"Second: doing a good thing so you’ll feel good about yourself doesn’t seem healthy. "
If you're just taking up space in the world and doing nothing for others, SHOULD you feel good about yourself? And I can understand having greater care for people you know and love, but could this not also be exploited as well? "I know knocking off Johnny makes you all squeamish, but it's for the family. You wouldn't chicken out on your family, would you?"
Those "others" you talk about helping - are they just sitting around taking up space in the world? Why do you feel good about helping people who are "just taking up space", and how is this the best possible use of your time.
Or, alternately, if the people you are trying to help are themselves trying to help other people, doesn't that at some point trade against everybody helping themselves and skipping the extra transaction costs? Particularly if the "everybody helping everybody" thing is pushed to the EA ideal of donating every marginal dollar, because by that point you've run out of low-hanging fruit on the "helping other people" front.
That just sounds like communal living. Everybody contributes, therefore nobody goes without, therefore nobody just takes up space unless they become physically incapacitated. But because it's understood that they would contribute if they could, and everybody is in the contributing habit anyway, it doesn't feel like a burden.
1) Scott knows that. Jeez, do yoou think that’s news? Donating a kidney and engaging in effective altruism are not mutually exclusive. He can engage just as energetically in EA with one kidney as with 2.
2) You don't quite get the feeling good thing. It's not feeling virtuous. It's not the ethical equivalent of feeling smart because you just got your LSAT score back and it's really high. It's an *emotion* you get from direct giving to a stranger. The first time I felt it was while I was in grad school. I signed up for one of those "give to the needy" Christmas things, mostly because I was bored. I was given the ages, clothing sizes and modest Christmas wish lists of the members of a family, and I went to the mall and bought all the stuff, plus a few items I thought could not fail to please — one was a baseball-sized Hershey kiss. Later, I felt unexpectedly emotional while wrapping everything — suddenly felt very loving towards these strangers. And for days afterwards I daydreamed about them opening the presents, and hoped they were happy with them. I yearned to watch them unwrap them (but to be invisible, so there were no weird awkward thank you’s.). It was definitely a good feeling, but it was not at all a kind of pride. The closest I can come is to say that it put me in touch with a loving side of myself that I did not know existed. It felt good to manifest that side. I do understand that this sort of direct giving is not an effective use of resources. The $100 or so I spent on presents could no doubt have been used much more effectively, produced much more total human benefit. But I think direct giving, while statistically ineffective, is a good spiritual practice for EAs and others. It puts you in touch with a side of you that wants to give more.
3) Are you aware that you can’t give a kidney to just anyone? You have to be a match on most of 6 (I think it’s 6) different variables — things like blood type. While family members are more likely to be matches , it’s far from a sure thing even for siblings and parents, who are the relatives you share the most genes with. With them there is I believe about a 50% chance that you will be a half-match (match on half the variables) which is decent but not great. Once you get to aunts and uncles and cousins, the chances drop pretty low. So let’s think about the numbers, as EA’s do. Scott is 38. He has 12 more years before he’s too old to be a desirable donor. He has 2 parents & I believe one sibling. Regarding kids, let’s think large and assume he will father 3. So he will have 6 relatives with whom there’s a decent but not great chance he’d be a match. And what are the chances one of them will need a kidney in the next 12 years? Just looked up what percent of population currently has end stage kidney disease. It’s about 1 person in 500. I'm sure the majority of them are adults, and half of Scott's 6 future relatives in our model will be children during the 12 years when he is young enough to donate. So overall it’s quite unlikely that one of Scott’s close relatives will need a transplant in the next few years, and even unlikelier that somebody will need one AND he will be a match. Given all that, does it make sense to hang on to his spare kidney on the off chance a close relative will need it in the next 12 years?
At least in Britain (? Not sure about country) they have a system where you can "trade" for optimal kidneys, where, say there's several donors with incompatible relatives with failing kidneys, and they keep getting matched up with another incompatible donor compatible receiver pair, until s eventually someone comes in and completes the chain, so then all the recipients get an appropriate kidney and all donors have donated.
I’d love to know if other women have considered this and have better info on the risk of being one kidney’d for future pregnancies. I know pregnancy taxes your kidneys more than ordinary life, and since I have a history of miscarriage I’ve been reluctant to add any new risks.
(I’m also curious if having one kidney means being risked out by eg a birthing center or a midwifery practice).
They did note some pregnancy-associated risk increase post-donation, such as a higher likelihood of fetal loss (19.2% vs. 11.3%), gestational diabetes (2.7% vs. 0.7%), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and preeclampsia (5.5% vs. 0.8%). Also, a lower likelihood of full-term deliveries (73.7% vs. 84.6%).
These outcomes were more likely in people's post-donation pregnancies, than their pre-donation pregnancies. Sounds like they tried to model age in, but they admit that it is hard to be fully sure they factored out age effects. Kidney donation screening seems to have meant the pre-donation baseline started out at better than genpop, and they characterized the post-donation numbers as similar to genpop and lower than individuals with kidney disease? Looks like a risk-increase, though.
Now that I have two kids, I wouldn't actually do it.
One of my kids is disabled (autism) and even a tiny increased risk of death or shortened lifespan is too risky for me, because he's probably going to need life long support from me.
It's also reduced my donations to charity significantly for the same reason, I need to save all the money I can for after I die because he's unlikely to be able to have a job in the future.
In retrospect I should have skipped having kids entirely and done kidney donation instead, but hindsight is 20/20.
I am stoked about using IVF with embryo selection to select the embryos with the fewest risky variants and the fewest de novo mutations. Reducing the rates of de novo mutations and risky variants by 1SD each generation is a huge boon to health. In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient.
"In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient."
Even cheaper and more convenient if regulators get out of the way and just allow the crips and 'tards to be aborted, right? IVF etc. is expensive and time-consuming, just dump the failed attempt and try again, and if your genes are too mucked-up to produce healthy kids, stop trying to have kids. That's the sensible solution, yes?
Yes, and I say that unironically. I don't want to get into an abortion argument because those are tiresome and repetitive, but I'm curious about your counterargument to this: "if your genes are too mucked-up to produce healthy kids, stop trying to have kids"
What's wrong with people voluntarily choosing not to have kids to spare them horrible suffering?
Sure, if it's a disease that causes horrible suffering. I'm not sure even acute enough autism to need lifelong support inflicts "horrible suffering," to go back to the conversation starter.
We actually had both our kids fully sequenced and the polygenic score for autism is actually higher in my neurotypical kid than in my autistic one. At the current level of technology it's clear the power is just not there yet.
I remember talking to someone in this field a while ago who suggested that it is in fact still better to have natural conception if possible vs pre-screened IVF because of an inherent lower risk of mutations as seen in (some?) studies. I think this is something that people might want to look into before deciding to pursue genetic screening for embryos.
parental age (especially the father's age) is the biggest modifiable risk factor for de novo mutations. IVF users would tend to be older and sicker than natural conceptioners so it's probably just an artifact unless they explicitly controlled for that. But anyway they can just measure the number of DNMs in each embryo after the embryos are made and factor that into the choice of which embryos to use.
also the paternal age DNM problem could be completely avoided if dudes freeze sperm when they're 16. Providing that for free would be 100x worth it for a country with cradle to grave nationalized healthcare.
