>I donated my kidney, but I’m probably not going to donate a lobe of my liver .... I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful.

Oh, i actually read your article and decided to do exactly that 😰, that's kinda worrying to hear!

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The HIPAA thing has an easy workaround: you just advertise broadly that anyone who needs a kidney should write to you. That also simultaneously solves the problem of the potential kidney donors (aka the victims of emotional extortion campaign) considering any letter they may receive absurd prima facie.

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I imagine the reason transplant psychologists are so pointlessly paranoid when it comes to anxiety about transplants is that anyone who comes out of a kidney donation thinking "oh man I shouldn't have done that" or "I didn't give informed consent for this" is a nuclear grade PR nightmare for them so they lean all the way into CYA and then some.

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I'm very confused by Kronopath's objection. He seems to be bothered by the fact that someone saying, "you should do X it's the moral/altruistic thing to do" doesn't have your best interests at heart. But that's a really odd objection to a claim that **on it's face** admits to not having your best interests at heart.

If I suggest to you that you ought to donate more of your money to bed nets because it's the right thing to do it would be extremely strange to reply, "hey wait a minute, donating money would make me poorer. You're trying to trick me into doing something not in my best interest." I mean, if I thought it was in your best interest I'd say it's in your interest not appeal to a moral duty.

Maybe Kronopath has in mind some kind of best interest that incorporates meeting your moral obligations. But that's still an odd thing because we (if we believe in obligations at all not just a partial order on choices) think it's better if people go beyond their moral duty so it's weird to see any attempt to persuade someone to do that, no matter how overtly it conveys that, as somehow suspect.

The best interpretation I can give to this is to think about what it felt like as a young man who was still catholic when my moral sense was constantly plauging me with guilt and I felt somehow manipulated by it and constant feelings of anxiety that I wasn't being moral enough. I can understand that, but I'm not sure someone who had that kind of anxiety about being moral enough would raise the issue (if you're so guilty you feel coercive pressure to donate how would that same pressure allow you to so clearly critisize even suggesting donating is good).

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Behold! Our assessment of the people who are balking at donating a kidney, and attempting to argue people *out* of donating a kidney are doing so because:

1) They feel scared of the idea of donating a kidney

2) They feel ashamed that they are scared

3) They have a fair amount of pride, and have a strong aversion to the feeling of 'shame'

4) They are intelligent

5) They use their brainpower to come up with a reason for why it is logically unwise to donate a kidney

6) Now that they have a logical reason for their aversion, they can use that to rationalize away the shame

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"modulo the appendix"

The appendix is actually useful! Apart from its function as a lymphoid organ, it helps maintain regular gut flora - particularly after a bout of diarrhea. So ... keep it if you can. Maybe even give it a pat on the back, or a 'Good job, appendix. Keep up the good work keeping me healthy!' every now and then.

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I'd love to know if people who have strong negative feelings about this also feel strongly about not switching tracks in the trolley problem.

Like it's always seemed crazy to me that people care (aside from pragmatic concerns) that the donor might regret the choice. Ok, they regret it but I bet the recipient would regret it not having happened any more.

One hypothesis is that they see there to be a higher moral bar required to make changes from the status quo...hence the trolley question.

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Lots of people said you wouldn’t have two kidneys if going through all that effort to grow two wasn’t important

But isn’t having two of a thing just down to us having bilateral symmetry?

Is there any feature in our body, that has been suppressed such that we don’t have two of them as bilateral symmetry would dictate?

The heart is the only thing that comes close that I’m aware of

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Another question for those who generally are skeptical of donating a kidney. Imagine we can return kidneys to the initial donor and someone who donated a kidney runs into trouble and needs a second kidney. Do you feel similarly skeptical about the kidney recipient donating the kidney they recieved back to the original donor or do you feel that's presumptively ok and we don't need to carefully check they won't regret it.

In other words is the feeling about some sense of ownership of your own body (so returning isn't as suspect) or is it about the change relative to the status quo (or other I guess).

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To calibrate your risk of chronic pain better, you should ask your surgeon the rate of chronic pain their patients experience.

Indeed, this is a good practice for any surgery or other procedure that produces complications. Who cares if 1 in 5,000 people nationwide have their face go numb as a result of some dental procedure. If my dentist makes 1 in 50 people's faces go numb, then I start to worry!

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Nov 7·edited Nov 7

What if donating a kidney isn't altruistic, but instead, a sensible, self-interested way to bump yourself up to the top of the kidney donation list if you ever need it? A positive-sum cooperation game where the donor and donee both benefit.

The stories from people who had kidney failure made think, "what if I have kidney failure one day? Man I hope someone will donate to me"

Then I remembered how apparently donors get bumped to the top of the donation list in the future, should they ever need a kidney...

Maybe for that reason alone, donating a kidney is actually selfishly the most healthy thing to do? If you donate, you go from two kidneys to one, and thereby have a greater risk of needing a donated kidney yourself. But you *already* have a background risk of needing a kidney one day. And if donating now can be a protective factor for that, in that you'll be bumped to the top of the kidney list if you ever need one, it sounds like opting into slightly higher risk of needing a kidney in the future in exchange for insurance that if you ever lose a kidney, you'll be just about guaranteed a donor!

It makes donating a kidney sound less like a highly altruistic act and more like a sensible way to opt in to positive-sum cooperation game.

If this were true then publicising that message could encourage donation maybe even more than a message "you'll be a wonderful person".

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> "This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here?"

It is a curious phenomenon. Maybe best understood as a kind of co-operation with the other agent (qua rational agent)? I could see Kantians thinking this was the appropriate way to respect their status as a rational being and end-in-themselves. Or you could frame it as an application of the Golden Rule: Just as we'd want others to warn us off from *excessive* altruism / self-sacrifice, so we should warn off others that are about to make such a (putative) error.

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Doesn't donating a kidney exhibit a revealed preference against longtermism/EA more generally? Scott kind of touches on this in his article ("doesn't depend on a rickety tower of assumptions"), but if you think it's rickety enough to justify a non-trivial effort/cash/amount of compassion to donate your own kidney, how strongly do you really believe in trying to dedicating one's life to lowering some x-risk by 10bps? Or is this just a case of consumption, a feel-good experience whose altruistic impact is trivial compared to things like MIRI donations and bednets? My own feeling is that this is not what's going on, and people feel/think kidney donation is more important than other EA interventions because it feels more altruistic (in fact, there's a strong argument it that it is).

Separately, I would love to hear a more direct response to Kronopath's heuristic of "no unnatural interventions unless necessary." I think it's a pretty good one, and disagree with the characterization of "some studies say x but it seems unnatural so no" as "epistemic learned helplessness." It reminds me of Scott's discussion of "no evidence"--there is some base rate of things that are perceived to have "no evidence" of harmful effects that mess with the body in weird ways later being found to have harmful effects! For example, cigarettes, most of medicine in the middle ages, and so on. I think this wedge is a difference between myself and most rationalists on issues like kidney donation and circumcision, but Scott seems to view this as just pure fallacy/failure mode on my part.

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> a lot of people insist on defining the moral law such that they are following it maximally at all times. Nobody really follows the moral law maximally at all times, so this means people end up endorsing completely crazy moral principles like “it’s morally wrong to donate your kidney”. I think it’s easier to just relax that constraint, have a flexible and reasonable view of the moral law, and admit you don’t follow it perfectly.

This seems right to me. Probably more controversially, I think it applies to a lot of rationalists with regard to animal welfare. Many are theoretically committed to the idea that all sentient experiences matter and suffering is bad, but (for whatever reason) aren't motivated to change their diet accordingly. So you end up with a suspiciously large number of people making the calculation that their (expected) personal impact on the future of the world is so great that it is morally optimal for them to eat factory-farmed meat rather than waste precious mental cycles avoiding it.

