argues that Heti’s writing dramatizes tensions between conflicting temporalities, from the linear, future-oriented time of productivity guides to the expansive time of creative flow, fate, and chance.

The OPTN routinely secures public comment on its proposals. The public generally consists of organ transplantation practitioners, individual patients, and organizations representing patients with transplant-relevant diseases. Thus, it might be better labeled “community participation.” Community participation occurs within the organ-specific committees that lead on the development of allocation rules as well as through interaction with committees with crosscutting portfolios, such as those considering patient and minority interests, and regional meetings. Committees issue white papers, progress reports, and proposals for community comment. Particularly with respect to proposals, committees respond to community comments in their submission of final proposals to the Board of Directors. For the CD initiative, the OPTN also sought community input from analytical hierarchy process (AHP) exercises at both the committee and community level. Information from the AHP had some influence in the development of the CD proposal for lungs. More generally, its value was in providing a focus for eliciting more participation and obtaining more focused qualitative comments.

Policy networks can inform policy design with expertise and build support, or at least acquiescence, for policy change. When policy networks do not arise organically, they can be created through various forms of constructed collaboration. At one extreme, the construction may simply involve tapping expertise through advisory committees. At the other extreme, the constructed arena may delegate policy choice to organizations of stakeholders like the OPTN. Prior research assessed the capacity of the OPTN for evidence-based incremental change in organ allocation rules. This study considered continuous distribution as a radical change in allocation rules. The success of the lung CD serves as a proof of concept for continuous distribution and suggests that it can be effectively implemented for other organs. It also considers stakeholder rulemaking as an institutional alternative in other complex policy areas. Key considerations include whether it can be constructed to engage all relevant stakeholders and induce their willingness to provide expertise.

This book has discussed the power, responsibility and accountability of the US President, examining the Founders’ intentions and the very different presidency we have today. The President is more powerful and less accountable than the Founders ever imagined. Responsible exercise of presidential power today depends more than ever on the character of the person who occupies the presidency. Americans for good reason have less confidence in the constitutional checks and balances the Founders anticipated would restrain abuse of presidential power.

Chapter 2 continues to focus on self-help public speech and cultural authority but turns to the work of Paul Beatty, in particular his early novel, Tuff (2000), and later work, The Sellout, published in 2015, the same year Beatty also gave a commencement address. I explore Beatty’s ambivalent engagement with multiple discourses of self-help, from his burlesques of assimilationist ‘racial uplift’ leadership to his depictions of Black women’s empowerment cultures and descriptions of African-American social psychology frameworks. I argue that while Beatty satirizes the booming voices of self-help speakers, the reductiveness of self-help mottos, and the individualizing effects of ‘self esteem’ culture, he also finds aesthetically and ethically generative possibilities in grassroots self-help praxis and the clash of lived, communitarian forms of wisdom.

In the summer of 1787, the young American republic was in a moment of crisis. After eight years of wars to gain independence from the British, the American experiment, despite its high-minded goals, was close to failing. The United States’ first form of government, the Articles of Confederation, had left the thirteen states largely to manage their own affairs as quasi-independent states. The dispersion of power among the states had led to a variety of issues, including dueling foreign policies between the states; each state having its own currency, which made trade between the states and with foreign nations nearly impossible; an inability of the central government to impose taxes to pay off war debts; a reliance on state militias rather than a professionalized military controlled by the central government; and a lack of executive leadership in the central government.