I remember looking into this before I donated my kidney, and the only risk that I recall there being solid evidence for was a slight increase in the risk of pre-eclampsia. That said, it's totally reasonable to wait until you're done having kids, especially if you've had problems in the past.
In the realm of anecdotes: I had an uncomplicated pregnancy and now I have a beautiful, healthy one-month-old!
Out of curiosity did you donate your kidney to a stranger like Scott did?
My guess would be that "donating your kidney without a known recipient" falls in to the category of things that males are far more likely to do than females.
Obviously my theory is untestable if indeed there are greater risks for women (either for their bodily health or reproductive health), but simply based on my limited knowledge of male and female psychology I would imagine that (unless it became the social norm or otherwise "cool") the number of men donating kidneys to unknown participants compared to the number of women donating kidneys to unknown participants would be at least 5 to 1.
Like I said though, if indeed there are greater risks to women then my theory can be proven wrong (if indeed there is greater parity than 5 to 1) but can't be proven right (because rational concerns wouldn't be gender equivalent).
I did donate my kidney to a stranger, actually. Let this be a lesson to you about making assumptions about people based on their gender, especially when those people are rationalists.
Hey, I hedged every which way to Sunday! 😂 Hell, my comment was even an attempt to CALL FOR MY CORRECTION!
Let that be a lesson to YOU about making assumptions about a stranger. 😉
I am 100% certain that what I did was as close to truth-seeking and overcoming bias as is possible to one of flesh and blood.
All that said, text fails to convey... pretty much everything. So let me say that I'm writing this with a sly smirk on my face as a friend joshing you because I'm reading your comment as coming from the same intent.
If you're serious though, I'd be glad to have an octagon death match of unbiasedness. We could make a youtube video attempting to uncover each other's irrationalities. Uncovering my own bias is like my favorite thing!
All that said, A. I still assume that the numbers are 5:1 in cultures where it isn't considered within the bounds of normalcy (it amazes me to learn that there's a community where it IS considered normal! and B. Bravo!!!!! 👏👏👏❣️❣️❣️❣️❣️❣️❣️❣️❣️❣️ A thousand or million times bravo What you did is absolutely amazing. You are a wonderful beautiful person. As a human on this planet I *personally* thank you for contributing to us and wish you snd your family every single happiness. Really, may there be more people like you. 🙏
If I could live my life over again, I'd donate a kidney at age 20-25 —i.e., old enough to be an Official Adult but too young to have kids. That seems like a good option for women who intend to have kids, to balance out the risks of potential pregnancy which will probably happen at 25-40 and the risk of an aging kidney being less useful.
I (25F) donated this year (also at Weill Cornell!), and my personal calculation was that because I'm already at very low risk of pre-eclampsia due to various factors, I could stomach being at slightly higher risk. My medical team told me that if/when I get pregnant, the pregnancy will automatically be treated as a higher-risk pregnancy, and appropriate precautions will be taken. That being said, I've never been pregnant, so my "calculations" were based on vibes. I also figured it would be much, much easier logistically to donate before I had kids than after. Also - I personally would be fully open to adoption in the event I was unable to have kids biologically, so for me personally it didn't necessarily feel like any of my options were being taken away.
Other than in the immediate hours after donating, when I was in a good deal of pain (and until I heard that the transplant had gone well and my recipient was recovering, which, like Scott said, put things into perspective), I have not regretted my donation for a moment. It is in all likelihood the greatest thing I'll do with my life (in an optimistic way!).
Thank you for donating, and that's a very helpful comment! I have sought out practices (midwives, birthing centers) that take an aggressive approach to "risking out" patients and banning them. Attempting a VBAC got me risked out from a group of birthing center midwives and accepted by a group of hospital midwives (it worked!).
To me, this suggests that it's not a good idea for women to donate a kidney if they suspect they'd strongly like to try home births, birthing center births, low intervention births and the lack of a kidney means they'll be risked out of compatible practices.
I'm more confident the increase in risk would lead to being dropped by those practitioners than that it *should.* But it's rare enough that I suspect many will not be up to consider the risk and run the numbers but will simple say "that's non-standard risk and we don't do it."
As a post pregnancy x2 woman, I would advise waiting until you have had children. There are just so many surprising changes to one's body during and following pregnancy that if healthy offspring with a healthy mom are your priority, holding off on adding an additional possible complication seems wise.
I think I'd have been very excited about donating a spare kidney when my kids were elementary school age if that had been at all a thing I knew about and if I'd been in a different relationship (my husband so objected to my donating blood that I stopped, even though I'd been doing it with no noticeable problems for 15 years, and went back to donating after we separated, again with no problems).
I believe that bodily integrity has a value in and of itself, independent of any utilitarian calculation around whether you will need a particular organ. (I don't mean "integrity" in some metaphorical sense. I mean it in the literal sense of keeping the physical phenotype in accord with its basic genotypic design.) Obviously, there will be a thousand and one exceptions in practice. (Fair warning: if you respond by giving me examples of such exceptions, I will be extremely unimpressed.) Every time one gives oneself a paper cut, one is violating bodily integrity in some small way. Of course. But I try not to do that on purpose, except perhaps to treat some greater medical ailment.
If you insist on utilitarianism, I suppose you could justify my position with some kind of rule-utilitarianism as opposed to act-utilitarianism. But I'm not a utilitarian at all.
I guess I don't understand what it means to assert a strange moral rule that there's no a priori reason to expect, admit that there are many exceptions where it's not true and you can't explain why, then continue to assert that it's a moral rule rather than a heuristic.
A: "I went to the park yesterday"
B: "What? You should never go to things beginning with P!"
A: "But don't people go to the port and the parlor and the palace all the time? And you never object to that?"
B: "Yes, obviously there are a thousand and one exceptions in practice. But you shouldn't go to the park. That's just how moral law works."
I don't know how you could possibly argue with B at this point, it just doesn't seem like there's any positive reason to believe him.
Keep your bodily integrity, if you must, and celebrate those who save lives in real time in the real world! If Sam bankman Fried just gave a body part instead of his soul, we’d all be better off
Is "keep one's body intact" really a "strange moral rule?"
Your story about "not going to places that begin with P" is the kind of story I'd expect a utilitarian to tell. And yet, "keep my body intact" doesn't seem anything at all to me like "don't go to places that begin with P."
Why might that be? Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant. But it seems to me that such factors, especially in regard to matters of the body, sex, and relations, might be very important indeed.
To ward off annoying evangelical utilitarians, you just tell them that you have a utility function different from theirs (I think that's actually just true, even if you reject the label, but I might be using the term idiosyncratically). They ought to know they can't argue with that.
You're right –– but only in the trivial sense that any norm can be reproduced by sculpting a custom utility function for it. I understand that, but consider it an unhelpful exercise.