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>Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice. This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here? This isn’t mysterious at all to me intuitively (I can imagine doing the same thing in some circumstances) but it sure is hard for me to explicitly model.

My best guess is that this is essentially a flavor of tribalism.

Even if you don't have a specific argument in mind for why some particular behavior is likely to be harmful, you're liable to feel wary, and want to push back, if you have the impression that it's characteristic of a weird and alien viewpoint which is likely to clash with your own in significant ways.

If you're a person who (for example,) has an overall negative view of the religion of Islam, and believe it promotes dangerous and regressive social behaviors, and you see a Muslim participating in daily prayers, you'd likely feel anxious, not because you'd have some specific reason in mind for why participating in daily prayers is harmful, but because it activates your "Oh, this is a thing from that cultural group I distrust" thought patterns. Those feelings might be grounded in more specific fears of things you might clash over culturally, but those fears don't need to have any specific reference to the daily prayers, that's just something that functions as a cultural identifier.

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"I donated my kidney, but I’m probably not going to donate a lobe of my liver (even though this is also mostly safe and also helps people in need). This isn’t because there’s a real distinction about which parts of my body are vs. aren’t sacred, it’s just that I guess I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful."

Scott, have you spoken to anyone who's donated part of their liver? I have. It's not "very hard."

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FWIW Manifold puts a 50% chance on LDNT being false, though not for any specific threshold.


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A bit disappointing how many rationalists don't think any deeper than "that's like weird so ewwww." It's like fifth grade all over again.

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One additional point I think is worthwhile for Scott's particular donation:

My guess is that Scott will at minimum influence 50-100 future kidney donations with his posts and kidney advocacy. Potentially much more. I am dead-certain that Dylan Matthews, as an example, has led to *hundreds* at minimum and potentially thousands of donations on the high end as a result of his articles and advocacy. And I think Scott is roughly on par, influencer-wise, with Dylan.

So his decision isn't really just "Is my donation worth it". It's particularly impactful for him (and any other person with a huge platform) to donate, because of the multiplier effect they cause.

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"You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal."

I'm sorry. I may be missing something, but I just don't understand how Scott can keep describing Effective Altruism like this ("do the most good"), and how so few comments seem to really challenge this head-on, when Scott (along with this community) was the one who popularised the most lucid description of this exact fallacy: the motte-and-bailey.

Doing the most good means, in practice, saying hypothetical future uploaded "people" are as important as real people, with people lives and real suffering, who actually exist right now. It means actively supporting the destruction of "unwanted" human life on an unimaginable scale to slightly benefit the majority. Or less horrifically, it means getting the best outcomes *at the expense of every other moral value*: e.g. embracing the widely-recognised vice of greed in "earning to give".

HOW is calling these things "doing the most good" ANY different from calling feminist positions (eliminating due process, cryshing freedom of speech) "believing that women are people"? That was the context Scott originally introduced the concept of motte-bailey, and yet it never gets applied to EA. The only possible defence I can imagine is that the above EA positions are not very common. Is this the case? And if not, am I missing some reason this whole ideology isn't as dishonest and cult-like as every other one?

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> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me. (The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here. Still, the US was one of the first, and I’m still proud of it.)

I don't think we can really claim to have defeated the evil bioethicists here; selling kidneys is still illegal. (May also be due to the evil pro-poverty lobby.)

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"Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice. This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here?"

It's selfish. People don't want to donate a kidney because that's a lot of work, so it's in their self-interest to avoid the normalization of kidney donation, lest they find themselves in a world where every annoying charity worker is badgering them for internal organs.

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> I’m going to do the jerk thing here and accuse Stephen of being wrong about his own internal processes.

No, Scott, you're not being a jerk. You're a very nice guy. But you're also wrong here.

> How did Stephen come to value bodily integrity... “Value bodily integrity” is a useful heuristic for avoiding bad things.

"Value bodily integrity" isn't a heuristic for me for avoiding other bad things. Rather, bodily integrity is itself a good, among others. In computer science jargon, you might say it's a "primitive."

> I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions.

No, I wouldn't consider these exceptions at all (although I approve of all of them). That's because they simply don't violate bodily integrity in the relevant sense, as does removing an organ. Rather, they improve health or function in other ways (i.e., without violating bodily integrity).

> How come I, an outsider without access to his moral reasoning, can predict what exceptions he’ll allow?

As noted, you can't. (While you correctly predicted that I would approve of those things, you mistakenly took them to be exceptions to avoidance of violating bodily integrity.)

> Probably because he allows as an exception anywhere benefits > costs.

No, I would allow exceptions where I'm aiming to serve a greater good, such as "restore my bodily function when there is no better way." I know this may sound like the same thing to you, but it's not, and the attempt to recast it into cost/benefit terms will actually change it into something different (that produces different answers to some questions). Key point: I consider the goods in question to be nonfungible, not fungible utility.

> I propose he’s using it as a heuristic for what he really wants, which is something like trying to stay healthy and safe while balancing that out with satisfying his other values.

• Again, not a heuristic at all.

• Health is certainly a related though distinct good.

• Again, vaccines simply don't violate bodily integrity, so not even an exception.

> kidney donation still emotionally feels really scary and not beneficial to Stephen, he prefers not to do it, he can’t come up with a great utilitarian case for not doing it, so he falls back on a semi-crystallized heuristic

I don't find kidney donation emotionally really scary. I'm actually pretty adventuresome in terms of medical interventions (just not those that violate bodily integrity lol). I don't even look for utilitarian cases for or against things, because I don't think that's what makes them good or bad. I don't much rely on heuristics for this sort of thing.

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Regarding the "how is this not like a cult getting people's money" comment, I saw people point out that the kidney is not going to the cult, but to strangers. But I didn't see anyone point out that religious movements that persuade people to devote a lot of their money and time *to good-faith charitable causes* (i.e. benefiting strangers, not the religious leaders) rather than to self-serving cult leaders aren't vilified; they're generally praised. So it seems like the commenter's argument is "if we don't like it when people are persuaded to do harmful things, why should we like it when they're persuaded to do good things?"

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> I think a lot of people have a heuristic of something like “if you’re making a profit, you’re probably screwing someone over”.

There's a term for this: https://en.wikipedia.org/wiki/Limited_good

(Also a lot of people will straight-up openly assert this. I don't know how they explain why they themselves engage in trade when they are apparently losing from it.)

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Nov 7·edited Nov 7

An anecdote in favor of transplant evaluation people: I was recently a stem cell donor for my dad's cancer treatment. I had to talk to a social worker, whose job was to tick a bunch of boxes saying I was sane enough to consent to the procedure, and wasn't being coerced.

She was as upfront as she could possibly be, short of grossly breaching professional norms like, that her job was basically to make sure I wasn't part of the tiny minority of people who are actually being blackmailed into donating by their families, and that aside from that our conversation was basically useless. When she asked me "can you tell me in your own words why you're donating" and I looked at her like she was an idiot and said "because I don't want my dad to die of cancer" she chuckled and gave me a "yeah I get that a lot" smirk. She also gave me some off-label advice on how to avoid feeling like crap after the donations ("the doctors will just tell you to hydrate, but those electrolyte sports drinks are really where it's at, chug a bunch of Gatorade the day before and right after the procedure and you won't even notice the side effects"). I can't say whether her advice was actually good, but I followed it and I felt fine.

None of this means you shouldn't lie to these people, because the consequences of telling the truth if you happen to get an evil one are terrible. But there is at least one of them who is a sane human being.