Yeah, I agree: I don't think it's a useful exercise either. It's just that "utilitarianism" is as meaningful a name of the doctrine as "do-the-right-thing-ism," when it usually means something like "maximize-the-total-global-QALYs-ism" which doesn't correspond very closely to mine. (The alternative doctrines that try to describe themselves without reference to to utility functions strike me as either incoherent or downright evil, so this kind of trivial description is the best I've got. The detail is then in WHAT my utility function is, loyalty, honor, duty, etc.)
That's one of many reasons I don't consider myself a utilitarian. You can game the system to come up with any outcome you want, and it gives you the freedom to justify that. SBF probably still feels justified, even with the outright fraud.
If you posit that there are more utils in murdering people, you can justify that too. Maybe you're the Punisher, killing the worst people that the law can't handle. Or you've done the math and some people's lives just aren't worth living, so it's worth the hit to your utils to save them.
I'm a deontologist, so I just say that murder is wrong.
I think the example of SBF has been too quickly and too defensively bracketed. ("Oh, it turned out that he was just a fraud, not a *real* EA." Hmm, not a true Scotsman, you mean?)
My reading of SBF is that he was sincere, in the sense of sincerely following his Maximum Expected Utility, as he calculated it, and that led him to disregard ethical norms that did not accord with the latter.
In fact, AND THIS IS THE CRUCIAL BIT, like Scott, he would have demanded that those ethical norms be justified in terms of Maximum Expected Utility, and then dismissed them as "strange" when they were not.
In Sweden, we have a huge problem with "people the law can't handle," and a fair share of the populace is ready to applaud any such Punisher killing them off in the name of total utility. If so, we'll see where that takes us (Nazi Germany or El Salvador?). However, it will have to be compared to where we're heading now (probably Mexico).
Deontologically self-imposed limitations might eventually face ethical opportunity costs that make you want to reconsider them. Then the cultural evolutionary selection processes will undergo some learning that includes selecting away the principled. This is not a normative point but a descriptive one.
Any one person's ethical stance will, of course, be that particular individual's decision. The bigger issue is what norm will prevail, under what circumstances.
There's a complexity about that which is about comparison of utility between people and aggregation of utility across populations.
Most kinds of utilitarianism say that you should aspire to maximize total or average utility (or some variant of those meant to address paradoxes and counterintuitive results), of "everyone". In that case your different utility function would mean that *your personal contribution* to total (or average or whatever) global utility would be weird or hard to predict, but that doesn't change the utilitarian goal of trying to maximize something globally, nor the utilitarian moral intuition that *you, too* should being trying to maximize something globally!
(There's a whole set of criticisms of utilitarianism based on the conceptual difficulties of how to compare or aggregate utilities between different subjects-of-experience.)
A more considering stance would recognize that humans don't have complete degrees of freedom in their divergence in values, and so while there can be a legitimate underlying value difference, it can be exacerbated beyond the value it would have on reflection! So it can still be worthwhile to talk over it.
"I want to keep my body intact because it feels right to me" is perfectly fine and unsurprising.
"As a moral rule, one ought to keep one's body intact" is weird as hell and you haven't even made an attempt to justify it. The only way I could even imagine making an attempt to justify it would be through some form of divine command theory... but if you think you have a decent justification, I'm all ears.
Exactly. My first thought was of the now-defunct proscription in the Catholic Church against cremation and the revulsion of Catholic parents at the thought of ear-piercing or any other body modification. The point was that Christ was going to want to resurrect your whole body on Judgment Day. That was their strong argument for keeping one's body intact. It's a belief, nothing more. OK for you if that's how you feel, but not compelling to anyone who doesn't share that feeling/belief.
> Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant.
There's a bunch of posts on the EffectiveAltruism forum and LessWrong about considerations like these, acting like EA is just naive utilitarianism is just a strawman imo.
You can infact have a higher value for bodily integrity than others! It just does actually seem like an odd value to settle on, especially when its qualified with a bunch of exceptions, which is what Scott is getting at. This is still compatible with consequentialism, and would just mean that you have a higher personal-cost for certain kidney operations.
I agree that having my body altered is significant, but that's primarily due to a combination of the unpleasantness, cost, and the possible problems that come from it (Scott's description of how the surgery before and after made my mind rate the cost for donating a kidney higher than I thought it was from vague thoughts before the post). But also, while it would be very uncomfortable to get a cybernetic eye that works better than human eyes (once we have them), I'd still be very interested to get them. It would just be worth the cost.
I think what Scott is getting at is that your form of bodily integrity value is an odd sort of rule, that makes less sense than other rules that are common (such as do not lie, do not murder). It makes sense as something to prefer, but doesn't make sense as something that tries to be set down as a law like 'do not lie' often tries to be.
"Keeping one's body 'intact' has intrinsic rather than instrumental value", which was what you said originally (slightly paphrased but I don't think misrepresented), does seem a bit strange, yes. Granted, the word "intact" has positive connotations, typically if asked if I'd prefer thing x to be intact, I'll say yes for most xes I care about. But when you try to figure out what the nice-sounding-thing "keep your body intact" means in practice, there's plenty of room for disagreement about what it should mean and whether it would be good.
If the meaning you intend by "keep your body intact" doesn't ground out in it being functional and healthy (which a body can be after an organ donation, in the same way as it can be after things I imagine you were thinking of as silly counter-examples, like hair loss and clipping your nails), and doesn't draw the line between an intact body and say a broken or improperly divided one in a way that recognizes the value of being able to function well, then I think whatever your definition of intactness/integrity is is likely on the wrong track, and would be strange to treat as a moral good. Also, if your values of bodily-intactness are selfish and don't recognize the goodness of giving something of your own body to help someone else's body function well and be more intact than it was (if, in other words, you wouldn't endorse trading a little of your body's intactness to help someone else a lot with theirs), then, I mean, ok, that's what you think is good. Seems strange and unconvincing to me.
If, however, you define bodily intactness with reference to bodies with parts that function well together, recognizing the physical fact that we're all ships of theseus, and if you are willing to agree that more people with intact bodies is better, and giving a bit of your body that makes you only very marginally less "intact" than you were to someone so theirs can be more intact, would be a good and generous act because of the effects on bodily intactness, then there really isn't a disagreement here, just a confusion in use of words. But it seems like you think organ donation would be bad by your moral values because it means you're no longer intact, so there is ovbiously some more substantive disagreement here, I guess.
I would agree with him that keeping your body intact has intrinsic value. That doesn't mean there aren't other values - helping others is another value. That does mean there is a trade-off, and you lose something above and beyond the inconvenience and pain and risk of complications.
OK, that's fine, I suppose. I am a left leg below knee amputee, so on thinking about this more it occurs to me that it is possible that my sense of whether and why bodily intactness matters relies less on intuition and more on explicitly thinking about my situation than most people :D. And so thinking that intactness matters might be something that a lot of people think, and I just don't, unless there's an impact on functionality, and it seemed strange to me because I'm just different. But actually, if we're just talking about intuitions about what is valuable, I can also see why "don't remove bits of me" is a fairly good heuristic generally, and this was emphatically more true before modern medicine. Sometimes the modern environment means our intuitions about what is good, formed in a very different environment, can lead us astray.