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"And Stephen admits there are “a thousand and one exceptions”. Later in the thread, he lists some of these: blood donations, haircuts, laser eye surgery. I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions."

I don't think it's that hard to square the circle on "exceptions" to the notion of bodily integrity. The examples given would violate bodily integrity only if you define that in terms of the structural composition of the body (i.e. keeping the body as it is, without additions or removals), perhaps out a sense of purity or a belief in the sanctity of the form. But if instead you view bodily integrity as conditional on the functioning of the body, then the exceptions stop being exceptions and become legitimate extensions of the idea. Blood donations, vaccinations, haircuts, pacemakers, and so on are fine because they either improve bodily functioning or don't negatively impact it in any permanent manner. Donating an organ, in contrast, does.

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I see a typo on something I said, I meant chimeric not chiral 😅

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Thanks for highlighting my comment. My last name is Böttger not Bottger, with an o Umlaut. Not that it really matters, since you wrote it correctly in the Book Review Contest 2023 Winners post.

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> I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice.

My guess on the underlying instincts: the person you're talking to matters more than someone who will never know you existed. So you want to talk like you're protecting their interests. And the people being talked to were potential donors; potential recipients weren't on the radar.

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I know this doesn't bring much to the discussion, but the phrase "Opt-Out Organ Donation" just makes me feel such an instinctive fear like I've never felt about any other string of words. I imagine that I've spent way too much time around the privacy protection and free software side of the internet where the words "opt-out" 99% of the time have a very bad to Orwellian bad connotation (as in "oops, you forgot to opt-out of Google Maps tracking your precise location 24/7 and selling it to advertisers/law enforcement/anybody else" bad), but still.

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Two related ideas:

In many transactions, each party has separate representatives. (Buying a house for example: the buyer and seller each have an agent, and it's a bad idea for these to be the same person.) It seems like some of the challenges with those who participate in transplant evaluation are because their responsibility is to the hospital, not the donor. Your representative could help you understand the process, the kind of questions you'll be asked and how best to answer truthfully, and redirect to a different hospital if needed.

Separately, I wonder about a survey that asks whether you'd be willing to donate a kidney and, upon receiving an affirmative answer, pivots to "great, let's get you scheduled".

Perhaps these could even be combined: those who express interest in donating are assigned a donor advocate who acts in the prospective donor's best interest, helping them to reflect on and make an informed decision, and then guides them through the rest of the process.

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"I resent being treated as the dupe of an ideology that I helped form."

And I resented your initial blog post on this topic, but I didn't say anything at the time. Now I'll say something I suppose.

You've been duped by an ideology that you helped form. This ideology doesn't even sound correct or good to most normal people (your simplistic notion that it's just trying to do the most good is as ridiculous as a Communist trying to say that Communism is just wanting equality for everyone), and it has done extensive damage to the world as it stands. Oh, but somewhere some people were nice to you or something, so who could have predicted that FTX was a scam? I would have said it was probably a scam, because I think EA is an obvious hotbed for scams. Everybody who dislikes EA's would have probably said it. But you've donated a kidney and others have too, so all's well that ends well. You can calculate this scientifically or mathematically or something, using methods that your cult finds convincing, as do high prestige morons.

Bodily integrity is not a heuristic. It's not a weird moral rule, some kind of basic assumption for practical purposes. Not everything is a heuristic, heuristics are for decision making especially in mathematics and social science fields, they aren't identical to priors, or moral values, or sentiments, or traditions, or any of the other dozen alternatives that would lead somebody to dismiss your kidney argument out of hand. But if you think these are actually all synonyms, maybe use some of them for once.

More importantly, there is an alternative phrase for bodily integrity. Bodily sanctity. Far from being some weird moral rule, a strange exception or random thing, this is an explicitly stated position in the biggest religions in the world, religions that have been far more dominant in the past than now. Here's a heuristic for you, what is old is tried and tested, what is new is probably wrong, and your entire world view doesn't extend before the modern era. I don't want to hear about "exceptions" from people who can't identify what is and isn't a heuristic, and can't fathom why anybody would believe in bodily sanctity, or understand how it works for normal people (not all of this is targeted at Scott specifically). As much as I don't want to defend somebody when they didn't ask for it, when Stephen made his comment, I would say his comment was a heuristic only in the sense of being a blog comment, not as a moral position. Because Rationalists are so weird, and not in a good way, it would take a lot of time to explain extremely basic and widely held notions of the sanctity of the body, the difference between the essence of an object and its particular instance, what is and is not the "body" in the specific way under discussion, etc. So you fall back on simplistic version of the argument, accept that exceptions can be found under this simplistic version, and try to move on for the sake of discussion.

And I'm not even of the opinion that one shouldn't donate their kidney. Sure, do it, it can be altruistic. But it can also be a bad thing. Perhaps it can be bad when you make a blog post about it to a large number of people in an attempt to convince them to offer up their organs in the name of your cults and the false god QALY.

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I also value body integrity, but differently- not as a heuristic, it is something I actually feel strongly about. Even a thought of some internal part being taken away feels awful, even if it’s a part that doesn’t make a difference. I don’t really feel like the hair (except maybe for the follicles) is a part of it, I feel strongly interventions that don’t make the body in the long term different from what it was, I would suffer but agree to a removal of something that contains cancer. Vaccinations are fine, as they don’t take away or change anything. Piercing’s not fine, physically don’t like the idea. Donating a kidney to someone in need is not fine, even if it didn’t affect anything in the body, because I’d feel bad about missing it, not having it connected to the rest of me anymore, etc., so unless it is somehow really important (a close relative needs it), I wouldn’t do it, this is not a resource I’m happy to use to improve the lives of others

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I liked this post and I really enjoy reading here. However, the last but one paragraph kind of churned something inside me. It is offtopic but I think still worth mentioning.

> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me.

It is weird for me is to be proud of one's country because I think there is a lot to be ashamed of for (almost?) every country (for a reasonable person) and I cannot imagine the US are an exception. Can someone be proud and ashamed for the very same thing? I think it doesn't make sense, shame and pride are opposites. Am I correct?

Also, pride of the mentioned aspects of the US society, eg. freedom of speech, is questionable in my point of view. To me, pride is a rather personal feeling. I mean how much can someone be proud of something which they have not influenced, but were lucky enough to be born in the "right" place?

(Apart from this it is also weird for me to say "American" and when actually meaning "US-American" although it is common practice.)

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“ Sometimes they spend all their time gaining more and more power and popularity, and never get around to using it for good. ”

Reminds me of the joke about the corrupted politician.

“He started off doing good, but he ended up doing well. “

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I'm a little confused by the Wytham Abbey point in the original article, and more confused by the follow up here.

The point (from Owen Cotton-Barratt's own words) was "The main case for the project was not a cost-saving one, but that if it was a success it could generate many more valuable workshops than would otherwise exist. Note that this is a much less expensive experiment than it may look on face value, since we retain the underlying asset of the building.

We wanted to be close to Oxford for easy access to the intellectual communities there. (Property prices weren’t falling off significantly with distance until travel time from Oxford and London had become significantly higher.) We looked at a lot of properties online, and visited the three properties we found for sale with 20+ bedrooms within about 50 minutes of Oxford. These were all “country houses”, which are commonly repurposed as event venues in England. The other two were cheaper (one ~£6M and one ~£9M at the end of a competitive process; compared to a purchase price for Wytham of a bit under £15M) but needed significantly more work before they were usable, which would have added large expense (running into the millions) and delay (likely years). (And renovation expense isn’t obviously recoverable if one sells — it depends on how much the buyers want the same things from the property as you do.)"

The original article seems (given Scott's participation and knowledge of the above quote (see reddit thread below)) calculated to drive rage engagement. Fine, sometimes it's good to get the blood moving. But then follow-up here also seems to forget we know why they bought the castle.