Shorter and more to the point than my earlier post: valuing keeping one's body intact as an intrinsic good absent any reference to its function and health would be a strange moral rule, yes.
Valuing an intact body because of how it's functional when intact is not strange, but it is also not incompatible with organ donation.
The fact that you find organ donation goes against your moral value of intactness, strongly suggests you place a strange value on keeping yourself "intact" even when you don't need to for health and function. One wonders what other things you might object to on grounds of bodily integrity.
I mean... keeping the phenotype in accord with the genotype's design? First off, your genotype wasn't designed. But secondly, why do you care about that? Would you care about that even in the case where your genotype included Huntington's or some other thing that made your life bad? If you had the gene for increased risk of breast cancer, would you object to surgical intervention, in that the integrity-respecting thing to do is die of breast cancer?
Unless your "integrity" value grounds out in a healthy and functioning body, then yes, it would be strange.
I kind of agree with SA that your point here is put pretty weirdly, but I want to draw attention instead to this weird tactic you are using of only contrasting your theory with utilitarianism. "It is intrinsically good to keep your body intact" is a specific rule, "utilitarianism" is a specific theory. It is true that utilitarianism does not include this rule, but you can't defend this specific rule by contrasting it to one specific unpopular theory. Lots of non-utilitarians will also find this rule unpersuasive, you are setting yourself up for too easy a job by shrugging at disagreement and going "I guess the utilitarians are at it again". It's fine if you don't have some specific justification you can give, lots of people bottom out parts of morality in basic moral intuitions, but you should, in that case, admit that you are losing anyone who does not share your intuition, not merely anyone who is a utilitarian (and of course if you do have some more basic foundation, you should give that rather than just picking on the utilitarians).
The "strange moral rule"s you're talking about are usually things backed up strongly by moral intuitions. You know, those things that everyone recognises but that utilitarians seem to make a herculean effort to pretend don't exist. They're certainly not remotely arbitrary rules.
One may not share those moral intuitions for particular Rules, but they're invariably held far, far more widely than the intuitions for many of the things utilitarians advocate. Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever. Utilitarianism at its worst literally tells you to execute innocent scapegoats to appease a mob.
That's just one of a half dozen crippling problems for utilitarianism (where it gives not just a non-moral answer, but the anti-moral answer). Another crippling problem: it's pretty clear, and all commenters agree, that you, Scott, did a really great, heroic thing. And you did. Yet under utilitarianism, you just did the bare minimum you're obligated to, and in fact fell far short of that if you're not living in a cardboard box and donating everything you don't literally need to survive. And you apparently don't deserve any praise at all.
The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
You're greatly overestimating how many people here subscribe to the sort of pure utilitarianism you're describing. Plus Scott and anyone else who's read the sequences is unlikely to be that sort of utilitarian, by virtue of how the sequences focuses on the ways overly simplistic moral theories lead to abhorrent consequences if actually taken to their logical extremes.
>Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever.
Do you seriously not know the basic textbook criticisms of deontology? Like how a universal prohibition on lying when put up against a tyrannical government, forces you to not lie about hiding dissidents in your basement?
1. I was a bit reluctant to turn a celebration of Scott doing a good deed into an argument about utilitarianism. But this is the first EA/utilitatianism-related post for a long time, so I'm doing that. I'm in awe of Scott's principled and compassionate greatness though.
2. I am just a bit sick of something in this community that may not be an actual motte-and-bailey, but functions a bit like one. When asked or challenged, most people here disavow utilitarianism in its pure or even substantial form. And then, when no one's challenging it, many of them fall back into talking as though it's obviously true, obviously uncontroversial, and then some indeed get very angry at the existence of people who criticise or oppose Effective Altruism. This part *is* a basic motte-and-bailey: when challenged EA is merely giving more effectively, when not challenged it's full-throated utilitarian dogma (at least for some people). It's also depressing when a charity discussion comes up and I think "finally something everyone can agree is good, and come together on", and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that. Much like a Christian charity spending a bit on distributing food and a lot more on distributing bibles, or worse actually because the latter probably brings *some* benefit to real people who actually exist.
3. I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing). I also find a lot of it's terribly written (bad and unclear argumentative structure, even occasional bad grammar). I can't for the life of me understand its popularity around here, but I guess that's a whole other discussion. I certainly can't see what substantive insight people get out of it
4. That objection is to Kantianism specifically, not deonology generally. The major advantage of deontological theories is there are so many of them (Kantian fairness-based theories, rights-based theories, contractualist theories), and each form itself is very flexible and debateable, allowing them be molded to actually fit common moral intuitions instead of violating them. The lying example is Kant's own interpretation of his theory, but it could be interpreted differently depending on how you understand the "maxim" you are following in that particular axe-murderer edge case, and to what cases it's precisely universalised.
In any case I'm not saying other moral theories don't have problems, but I think utilitarianism has far more of them, and they seem to be often ignored when not being directly challenged.
"If you find mistakes, feel free to point them out."
I plan to do so (to some extent) in an open thread at some point. It's a big discussion.
The "simplicity" I'm talking about is mostly the writing style, not the arguments. Really, I find that there mostly are no arguments, or at least not clear and explicit ones. Maybe I haven't read enough of it or I'm misremembering what I have read, but my impression is that it's generally either all-over-the-place rambling (leaving me thinking "what the hell are you trying to say? could you be so helpful as to write out your conclusion, and preferably your reasons too, in clear sentences?") or asserting as "obvious" significant and very much non-obvious philosophical claims about reality.*
But its popularity around here (especially among fans of such well-written, lucid and clearly argued writing as Scott's) makes me wonder if I'm missing something.
"Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess."
And most Continental Philosophy has the same problem: very rambling and unclearly written, and seemingly deliberately so. I think the 19th century German stuff (Hegel, Nietzsche) isn't *as* bad as the 20th century French, but on the whole both it and stuff by EY seem to have an ideological objection to clearly laying out their arguments.
*As a general example that I'm not sure was said by EY in so many words, but that comes across to me strongly in his writing: we obviously can't learn anything about reality by just thinking about it. Or, with a circular argument instead of no argument: the reason we know you can't learn about reality by thinking, is that if you're just thinking you're not testing your observations out in the world, and obviously that's the only way to learn about reality.
The reason we know empiricism is true, is that obviously empiricism is true.
It sounds like your perception of a motte and bailey is partly you lumping together people with very different levels of sophistication in their views.
I think the most serious rationalists who've put much thought into moral philosophy and read the sequences tend to be moral antirealists.
You're somewhat conflating between people who are just naive utilitarians who almost certainly haven't read the sequences, and people who view moral philosophy as primarily useful for guiding your moral views towards internal consistency.
Though people also often confuse things with very non standard conceptions of utilitarianism: like the idea that if you can rank the desirability of potential worlds in a non-circular manner then that constitutes a utility function.
>and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that.