They set out looking for fancy venues right by Oxford. The fancy was part of the search, they want to own the EA conference version of the Institute for Advanced Study (a cool house in the woods. It was never "we need to save money on conference venues", it was "we need to save money on really cooooolll conference venues that are close to Oxford and inspire the soul". Fine, but setting this out as if it was somehow magically the cheapest way to do this (including converting a warehouse or cube farm office building) is baiting people into a (correct) gut-reaction of "that's bullshit".

tl;dr, the math probably works out if you include inspiring people near Oxford, but it was not a cost decision and retrofitting a warehouse was never on the table. People are riled up about this b/c it's presented (even in the EA-adjacent community) as "cost-effective to buy a castle as a convention center" when that's an intentionally inflammatory framing.



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Nov 7·edited Nov 7

> The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here.

Strange. I can't imagine why the German government would be squeamish about organ donation from healthy individuals to random German citizens. Maybe if I concentrated I could figure it out. But there's six million other things I have to do. I'll try to think about it in the shower.

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I’m actually mildly annoyed at the negativity of some of these comments. Mark Twain: “No good deed goes unpunished.”

How many of the commenters criticising Scott’s decision have actually met someone on dialysis? Or after a renal transplant? I think Scott quoted a disability adjusted life year improvement from 70% to 90% but this is a scale that ranks someone with chronic untreatable depression and constant suicidality at 40%. The commenter above who felt that his time on dialysis was basically a period in limbo awaiting transplant is a typical story. Nephrologists like to say that the dumbest kidney is still much smarter than the smartest nephrologist; our various mechanical systems are vastly inferior to an actual kidney in removing bodily waste. And it’s not a coincidence that dialysis starts with “die,” the median life expectancy is around 5 years.

Contrast that with a transplant recipient who in most cases after a period of recovery can expect a more or less normal life (granted, with the aid of strong immunosuppressive drugs), with a life expectancy of 15 - 20 years. You can perhaps appreciate how grateful such a person would be.

I have no strong feelings about the philosophy of EA, but I do strongly feel that a world where more people donate organs to those in need is a better world, notwithstanding the tiny and well documented risks involved to the donor. I understand that some commenters have a vague feeling of “yuck” but see how “yuck” you feel when you are in desperate need of a life saving transplant and there’s thousands of other people before you.

(I will probably not donate a kidney but only because Scott is a much better person than me.)

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Nov 7·edited Nov 7

I'm still thinking about donating and I have another dumb question. Why are there so many people on dialysis? Why isn't it the case that every person who needs one is able move someone who knows them to donate (I personally would have zero hesitation if I actually knew anyone who needed one)? Are their family members/friends/cowerkers/acquantances just sitting back letting them die?

Seems unbelievably stingy to me. Any insights on this would really help me to feel like I understand what I'd be doing.

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I think your take on the comments made me more uncomfortable with the original article after I went back and read it. Like some of the commenters you commented on, I'm trying to figure out why by writing a comment :)

TLDR: I'm glad you did it. I never downloaded the Good Person Who Just Wants To Help Human Personality Template. Kidneys seem safe to donate and have low long-term costs to the donor. I feel like you're moralizing about the best place to be on an ethical gradient when there is probably a vast savannah between the high moral peaks that EA/idpol/religious people get their climbing gear out for. I just wanna grill, man.

- I THINK the thing I'm uncomfortable with is something like "a lot of people are telling me how I should live my life and clearly a lot of them are dead fucking wrong, so why should I trust this guy?" The drive to moralizing and tinkering with optimal God Seeking Behaviour drives me wild! In my late 30s I finally came to terms with religious people who want to live under the thumb of ideology as long as they don't try to get in my face about it, just at the time when Social Justice types replaced God with identity politics and invented new idols to worship. Your framing feels like the same type of shape (triangular?) as the other God Seeking Behaviour, just using QAYL

- Any memeplex (EA, idpol, christianity) gradually gets more complexified and zealous. EA might have started out as "let's donate mosquito nets" and now is moving in to the "you should do this with your body" just like idpol started out as "this is how it feels like to be X identity, show some sympathy" and ended up at "because of your genetics you have original sin; pray with me it would be a pity if you lost your job"

- `[...] but I’m probably not going to donate a lobe of my liver [...] . it’s just that I guess I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful`

- I'm pretty sure this is the sentiment that I just can't sign up for. You are judging on a moral gradient, and there are a lot of people out there judging on a moral gradient about how to be the best person. The axiology article is throwing a wrench in to me typing this during my morning coffee before work, but what if there is a vast savannah of "being pretty okay" between the high moral mountains of "being really good"? Is the imaginary Taylor Swift, Pumpkin Spice Latte, SUV commuter who donates to the food bank not measuring up or are they just "being pretty okay"?

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Thank you so much for doing this. I will be likely receiving a kidney transplant in the next six months or so from my wife. I am incredibly grateful to her for the gift she is giving me and I know someone else is incredibly grateful for the gift you have given.

God bless you.

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On the subject of legalizing donations for money: I know that the original post here labelled the "seduced by a hot stranger; wake up in an ice bath" scenario as an urban legend, but if kidney donations for money were legal and routine, how many actual organ thefts might occur? I am mostly worried about the developing world here, where people are more desperate and where a corrupt doctor or official might more easily fake the documentation that a recipient would demand.

I do not think donations for money are sinful or "deontologically wrong" or sinful, but I do worry about creating a market where organ stealing might get rewarded. Has anyone made an attempt to model or quantify this risk?

To riff on Galton-Erlich-Buck, "Altruists argued, with noble intentions, that we should implement a market for organ transplants in a responsible and ethical way. Eventually, people agreed, and they proceeded to implement a market for organ transplants in a horrifying way, with voluntariness badly compromised."

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I am glad to declare that melatonin is now easily available in Germany. (One still needs a doctor's "Rezept" to buy sildenafil aka viagra). Kidney donation is still highly suspect and if it for money: *straight out of hell* as the German WaPo "Der SPIEGEL" shows in https://www.spiegel.de/international/world/the-illegal-trade-in-organ-is-fueled-by-desperation-and-growing-a-847473.html: "... According to Kishore, it is "paternalistic" and "dogmatic" to try to bar poor donors from selling their body parts, since doing so could provide them with a new life.

This may sound like a valid argument when it's posed as part of an academic theory. But it crumbles in the reality of the slums of India, Bangladesh, Egypt and the Philippines. There have been studies that included surveys of people in these countries who had sold a kidney. Many of them complained of poor physical and emotional health, and the overwhelming majority had spent the money within only a few months. Their lives did not improve. In fact, many were now worse off than before because they could no longer perform heavy labor or even work at all anymore.

Most had also failed to consider that the sale of about 160 grams of tissue would marginalize them even further, so that they would end up being relegated to the same level as prostitutes within the social structure of their countries. Moldovan organ donors told researchers that they were berated as "one-kidneyers" and "half-men," and told that now they would never be able to find a wife. ..."


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"I do psych evals for surgery sometimes, and I’ve read the papers on how to do them, and the official criteria all seem pretty reasonable, so I have no idea where these people are getting this from or, how they possibly go so wrong."

I'm gonna hazard a guess at: lawsuits. I did a quick Google about "lawsuits for organ donation" and you get a nice selection of results where everyone is suing everybody else about "you took organs without consent", "you are sending harvested organs out of our state to the big cities", a really sad one about "the recipient contracted cancer from the donated organ and died" and plenty more.

Here's a lawfirm giving a handy rundown of "can you sue and on what grounds?"


"What Proof Is Needed for a Transplant Malpractice Claim?

In the context of a medical malpractice claim, professional negligence is negligence that is committed by:



Healthcare providers;


Other institutions.

Professional negligence involves a failure to do something that a reasonably prudent doctor, nurse, medical provider, hospital, or other institution would do. Professional negligence may also arise when one of these parties does something that a similarly situated party would not do under the same circumstances.

Jury instructions that are provided in professional negligence cases ask that the jury consider whether or not the party on trial was negligent. The jury will be instructed to consider all opinion testimony from expert witnesses.

Can I Sue for Failed Organ Transplant Surgery Even After Signing a Waiver?

Yes, it may be possible for an individual to sue for a failed organ transplant surgery even if they signed a waiver. Waivers can vary greatly, so it is important for an individual to review what they are signing prior to their surgery.

A waiver is a document that indicates that the patient understands they are waiving their right to a claim. Medical waivers are attempts by service providers to avoid legal liability from injured patients.

Medical waivers are often very broad and will try to include all injuries and losses. Simply because an individual signed a waiver does not always mean it will be enforceable."

I can see hospitals deciding to err on the side of caution because of CONSENT CONSENT CONSENT*. Suppose someone donates an organ, then a couple of years later they regret that decision for whatever reason. Maybe they decide "I never really wanted to do that, it must be somebody's fault, it must be the hospital is to blame!" and they go see a lawyer.

"How did you feel the day of the operation?"

"Well, I was anxious and worried and scared"

"Did the hospital do anything?"

"No, they never asked me, just went ahead with the operation"

BINGO! The hospital failed in its duty of care to a vulnerable person, so now we're going to ask for $$$$ in damages.

So now all the legal advisers to the hospitals tell them to make sure to ask the potential donor how they feel.

"How did you feel?"

"I was anxious and worried and scared"

"What did the hospital do?"

"They asked me how I felt, and I told them, and then they went ahead with the operation"

BINGO! This was coercion, and we're going to ask for $$$$$ in damages!

So now the hospitals are advised that not only do they have to ask and make sure the donor still wants to go ahead with it, they can't go ahead unless the donor is happy to do so.

And no, having your staff psychiatrist chat to the donor for ten minutes before they go under isn't good enough, because the potential donor could feel persuaded/intimidated/coerced into going ahead. So you have to make sure they have plenty of time to be absolutely sure they want to do this. Hence the six months of therapy routine. Because all the legal decisions in cases that went before about "how did you feel"/"did the hospital ask how you felt"/"did the hospital offer you any guidance or support?"/"did you feel pressured into going ahead?" are now precedent for any subsequent court cases.

*Think of all the media articles about "sure, we were in a relationship and sure, we were having consensual sex but that one time I wasn't really in the mood but had sex anyway and now looking back at it five years later that wasn't consent so it was rape".

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On the pig kidney thing, my partner works for the company doing that work, and it has been really interesting to hear about it from a laymen without a science background. She even got to visit the genetically modified pigs. One fun fact about them: if you have a red meat allergy (like from the Lone Star Tick) you can still eat the meat from their pigs, because they are bread without the protein which your immune system incorrectly responds to.

While I believe that so far they only attempt at kidney donation has been hooking the kidneys up to a patient who was in a coma, my understanding is that it went pretty well? The test stopped because they pulled the plug, so obviously the long-term impact has not yet been studied.

The more newsworthy donation attempts have been two heart transplants on recipients who did not qualify for transplant and were about to die anyway. The first lived for two months but eventually succumbed to pig herpes. The second seemed a lot more promising and was doing well until dying suddenly 6 weeks after surgery. The reasons for the abrupt failure are not yet public (and might be unknown by even the involved team, I don't have any non-public information on this one).

If anyone has any questions I'd be happy to ask my partner about what information she can provide that is sharable.

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Something I forgot to ask on the original article, but that I’m still wondering about: how much difference does it make, both for the donor and the receiver, *when* then donor donates? Would there be a benefit/detriment to either if a prospective donor that is 25 years old waits 5 years, 10 years, 20 years, 40 years before donating?

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>"if someone invents something new which is approximately as body-integrity-violating but also >approximately as beneficial as vaccines, Stephen will support it."

At this point we can easily imagine sci-fi style robotic/cybernetic/whatever implants being available by the end of our lifetime. Pacemakers are already kinda-sorta that. But there's a shared revulsion to these things, even among sci-fi fans who are already pro-science and imaginative. Star Trek's main villains for the past 30 years are the Borg. Star Wars villain Darth Vader is considered an abomination for being "more machine than man, now". Even the genetically-enhanced doctor on Deep Space Nine is afraid to continue adding cybernetic implants to an important religious leader and friend, on account of a fundamental fear that what comes out the other side would not be the same man. Point being, even a futurist open-minded audience shares this heuristic and has a visceral fear of crossing certain lines with regard to bodily integrity.

I would assume this commenter would decline robotic implants. "Hey you let us put this vaccine in you to boost you immune system, why won't you get this robot eye that sees 1000 yards and lets you change your eye color at will?" There is a primal sense shared by most people that you don't want to mess around too much with your body, ancient cultures were frightened by tales of chimeric creatures, and most in modern society find it unsettling to see people with bizarre piercings all over their body.

I don't think donating a kidney is disgusting in that way, I'm glad Scott feels good about having helped somebody even if it's not the sort of thing I would do. But I definitely have a tendency to view the body as a system you can horribly wreck by tinkering around with a thing here and a thing there, and that our incomplete knowledge of the body leaves a lot of room for me to fall back on "for every intended consequence, there's 3 unintended consequences". Normalizing kidney donation may well be a net benefit, but there IS a line beyond which I would not want to normalize screwing around with our bodies even if it it was beneficial on the face of it.

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Intellectual contortions presented as moral reasoning that invariably culminate in an altruistic obligation. All of this ignoring epistemic difficulties like The More Data You Have, The Further You Are From the Truth (https://www.youtube.com/watch?v=fuFzv1AwBKQ) and how the removal of a kidney is exactly the sort of situation that ought to evoke Chesterton’s Fence (https://fs.blog/chestertons-fence/) type trepidation. Human physiology is complex to an extent that our modern understanding, robust as it may be, cannot reasonably dispel such hesitation.

The motive behind your crusade is a conception of altruism that I find offensive, one that insists we extract and metricize our virtue, that our sense of self-esteem ought to be derived extrinsically. You shouldn’t feel good about yourself unless you justify your existence through others. Forget yourself and serve the common good, and you can bask in the feeling of pristine self-righteousness, crowd-surfing on imaginary borrowed esteem. But it doesn’t satisfy the feeling of moral insufficiency that compelled you in the first place, so you seek to convince others as a form of reaffirmation. In this way, it’s contagious – like religion.

I might donate a kidney to a close friend, but nothing could ever convince me to donate one to a random stranger, and I think the impetus to try is deeply immoral. I don’t suspect you of lying, but I’m terrified of what you honestly seem to regard as moral action.

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Scott's comment in Section 5 of "it seems borderline enough that I’m still sticking with my heuristic of “IDK irradiating my body seems high risk of being bad” and his further offhand comment in Section 9 about being "way way way outside the bounds of common sense" strike me as pretty decent refutations of his rebuttals offered in Section 1. It seems, at least, non-standard to judge a tiny radiation risk from a procedure most people do without much worry, more seriously than 'IDK removing an organ seems high risk of being bad,' and that would bring it into the realm of "common sense," to which Scott later appeals. I don't think his interlocutors are arguing much differently than he is, just with different "IDKs" and "common sense."