You're confusing moral philosophy with epistemology here. If you think AI is liable to change the world dramatically in one's own lifetime, then that will necessarily inform your behavior under any nearly any moral framework.
> And you apparently don't deserve any praise at all. The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
On the contrary, you're the one who isn't quite grokking utilitarianism here. You're trying to graft a non-consequentialist account of moral desert to a consequentialist account of moral obligation: of course it's not going to make sense.
Utilitarianism does not say that only saints deserve praise; it has no special rules for issuing praise or blame at all. They're just ordinary actions, subject to the same imperative as any other. If the consequences of praising someone are good, do it. If they're not, don't.
Yes, that's my exact problem. It's blindingly clear to most people, as a matter of basic moral sense, that people who do good deserve praise and people who do evil deserve punishment. Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished! Both of these are grossly offensive to what morality actually *is*, as we have a sense of it.
It also implies that among the people praising Scott, those who are utilitarians don't actually mean it and are just speaking strategically to manipulate others to act. Which is a nasty thought.
> Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished!
Sure, naive utilitarianism.
But a proper discussion would include costs like 'it is often better to provide positive incentives' + 'being truthful is a good'.
... but also if the benefit was high enough, I would shame them. I don't have a hard rule that I won't do that. However shaming tends to generate a terrible culture that feeds on itself and/or self-flagellates enough to be damaging. It is also hard to evaluate whether that would really be better.
And for the murderer, you have the issue that you want to disincentivize murders. I'm pretty sure Scott has a post on this, but I failed to find it. If you strictly thought about the direct impacts of your choice, then if you let him go free then the murderer lives a decent life, but if you put him in prison then someone lives a bad life (ignoring that you imply he'd murder again). So you release him.
If you consistently follow this rule, then you've essentially given a Get Out of Jail Free card to anyone who can commit a bunch of murders (or other negative crimes), gets caught, and then can say they'll never do it again.
The proper analysis of this would be that you need to provide a disincentive. If you murder someone we throw you in jail. This makes so people are less likely to commit murder or stealing or whatever because they know they're likely to personally gain less from it.
This is similar to the analysis that some people give for the classic 'Doctor could save five lives by taking the organs of this one mostly-healthy person'. If you expect that an institution people can legibly trust (predict) to heal them and not do anything else would then help more people, than it is better than the alternative institution where you have to worry about getting your organs harvested and so you're less likely to go in because you broke your leg.
These do become deontology-like, but that's because I agree that deontology captures some ideas of our moral rules! However, I think that the utilitarian analysis lets you decide when it is reasonable to break them or shift them - if you do a proper analysis, which is hard! I see rules like 'Doctors will not harm their patients' as useful ways to be legibly trustworthy and reliable. The punishment of law is also about disincentivizing it from occurring in the first place.
As well, utilitarianism/consequentialism doesn't stop you from inherently wanting to punish others,
I don't really understand what you mean in that last paragraph. If some person praises Scott in order to manipulate (persuade) other people to do the same thing as Scott, what does it mean that this person might not "actually mean it"? If she is a utilitarian, she is doing that manipulation because she thinks that Scott did something that was a net good.
Do you mean that she needs to feel emotionally that Scott is to be praised, in addition to just calculating that donating a kidney is a net good? Like, she has to be emotionally sincere?
I've come to think I was too snarky and aggressive in the above comments, trying to simplistically refute utilitarianism, when other moral theories do indeed have problems too and there's a clear balancing act required. And utilitarians (especially those like Scott) are actually doing good in the world so who am I to oppose them?
What I do stand by is my point above that some utilitarians, including some commenters here, not only take it completely for granted but react with disbelief or worse that anyone could not be a utilitarian. I thnk *those* people specifically need to have all the many problems with utilitarianism shoved in their faces when they exhibit that attitude. But most probably aren't like that.
As for your question, I think what I was getting at was that if someone expresses praise for a deed, that should *necessarily* correlate with her thinking that deed was good. At least in theory, a utilitarian acts and speaks only to maximise good outcomes (not truth per se), and thus you can never be sure if she's speaking truthfully. But you make a good point that in the case of praise, the outcome and the truth are likely correlated. So my objection was perhaps not very coherent.
One hard case is whether you should let dictators have comfortable retirements or punish them if you can.
Maybe letting dictators have comfortable retirements will get more dictators to retire. Maybe punishing them will make them hang onto power as hard as they can. (Actually, no maybe for that one.)
But maybe punishing them discourages other people from becoming dictators.
There are so few dictators and the circumstances under which any dictator comes to power and leaves power are so unique, and dictators by definition change or subvert the entire system including any precedents or previous incentives.
Also people who become dictators already know that they're risking death if they ever get deposed and know not to trust any promises of a comfortable retirement.
I had LASIK to treat myopia, which was a phenotype caused by my genotype.
Genetics certainly play a role in obesity, and I wouldn't bet against genetic predispositions towards torn ACLs (or at least predispositions towards the foolhardy things we do to tear them).
I got evaluated for LASIK. (Sadly, I turned out not to be a good candidate.) LASIK pretty straightforwardly restores a normal function (seeing). It doesn't impinge on bodily integrity in the functional sense I have in mind.
Sure, it ablates tissue at the micro level. You can press that point if you like, but I'll consider it a kind of quibbling that doesn't interact with my actual position. Ditto with similar examples of medical repairs.
It seems to me that the principle you believe in is not really bodily integrity (because there are so many exceptions you accept), but something like "a person has an obligation not to damage his or her body's functioning".
Piercings, tattoos, circumcision, sterilization/vasectomy, hormonal contraception, abortion, breast implants/reconstruction, cosmetic surgery, sex reassignment surgery, anabolic steroids -- what is your opinion of these?
Does donating a kidney to a spouse or a relative also violate your principle?
Integrity and function are closely linked: removing an otherwise functioning organ is usually a sure way of impairing or destroying its function.
It's not really that I accept "exceptions" to damaging integrity as if they were special carve-outs. It's just that many such things are trivial (e.g., donating blood that will soon be renewed) or done precisely to restore function (e.g., LASIK or similar reparative procedures). I don't really view such things, properly understood, as "exceptions" at all.
I definitely disagree here. I share your view that bodily integrity has some intrinsic value, but I intuitively feel that LASIK violates that, which is why I would never get it.
LASIK is not so straighforward. It's a risky and experimental procedure, in that we still don't know the long-term effects of it. LASIK "restores function" (in some cases) by destroying tissue in ways that weaken the eye and the body as a whole, and there are just too many horror stories and too many risks for it to be justified.
In my view, this is not a coincidence or a flaw that can be corrected by a better procedure, but rather an inevitable effect of anything that harms bodily integrity.
You may well know more about LASIK than I do. If we have a difference here, I suspect it's about the facts of what LASIK does, not about the ethical principles to be applied.
So does a kidney transplant! Not saying that you should value other people's bodily integity as highly as your own, but presumably it should factor into your decisions if it is indeed something of value? I'm not saying anyone should do it, I'm still pondering it myself, but we come back to weighing up the loss to you (both definite and potential) against the gain to others.