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"Here’s a sort of daydream: some charity gets the list of the 40,000 people who are predicted to die next year for lack of a kidney. Then it chooses 40,000 random Americans in a 1:1 correspondence with the kidney patients. Then it sends each of those random Americans a letter, saying “Dear John, you have been paired with Bob Smith of Topeka, Kansas. He will die of kidney failure next year unless someone donates a kidney. We have randomly selected you as a potential donor. If you say no, we will not randomly select anyone else, and Bob will probably die. If you’re willing, please call this phone number.”

There’s some sense in which this charity would be doing zero work - just choosing random names from the phone book! - but it sure would be an interesting experiment. Would 25 - 50% of the people involved really go for it? I don’t know."

Two possible answers from me (and the second is the much more likely one):

(a) "Dear Prodnoses, I am terribly sorry to hear about poor old Bob. Certain to die, you say? In that case, for the minimal sum of, let's say, five million dollars I'd be more than happy to give him one of my kidneys. You cannot put a value on life, after all, so I'm sure Bob and/or his family would be willing to recompense me for the time and inconvenience in order to save their loved one. Bank details to follow as soon as you send me acceptance of my terms, love and kisses, Two Working Just Fine Kidneys-Haver"


(b) "Dear Busybodies, I'm sorry to hear that Bob is in such dire straits. From a sudden and unprovided death, deliver us, O Lord. However, since Bob knows his death is nigh, he will have time to prepare for it, and isn't that a blessing? This bit you include about kidneys, I'm not entirely sure what you are hinting at. Since I don't know Bob or the sky over him, why am I going to give him a kidney? You are labouring under a misapprehension there, my friends. Well, best wishes and tell Bob I'll pray for his departed soul! Your friend, Taking All My Bits With Me To My Grave".


"Comments From People Who Are Against This Sort Of Thing"

You know I had to do it:


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I loved your article and forwarded it to my sister-in-law in Holland. She is donating a kidney to a nurse she works with. She chuckled at parts of the article. You did a beautiful thing in donating a kidney. Thank you for sharing your experience!

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Not sure if this has been mentioned before, but it strikes me that the moral agency here being discussed is completely contingent on outside factors. However thorough your due diligence prior, your action stops at the door, and from thereon everything depends on a complex system of interventions, care, proper organ transport, etc. to work at near perfect levels - and for it to continue to do so. And we happen to be talking about a system where medical error is a leading cause of death or harm. I am speaking as a former ICU nurse (who has also seen 10/10 pain coming out of ORs).

There are a lot of moral actions that rely on outside factors, of course, but in such cases you can generally change how to direct your resources. I think our morality is based in intuitions without which no-one would care about rational arguments, and which prioritize observable and close effects over remote and theoretical or statistical ones - for good reason.

The action also requires consent. This is and should be a hard line in society and signals that it is not enough for something to be for the common good to be socially prescribed. You are doing something wonderful - but something that cannot be asked of anyone. A significant distinction morally, I think.

Of course, your rational arguments also occur in the context of a society where consent and individual agency are prioritized. But is it hard to imagine a highly top down society, maybe not to far removed, siding with your impeccable arguments, and distributing resources accordingly?

So what I am arguing is that seemingly universal principles can be very contingent.

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I am all for individual people donating their kidneys and I think they are heroic, but a social norm where you had to donate kidneys to be considered a real effective altruist and get access to high level business networking events is pretty horrifying but also the most plausible negative outcome, requiring only that in 50 years EA reverts to the mean and starts working like normal charity fundraising, or like a normal social group, on one of the advanced levels of that "reality/imitation/symbol/imitation of a symbol" hierarchy that I don't recall the name of.

The best way to avoid this that I have thought of is to talk about how great and selfless individual people are while loudly proclaiming how unsettling it is *in general*, so that it can never become a social norm that you have to do it to be average within this extreme community.

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Isn't there a more obvious objection that you can only donate a kidney once? If you give your kidney to a stranger, you can't also then give one to a dying loved one. Since (almost) everyone values loved one lives over stranger lives, there's some calculation to be done in terms of EV. Quick googling says 2/1000 Americans actively need transplants, and 1/7 adults experience kidney disease. Assuming you have at least 10 loved ones including yourself, you have to value a stranger's life at least at 1% of your own/loved ones' to make this decision.

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cool paradox with being protective of potential donors being "neither selfish nor altruistic". But idk it seems pretty obvious to me

Surely if someone was mistaken about their risk from donating (e.g. had some disease that would make it massively reduce their quality of life), you would tell them that, even if you thought them donating would still be net +utils. It's like honesty. This would be true even if the donor would never connect the dots and wouldn't regret the donation.

People who feel very uncomfortable with donating a kidney feel like their discomfort (to some degree) applies to other people too, that is they're making a bad decision for themselves. It's the same things as not stealing from the rich to give to the poor etc.

(I note I'm (somewhat) one of such people and my analysis presents us as pretty cool)

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I was really surprised at how much pushback you got for donating your kidney. Really strong, emotional feedback in many cases. I don't really get it.

After talking with some commentors who were upset with your post, I think part of the issue is the whole morality/axiology thing you mentioned. I think some people believe that is something is morally praiseworthy then it is morally required, and if you don't do it then you're a bad person, and this translated your kidney donation post into "if you don't donate a kidney you're a bad person" even though you kind of went out of your way not to say that.

Maybe it's because I'm a Christian that had "all men have sinned and fallen short of the glory of God" hammered into my head from an early age, but it seems clear to me that you're not trying to make anyone feel guilty for not donating their kidney. None of us are anywhere close to morally perfect, and that's okay.

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Had a random thought reading this article, EA:Charity::Sabremetrics:Baseball

Meaning, people acknowledge that the statistical modeling that's been added to baseball is invaluable if you want to actually win the most games over a season, so it would be irresponsible for coaches and managers not to use it, but a lot of fans of baseball feel that it ruined the thing they loved about baseball, which wasn't actually the number of games won but the narrative experience you could randomly have watching a game where something totally unexpected would occur and you would define part of your whole life experience as being present for that moment (the classic example is seeing someone throw a no-hitter, which you will never see in the modern game because its mathematically irresponsible to leave one pitcher in for an entire game).

Anyway, EA is great at the thing that most people would assume people engage with charity for, which is helping people. But it dilutes a lot of the narrative aspect of charity that is what people really want whether they acknowledge it or not; instead of charity being a magical moment of self-discovered selflessness, its some mathematically quantifiable that can tell you, objectively, the extent to which you are really optimized for "helping other people."

Anyway, I think donating a kidney obviously sort of bridges the gap between these two experiences.

Its a very personal story where the cost-benefit analysis is still something someone in EA would accept.

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I really appreciate the EA space for helping me come to the conclusion that I have no interest in altruism.

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I think my opinion is relatively simple: it is obviously a Good thing to donate organs, but most people (including me) are not particularly Good. Which is fine, really, being Neutral is fine and all that should be expected of anyone. It's just weird when some people feel the need to define Good in terms of the decisions and sacrifices they personally would make.

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> I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice. This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here?

First of all, I don't believe it is net positive. It certainly has some positive effects, but I value a working organ more if it's working in its true owner, not someone else, ceteris paribus (sort of like how kids should be raised by their biological parents). Then there are the nonphysical negatives like the OCD/scrupulosity issue or the self-harm / self-negation issue.

But even if it were *net* positive (say it saved 1000 lives), I don't think people should make major sacrifices of their own body just to help a stranger. I think it's wrong. I think that's a harmful and self-destructive thought process, and I'd like to see it eradicated.

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These discussions have made me realize that part of the reason barriers on kidney donation make me so mad is that they are an imposition onto me of the values of the medical ethics community that values status quo and not doing harm over improvement. An imposition of exactly the kind that medical ethicists insist would be immoral to do with respect to other values -- creating the impression that I'm being disrespected for being different.