If you don’t care whether others do it, and just regard organ donation as too risky/dangerous to consider for yourself, isn’t that just a matter of personal risk tolerance? Or would you advocate for shutting down voluntarily organ donation programs and the like, and enforcing strict restrictions on various surgical procedures?
I personally have very low risk tolerance for surgery (ex/ avoiding LASIK) but don’t think there’s a generalizable *moral* principle there.
The justification is that he doesn't want to donate his kidney but he also wants to continue feeling morally superior.
There's nothing terrible about not wanting to donate. I'm not planning on doing it. But trying to tear down people who do an obviously altruistic thing is very weak in my opinion.
No, that’s your hypothesis as to his actual motivation. Which may or may not be correct, but the principle of charity would seem to indicate that we should give him the chance to explain himself first.
There's something very interesting going on with this section of the concept space. I can't quite puzzle it out. It's worthy of further consideration, but perhaps of a style better suited to Sam Kriss than Scott Alexander.
When it comes to morality, my experience has been that almost everyone including me decides what they think/feel is right, and then finds a rationalization. They know the answer they want to get before trying to think it through logically, and logic is then used to justify the felt-correct conclusion. If a particular logical argument is shown to have a hole, another will be found, but the conclusion won't change, unless it is shown that two moral values are in conflict. Before I was aware of this happening to me, it happened 100% of the time. Now I aim for a lower number, like 90% :)
Considering the idea that organ donation might be bad because of "bodily integrity" is going to be hard for people who have read Scott's post and decided that what he did was very good.
Similarly, I expect that you feel some negative feeling (I'm not you so I won't try to describe your internal feelings in detail) around some of your organs not being in you any more - it feels wrong for that to happen, and all your inside-bits being inside you seems straightforwardly right, and logical consideration of whether "bodily integrity" is a coherent concept on which to base a moral view is informed by the fact that yes, obviously your inside-bits should be inside you, that's not really up for debate.
I've tried to make logical arguments in favour of organ donation and against an overly restrictive definition of bodily integrity that would forbid it, while allowing a less restrictive definition so you can have your core intuition respected, but I don't expect that to like, work. :D
I don't feel negatively toward Scott or his decision on a personal level. I assume his decision was motivated by subjectively positive feelings, just as he mentions in the post. I see part of the value of norms being that they help guide decision-making independently of such feelings.
What "norm" are you advocating for here, exactly, and why? Based on what I've read you post here, I am genuinely unsure. It seems like different things in different places.
At first I thought it was something like "keep the bits of you together, and don't pierce your skin, although little cuts like a papercut are OK, and there are other exceptions which are obvious to me and I will be unimpressed if you bring them up" (if I was to put it in simple terms as best I can). But then you said something along the lines of "let your genes express themselves", and then "be like a normal human". The last two things seem to be getting further and further away from what I've heard anyone else call "bodily integrity", and to contradict each other if you have rare genes.
Feel free to disregard what I thought you meant and just say what you actually mean, and why you think the norm you are advocating for is good.
I agree with your basic premise, but would phrase it slightly differently. I think that moral facts are experienced by intuition and emotion.
We can try to come up with logical explanations, or theories, that try to take all these moral facts and explain them, but no one has ever done this in a satisfactory way.
So, no, your conclusion should not change because someone pokes a hole in the theory you make up to try to explain it. The conclusion is a moral fact - it is what needs to be explained, and if the theory is unsatisfactory or defective, you need a new theory to explain it.
Hmmm.... depending on what you mean by "moral facts", I may or may not agree that such things exist. I view the moral emotions such as guilt and moral outrage and the desire to punish offenders and reward good behaviour, as, well, emotions. Although certainly they're socially useful emotions which help us operate more effectively in groups, not just random things we feel. And the rules we make up when we operate in a social setting must take account of those emotions, because otherwise nobody will buy into the rules. But sometimes, moral reactions can cloud our thinking, and if we were thinking from a more dispassionate perspective about the situation, we might take actions that our future selves (who have gotten some distance from the situation we're reacting to) would think are better. For example, what seems clearly fair and right in an almost-factual "this is how reality is" sort of sense, right after you have been wronged, might seem unkind and unfairly harsh and unwilling to take into account factors outside of the wrongdoer's control, on future reflection.
To me, the basic idea "moral reactions are social emotions that benefited us in the ancestral environment" seems a satisfactory explanation for why our moral emotions, our felt-certainties about right and wrong, are what they are. And that way of viewing morality, something like Jonathan Haidt's Moral Foundaations theory, as opposed to the "everyone is given a conscience which is a moral compass built into us by a higher moral authority, and every sane and mentally intact person's conscience agrees on what is right and what is wrong" I was raised with, does a much better job of explaining the behaviour of the people I see around me.
With that said: On general principles, it seems bad to decide what the answer to a question is before you've applied your ability to reason, and then use your ability to reason to find post-hoc justifications that sound reasonable.
But _why_? Is it about outcomes? Sure, ”don’t do weird things to your body for no reason” could be a fine heuristic, but the whole point here is that there _is_ a reason. So that doesn’t seem to work.
But if it’s not about outcomes, what _is_ it. about? Aesthetics? Some unusual theory of value where your bodily integrity is _inherntly_ valuable but the life of a stranger isn’t? And how did you arrive at this highly unusual and ideosyncratic moral system?
Aesthetics maybe. So far as it being idiosyncratic I do note that Einstein declined life-saving surgery on the basis that it was 'distasteful'. I think he was 76 though so he may have felt he wasn't losing that much. But it does suggest that this style of objection is not necessarily super rare. Nonetheless, it seems mostly irrelevant ... we don't need to convince the 20% of people who have weird non-utilitarian objections, we just need to get 0.1% of people on board...
I suspect you are just exercising a value judgement. For example, you are probably against getting ears pierced, but have no problem with daily glucose checks for diabetics, which involve a finger prick. You can heal effectively immediately and with no distinguishable effects from a finger prick (not even a scar, very likely) so your "bodily integrity" is restored.
One has no need for ear lobes, but I can see feeling something missing, a lacuna to use Scott's (new to me) word, if one or both were removed.
If you feel this way, feel free to keep your organs. I don't see, however, how this should apply to others who don't currently have the visceral reaction you have. Why try to convince others of it?
If someone is born with a malformation of some sort, is a surgery that brings one closer to the median aesthetic appearance aligned with your rule? Because that person's "genotypic design", as far as I can make sense of the term, would be to have that malformation.
The very fact that you can identify something as a "malformation" indicates that you recognize a human norm from which it deviates. I'm talking about that human norm, which I do not put on an equal footing with the deviation.
But humans vary wildly. Leg extension surgery to extend height will bring you closer to the norm in The Netherlands, but further from the norm of pygmees.
So you do not care about the person's genotype, but instead about an idealized notion of an "ideal human form" which, in your view, all people should aspire to. Is that it?
I'm curious what the implication is of this remark - just pointing out something missing from what the post thinks through, or is the idea that this means that people should not donate kidneys?
I'm kinda surprised they prescribed Tylenol instead of Ibuprofen honestly. Anybody know why they did? I had anaesthesia for a cortisone shot to help with postpartum osteitis pubis, so no painkillers really needed, but I can't remember the last time a doctor prescribed me Tylenol when I wasn't pregnant.
Hey Jeremiah, thanks for your podcast episode on donating. I shared with my wife, and we're discussing for me.
How do you feel about recent research suggesting acetaminophen may be little or no better than placebo? This is a serious question for me - I suffer from frequent mild migraines, and being able to pop an advil or two ~weekly is pretty big for my quality of life.
A couple thoughts, keeping in mind I am not a doctor:
My understanding is that having a couple advil a week wouldn't really be that harmful. If you were doing 4-6 advil per day for weeks/months on end, I think that would be bad. But in moderation it's probably fine?
Other than that I'm unsure about the acetaminophen/placebo stuff. It seems to work ok for me, but it could just be that I'm very placebo-y. I also am lucky to have never had any real medical issues, so I had nothing to really consider like that.
What I tell people a lot is that we don't need *everyone* to donate. If 1 in 1000 people donated, the kidney shortage would end overnight. If you seriously consider it, and conclude that it's not for you, then that's ok.
Also, ibuprofen is a mild blood thinner, and as such is probably not ideal for someone recovering from surgery.
I was hospitalized a few years back for a possible brain bleed (head injury with an ambiguous CT read), and I was specifically not given ibuprofen because of the blood thinning effects. Between that and having an intolerance to Vicodin (unknown whether of not this extends to other front-line opioids), they apparently decided that my only two painkiller options were Tylenol or Fentanyl.
Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
>Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
Yes, I'd imagine so. For most drugs you can simply compensate by taking more orally than you would IV, but if the liver gets too much paracetamol it breaks it down wrongly and kills itself, so that's a non-option (hence the warnings on all paracetamol packages to not do this). Hadn't actually considered it before, but it makes perfect sense.
It also gave my the idea of buying the oral dissolving powder form of Tylenol and taking it sublingually in hopes of getting similar effects. It isn't as dramatic as IV tylenol, but it does seem to kick in faster and work at least a little better than swallowing pills.
It depends. Ibuprofen is routinely used for post-op pain where the surgical procedure is not associated with any specially elevated bleeding risk. Possible brain bleed is very much the opposite situation!
Reading about all these studies reminds me of this classic SSC post https://slatestarcodex.com/2017/08/29/my-irb-nightmare/ and the thought I had while reading it - why aren't there places that make medical research more frictionless in order to benefit (somehow) from everyone being incentivized to do their research there? You know, like the Delaware or Switzerland of medical research? Could some similar kind of clustering benefit organ donation as well as the attendant research? I'm sure there's a reason why this doesn't happen, but what is it?
Partly this is because most medical research is done with an eye to eventually pleasing regulators in a specific country, and those regulators want the studies to be done in their country by their rules. For example, to get a drug approved by the FDA, you need to show them studies done in America.
Some people advocate testing a drug in another country to see if it really works, and then, if it does, doing the study in the USA to please the FDA. The advantage there is that if it doesn't work, you can avoid the expensive US trial entirely.
But another reason is normal human and systematic limitations. If you are an ordinary medicine professor at (let's say) Harvard, and you want to know whether some heart thing you do in the hospital every day is beneficial or not, you probably don't have the money or capacity to get someone in China to study it on a Chinese population. You might just want to study the thing you're doing, in your own hospital, to see if it works, and then write the paper yourself.
Participant population becomes an issue if you try to cluster like this.
I think if you had a population of a city where every non-rich citizen was participating in 5 different medical trials at once, because the city set favorable terms that brought every medical trial in teh world to their doorstep, that population would no longer be a meaningfully useful control group.
Because someone who is on 4 experimental medications before entering your study is likely to have unusual readings at baseline and unusual reactions to your new medication.
Even if one thought UCSF's screening criteria were reasonable, they sound badly out of order. If a history of childhood mental illness is potentially disqualifying in their eyes, they need to ask about that history very early in the process and not proceed with CT scans (for most), nuclear kidney scans, or even time-consuming and expensive investigations until they decide if that history is a dealbreaker for them. Asking a candidate donor to incur risk, meaningful expense, and/or serious inconvenience before addressing disqualifiers like this just isn't respectful.
I've been thinking about this. Their current method is "do all tests, including psych tests and radiologic tests", then "convene committee to see if any tests are disqualifying". You could imagine a two-step process, where they convene the committee once for the psych tests, then a second time after all tests. I'm nervous demanding this because I imagine it makes things more expensive and longer for everyone to catch a tiny number of people in this situation.
Perhaps they could develop a system where anything potentially disqualifying gets flagged before they continue the testing. At the testing level that could be a checklist, which isn't good, but then they could convene the committee or a smaller sub-committee to evaluate.
It really doesn't make sense for them or especially the donor to go through a bunch of other tests if they can tell that the person is going to be disqualified earlier.
Roughly speaking, shouldn't they be doing the potentially disqualifying tests in order of increasing "cost" per unit probability of being disqualified? ( By "cost", I'm pretending that medical risk (e.g. the ionizing radiation in a CAT scan), time, financial cost etc. can be scaled somehow and combined into one number per test.)
That's a reasonable concern, although the number of people disqualified for _any_ non-radiological reason after incurring risk, meaningful expense, and/or serious inconvenience might be more than tiny. And it shouldn't take a committee to tell the candidate that issue X could be a dealbreaker and what the program's general attitude toward issue X has been historically. Given the facts you presented, I doubt the UCSF committee's serious concerns could not have been reasonably anticipated by staff. I think my irreducible minimum would be informed consent -- the candidate needs to know that there is a strong possibility of rejection based on the information on file before incurring additional risk, meaningful expense, and/or serious inconvenience.
This certainly seems like it's scheduled for the benefit of the committee members, at the cost of the would-be donor, and the medical practitioners associated with the tests.
I think a "Coordinator" or a "Patient Representative" probably has more pull with the executive committee of the hospital than a doctor.,
If something as small as 'distant history of childhood OCD' is a disqualifier, then I'd imagine that it is NOT a tiny number being caught, and they absolutely need to do the psych evaluation first. About 20% of Americans have a mental health *diagnosis* let alone symptoms of a mental illness in the past that might be disqualifying. I have few friends that would pass that screening.
I'm saying that if this is the case at UCSF, then they absolutely need to do the psych eval first before making people go through the rest of the medical testing.
I'm very happy for you, and completely unable to evaluate this rationally because a friend of mine died donating her kidney to her dying husband.
If you asked her in the afterlife, she'd probably be OK with the choice, but the incredible guilt that her husband felt afterwards is almost unimaginable.
Once again, I am being irrational and this should not dissuade anyone else; I merely was triggered to share my story.
I'm sorry to hear that. You're under no obligation to give details, but my model expected this to be pretty rare, so I'm interested in hearing any details you feel okay providing.