In general, medical ethics requires we respect the choice of a patient to decline treatment even when the doctor is quite confident that not only will it benefit the patient but they'll retroactively appreciate it. Even if treating a patient whose mental illness has caused them to develop strong religious beliefs that cause them to oppose treatment (but still legally sane) medical ethicists hold that it wouldn't just be unwise but unethical to override that patient's own value judgement: even when that value judgement is to do something which they'll regret in the future.

Moreover, it wouldn't be ethical for a doctor to use coercive power they had over a patient to pressure them to accept. Sure, the doctor can try to persuade but they couldn't withhold some other needed medication unless the patient sees a psychiatrist who will try to convince them to take the drug they choose not to take, or to force them to get all sorts of other tests they don't wish to get to convince them they should follow the doctor's advice.

But yet when my ethics say that I care very much about not weighting the potential harms to myself over the benefits I'm told too bad we'll force you to do exactly that by creating a bunch of hurdles.

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One thing that seems overlooked is that, even if it's ok to donate a kidney to a stranger (which is doubtful), it's definitely not ok to brag about it! I think bragging might be the greater ethical lapse here.

I suspect a lot of donors do it just to brag, or wouldn't do it if they couldn't brag about it. Certainly no one should donate if they wouldn't do it in a hypothetical world where it was impossible to brag about it - that makes motives very suspect.

The argument for bragging is that it might convince others to donate. It's unclear to me that this would be a good thing, but even if so, the harm to yourself and others from bragging far outweights any benefit from convincing others to donate.

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I frankly dont trust the medical field, from "protests from the right sort of people doesn't spread COVID", to the number one medical trade organization endorsing baby murder and the sterilization of mentally ill youth, to my constant contact with entitled Pre-Meds(I have been the lab instructor for several O-Chem classes), to the insane rules around around voluntary organ donation (tried to donate bone morrow; was denied for mild sleep apnea I'll literally be on a positive airway pressure during surgery) to historical grievances like doctors supporting of whatever "in" thing like coersive eugenics, to the fact that I still have to pay $150 a month for a simple stimulant prescription(not the medication which is another 300 dollars, when I can get it, but I won't blame doctors for that specific piece of DEA bullshit), despite taking this medication for almost 12 years, so I am very sympathetic to The Lone Ranger's argument, they obviously dont need organs because if they did they wouldnt have all these silly rules in place preventing people from donating.

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I've been trying to work out why the original piece made me feel a little uneasy, when I rather admire what Scott and other donors do, as an act of straightforward selfless, kindness.....

And then it clicked. I think it's truly a fine thing to do. It is kind. Selfless. An act of grace. I'm not a christian but the christian tradition of valuing the gracious or even gratuitous act, a deed that may not be mandated by an ordinary moral code, is a very attractive concept.

EA at its worse sounds like a parody of utilitarianism. But its impulses are noble. Bernard Williams observed that utilitarianism thins out our moral language and thus thinking. Important distinct concepts such as love, honour, generosity, attention, grace (my partial list here, not his) get ignored or reduced, but these are central to long-standing notions of what it means to be a good person, of what it means to live well.

As I say, I admire the kidney donors. Perhaps Scott is too self-effacing to lay claim to the the virtues of what he has done but (to use another important word) it seems to me a noble thing.

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Among the problems with arguments from optics is that how you look depends on who's looking. People who hate lawyers will look down on you for getting a law degree, but law offices will hire you for it. People who believe that murder is wrong will look down on you for it but it's a big bonus in the gang status ecosystem.

More relevantly for this example, some people will ALWAYS think you're weird or even evil for trying to change the status quo. Optimizing your optics for those people means abdicating all desire to make the world a better place. Choosing your altruism based on "actually doing good" means picking a form of optimism that signals seriousness and correct beliefs to a subset of altruists even if it means spurning many other causes.

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Did no one comment from a markets standpoint? Legalizing the trade in live organs would solve a lot. Donors would get compensated for the risks (which don’t seem totally negligible and at least warrant further study) and their pain (just the word “catheter” is enough to ensure I would never do this except for a very well-behaved family member). As an added bonus, markets may even put a stop to the cringe moral preening of the donor class.

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The last comment talked about the fear of a supposed organ mafia in Germany. At least in Brazil, this is a real fear many people have, especially after a real case happened (The Pavesi case) , which even makes them unlikely to allow post-mortum donation of their organs, so this might also occur in countries that share low trust of authorities.

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Could one donate a kidney, feel good about it and then not tell anyone?

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Is there a breakdown on QALY for bone marrow donation vs. kidney donation? A friend of mine did a bone marrow donation, and he seemed to find it similarly transformative as an experience.

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Fuck man, Scott did something quite amazingly altruistic that not even 0.1% of people actually do. Huge kudos to him, end of story. Altruism has been a thing since there is a humanity, and people have even found it even in birds and other critters. Why do people feel the need to create a huge controversy about it is beyond me. No one is asking *you* to do it, and I don't think anyone could actually argue that it's unethical. Scott gets the satisfaction of personally giving some lucky unknown a huge improvement in quality of life, and to exercise his 100% pure-American freedom. Win-win for all involved.

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> You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal.

I think this might be because most people (even if they won't agree to it plainly put) internalize "good" as a relative goal to themselves, their in-group, etc. An abstract goal of doing the most good implies that one can objectively measure a "good" that isn't your own self- and group-interest, since if you're working to the best goals you have for yourself already, that's just unremarkable.

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>Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice. This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here?

It's the same reason some non-Vegans get mad at Vegans, and why smokers used to get mad at non-smokers.

If someone is doing something good hat you're not, it implicitly puts them above you in social hierarchy.

If a social norm comes into existence where lots and lots of people are doing a good thing that you're not doing and it seems normal to do that thing, you're suddenly actively being bad when you were just fine a moment ago.

People who don't intend to adhere to a newly forming social norm have an active interest in preventing that norm from forming, because it will be used to judge them in the future.

(Of course, this thought process is rarely explicit, and more commonly takes teh route of an ego-defense mechanism: 'People are trying to persuade everyone that doing X is good, but I'm a good person and I don't want to do X, X must be secretly bad for some reason and I should do the good thing and warn everyone against it')

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I don't understand how Scott says he was there at the founding of EA - the founding of EA was with Peter Singer's famous 1972 essay "Famine, Affluence, and Morality" which was before Scott was born.

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I hate writing critical comments other than in response to one or to rescue someone under critique.

Scott is the NICEST GUY. I never met him but I love him. I've recently had the good fortune to Zoom meet someone from this group and he's an amazing fellow. And most of what I've read from most people has been great too.

I have one bad experience with this group. It was early on in the hysteridemic and someone set up a Zoom or something. I was outdoors and recommending others live likewise and was mocked (behind my back of course, cowards gonna coward). But I was right and they were wrong.

So when I see a compadre's case getting stiffed in the main text I gotta come to his aid and point out that Scott missed the Lone Ranger but *shot the shit* out of his strawman.

Scott wasn't on that call and I'm certain that he would NOT have been like the rude (and oh so stupid) couple of snot-nosed know-nothings but he gave cover to The Scare and bears some of the responsibility for the impudent impunity with which his people acted to the one guy who was right.

Scott, with genuine respect, it seems that Lone Ranger doubts your medical evidence and you and the "rationalist community" generally when it comes to "socially good" medical matters.

I wasn't commenting then but I was reading, and you plus 90% of the people in this community were not only wrong but - ahead of the curve wrong - about Covid.

That jerkwad from the NYT who wanted to write a nice article about you and this community regarding how you "got covid right", did you a tremendous favor by totally ignoring your desire to not have your name revealed.

That killed the article that would have hung around your neck until the end of days.

I *LOVE* you, and I'm quite positive about nearly everyone in this community too but you were all Obviously And From The Start wrong-wrong-wrong and biased-biased-biased about Covid and there has never been a local "learning from our errors" in this space.

Or at least not one commensurate with the fact that this community was NOT uninfluential at that time.

This community and the many brainy indoor types that interact with it gave the kosher stamp of "smart serious men" approval to all the hysterics out there.

I don't know the numbers in kidney safety but dude has a point.

How many people here knowing lied or otherwise manipulated their words to get people to take the shot?

And that was waaaaayyyyyyyy down the line when everybody and their mother knew that "everybody would get Covid, it would kill the very medically compromised, and there's nothing we can do about any of it".

Oh, and that the shot was the placebo excuse for TPTB to call an official end to their hysterics without having to cede either fault or power.

I assume your numbers here are generally good so I won't dispute your claims about kidney donations, and in general I SUPPORT US ALL TAKING RESPONSIBILITY FOR EACH OTHER IN EVERY WAY.

But the shade he throws at your trustworthiness regarding matters medical that are within your understanding of "the moral good" isn't undeserved.

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Hi Scott - random IgA Nephropathy patient here. Your article made me cry in the good way. My life could depend on someone like you. Thanks for writing the article.

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Reading the original essay really shocked me to my core. It feels so insane to give a part of your body to a random person you don't even know.


How about: maybe not everybody is equal? To me, Scott is worth more than a random person. He's even worth more than 10 random people. One more year of Scott will probably improve the world more than 100 years of random other people. So 1% chance of complications during surgery would not be worth 100% certainty of giving a person 40? (50? I don't know his age) more years to live.

I mean, isn't that the whole idea of EA? That you should think about how to most efficiently save people?

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There's a lot of comments that are very bizzare to my own sense of morality. Maybe I'm just so Christian that I find it hard to comprehend people who assert that self-sacrifice is bad - not just not required, I understand that, but actually something that should be avoided and prevented? Sure, not everyone can be a saint, but apparently a lot more people agree with Randian objectivism than I would have thought?

To clarify, I'm pretty consequentialist when assessing right and wrong, but in order to have an actually usable defintion of morality I regard self-sacrifice for the sake of others as superegotory, not obligatory. Nobody is required to donate a kidney, I haven't done it so I'm in no position to criticise, but I still regard it as the right thing to do - in the same way that selling all you have to give it to the poor is the right thing to do, I just also haven't done that yet.

Anyway, I respect Scott more after this, and I'm glad he posted it because I think it may lead more people to do the same - not out of guilt, but out of a desire to better themselves/on-up other people, and isn't that what morality is all about?

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I found it puzzling that your original post there was a very strong argument that nobody paid any attention to, as far as I could tell:

> The procedure does increase your risk of kidney failure — but the average donor still has only a 1 to 2 percent chance of that happening. The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation.

If properly fleshed out it has a potential to be an absolute killer: donating a kidney is like buying insurance against dying from kidney failure, so if you're concerned about it, and the numbers work out in your favor, you should, based on purely selfish logic.

But there's a problem, it looks like there are two kinds of people: some are deeply concerned about being Good, and donating a kidney provides them with a tangible evidence that they are in fact Good. This goes like a refrain through the original post and all the comments from people who donated.

The other kind of people don't feel this urge as strongly, and reading the above makes them feel that they are being shamed into it. Also they naturally suspect that deep down the altruistic people donate for status (and they could be partially right, even in case of people who only brag about being Provably Good in internet comments).

Of course most people are likely somewhere in the middle of this spectrum, but are pushed towards the ends by some sort of a cascade amplifying the initial kneejerk reaction, if your first thought happens to be oh shit here's a chance to do some good you will keep warming up to the idea, if it was that the donors appear awfully smug, you will invent reasons for why they have no moral authority.

But most interestingly this theory explains why being bumped to the top of the list of kidney receivers was soundly ignored. Because the pro-donation people, including yourself, are all of the first kind, and if it turns that donating a kidney is a *selfish* act then why, it means that your certificate of being a Good Person is not as good as you thought!

Therefore an *effective* way to convince people to donate kidneys might require writing two different posts aimed at these different audiences. One, investigating whether donating a kidney is a good insurance against dying while waiting for a kidney transplant and any other potential benefits you can find, and not mentioning anything about being a Good Person, and another, basically the one you did write, aimed at people who always wanted to donate for altruistic reasons but haven't realized that it's actually something they can go and get done.

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"The multiphase abdominal CT used in kidney donation screening is 30 mSv"

For someone of your build, with modern scanners with automated tube current modulation, the dose would be closer to 10mSv. Here's a paper (It's 3-4 mSV per scan and 3 phases in the multiphase scan): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258803/

In the future with next generation photon counting scanners, radiation dose will go down another factor of 2-3 which should make this less of an issue.

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Late reply but this would be my full argument against kidney donation: https://ontologi.cc/21e64798347049258c3c6d05f0d7a23f

tl;dr scott I think you got the science wrong, and are conveying the idea that a very damaging procedure isn't, and I think a lot of young people considering donation might be doing so without having thought through all the ethical implications and internal processes leading to this and potentially resulting from them.

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I was thinking about my opposition to specifically monetary compensation for organ donation, and hit upon a solution which might actually be good - someone get the Catholic church or some other big religion to straight up confer sainthood onto organ donors. I think this is far less liable to abuse than paying people.

This seems to be the motive driving most EA altruistic donation, but that's secular, and a lot of people don't strongly identify with EA anyway. Enter: sainting.

Disadvantage: might make the average person who doesn't strongly identify with being/becoming a saint less likely to donate. I don't consider this a huge loss because I don't think they were likely donors to begin with.

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Thinking about the fall-injury incentives thing from https://slatestarcodex.com/2016/11/10/book-review-house-of-god/ is it possible that somehow adjusting the basis on which medicaid and other government programs pay for dialysis would motivate existing medical providers to throw their weight behind reforms?

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*Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice... So what’s the psychological motive here?*

Fairness intuition. The median kind of person who would consider altruistic kidney donation is likely to be overly generous, overly giving and vulnerable to exploitation. No one likes to see a vulnerable or unusually generous person being exploited by free riders who’d never reciprocate.

Of course I don’t think Scott himself is particularly vulnerable to exploitation or manipulation; he thinks everything through too carefully for that. But if kidney donation were normalised, I expect a lot of overly kind people with low self esteem would pay the price. (The same people would be vulnerable in the event of euthanasia being normalised.) These people would be mostly female.

I’d never, ever do it myself for far too many reasons to list. But the reason I wouldn’t like it to be normalised is that it would inevitably result in a net transfer of health from females to males, and most women are already sacrificing their health for others in thousands of small and large ways that add up to a massive injustice.

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Why should mentally ill people force their crappy genetics on someone else? They certainly will be horrible parents anyway, leaving their children or abusing them.

I hate my life and am mentally ill because of my useless father forcing me into this world (I grew up with a step father).

We need eugenics. Chris Langan has rightly defended it for decades. People don't care about their children anyway, killing or abandoning them. Were I not a Christian, I would kill myself immediately. In fact, were I not a Christian, I would forcibly sterilize the whole world. Who cares if you get sterilized, given how much sexual decadence exist today? Existing because your father and/or mother copulated with the n-th women or men just shows how meaningless our existence is and sexuality a curse by God which will not exist in Heaven, as Christ says Himself.

So stop this posturing please, ethics is a nonsense word for "morality" which has no basis outside religion, it cannot be defined by anyone but God.

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