I never heard the exact nature of the complications, so I can simply relate that she was an extremely healthy ~50-year-old woman and she died on the table.
Yeah this is what I was thinking the whole time reading this article. Like, great, you have a bunch of studies and stuff (you know, the things that are constantly being dinged here for being full of fraud or just plain old incompetent) telling me that having my body cut open and removing an organ I'm using isn't a problem.
And I don't believe them. Sorry, but generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it (modulo the appendix?).
That's why people don't donate kidneys unless it's to their family. It's clearly risky. A bunch of discredited health people saying it's not risky isn't gonna change that - COVID showed clearly that they are the sort of people who will lie at the drop of a hat if they think it'll make people behave in ways that are somehow more "pro social" regardless of actual risk.
I agree with this. I've had supposedly 'low risk' surgery proposed for my own benefit and turned it down on the basis that I want an in-tact peritoneum without scar tissue, and that anesthesia itself is not entirely safe. I don't think the studies saying donating a kidney is fine make any sense, unless you consider maybe it's a selection effect - IE, anyone with any questionable medical issue at all is screened out first - so the comparison to the 'general' population is not a fair comparison. Really you would want long term randomized controlled studies comparing only perfect donation candidates who were assigned to undergo surgery or abstain. Anyway, it's a selfless thing you did, which is great, but I still think organ donation is an ethically tricky thing, and it's not clearly a slam dunk. I think it makes sense to really make sure the donors don't feel pressured in any way. It's not clear that having the option to donate makes all people better off.
> generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it
Epistemic status: I read this somewhere
One argument I find convincing is that kidneys and livers in particular were built for a more hostile environment than we currently live in (unless you're an alcoholic), and so have excess capacity. The acceptable age (at death) for donating a kidney or liver is higher than for lungs or heart, because they're under less strain.
TBC I'm not donating a kidney and don't expect anyone else to, especially for free. But I think this particular argument is weaker than it looks.
Isn't the appendix now thought to be a reservoir of your intestinal microbiome to facilitate rapid repopulation of your gut after an event (e.g., infection, poisoning) that causes the system to be flushed out?
Congratulations Scott! I became a non-directed donor 14 years ago. I was inspired by a New Yorker article by Larissa MacFarquhar, you may decide whether that's better or worse than Vox.
In addition to the very obvious benefits to the recipient, who is still doing well, I think donating helped me solidify my adult identity. Not in any public way, no one in my current city of residence even knows except my wife and whoever has read my medical file. My experience is that much as the rite of circumcision is meant to bind us Talmud-readers to God, kidney donation binds one to principles of altruism in a way no amount of donated money ever will. Even as I've gotten older and less idealistic, I remind myself that I am a man who once donated a kidney, that I should never let my character stray too far from that of the younger man who was capable of such things. No regrets.
While you might change your mind about what exactly constitutes moral goodness, it's good to have a reminder to strive for moral goodness as you understand it.
>a ritual called “therapy” could absolve one of this impurity
When I read this section, I had the following thoughts in rapid succession:
- As a psychiatrist yourself, you are qualified to perform therapy. And you do mention that OCD is one of the conditions you treat in your patients.
- So could you do therapy on yourself? It would certainly be simpler and more convenient than going to a non-self therapist. Probably not as effective if you actually had an active problem you needed help with, but it seems more than adequate for an exercise in warding off evil spirits.
- Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
- So for mental health professionals who are qualified to perform therapy, does talking to yourself make you more sane, less sane, or have no net effect?
There is a minor psychoanalytic tradition of "autoanalysis" or "self-analysis" but I don't think it gained that much support from most theorists, although it seems like it's not particularly impossible that it could be very helpful to some people. (After all, apparently you can make pretty consequential changes in your own mind in other ways, like meditation practices.)
I kind of doubt that the panel would have accepted anything like "I promise to perform therapy on myself to treat my OCD, if necessary" or "I promise that, as a psychiatrist, I would not currently diagnose myself with OCD". :-(
The effectiveness of autotherapy would heavily depend on the approach--anyone can do a workbook on their own, for example. Some people, professionals and lay, have a lot of discipline and insight and can do this kind of thing very well independently. But not all people, and not for all problems. In some approaches the relationship with the therapist is a functional part of the technique, which can't be replicated alone. Being a mental health professional likely aids a personal quest for better mental health but the physician cannot always heal thyself. In medicine self-practice is at best frowned upon and at worst disallowed, for reasons that also apply to autotherapy. It's difficult to be objective, it's easy to take advantages that hurt you in the long run.
Talking to yourself is not inherently pathological. While "taking to yourself" conures up an image of someone walking around in public muttering to the voices in their head (and that's obviously not a good sign when it does occur) most self-talk is just a way of augmenting thought, with no ill implications.
(Sorry, I know it's kind of a joke, I can't help myself sometimes.)
> Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
By who? Talking to yourself is something everyone does all the time. It's widely depicted in popular TV shows as being completely normal behavior. (And in this case, the TV shows are correct.)
I'm being facetious. The joke is that "talking to yourself" in the literal sense is a common and usually harmless and occasionally beneficial behavior, but the same phrase is also often used as a shorthand for specific behaviors symptomatic of schizophrenia: either disordered ramblings directed at nobody in particular or conversations held where the other party is the product of delusions.
On reading that Scott was turned down for kidney donation on account of having had mild OCD in the past, my first thought was amazement that something apparently so unrelated could be a factor in their decision. He may as well have been rejected for once having an ingrowing toenail!
Or that it cast doubt on his state of mind in volunteering to donate (i.e., he could have been feeling compelled to donate rather than choosing freely).
I guess the issue is that the radioactive dye in the scan is very specifically absorbed by the kidneys (whereas the CT is just kind of "throwing X-rays at all the tissue and seeing what bounces off"), and also that the nuclear kidney scan is essentially 2-D while the CT is 3-D?
the dose from the nuclear kidney scan can be on the order of 1/10 that of a CT scan, so it might not be appropriate to think of it as totally negligible, unless they're talking about a slightly different procedure.
The radiation cancer risk argument is just wrong. This is from modelling studies not from prospective or retrospective studies. After 127 years of X-ray use there is not one study in adults that has shown increased risk. The low no-threshold LNT theory makes no sense and even if it were true it should be proven in a longitudinal studies.
Radiologists and others who work with radiation despite protection would have increased risk of cancer because there is always some radiation absorbed. There has been no extra risk reported except in the early days when they did not understand risk of high doses.
X-rays are 1/300th the radiation level we're talking about here, so not comparable. I don't think anyone has been irradiated by CT scans enough to empirically discredit LNT, but I'm interested in seeing any studies you might have available.
I like Jack Devanney (a Thorcon molten salt reactor founder I believe) on LNT
In "Circling the LNT Wagons" he analyses a slightly positive LNT study noting that:
"They excluded the data they had already collected from 12 of the 15 countries because ``of the limited resources and consequent need for efficiency in project coordination." The three countries that survived this project coordination process were France, UK, and the USA. The three countries selected just happened to be the only three countries in the 15 that had nuclear weapons programs."
Nuclear weapons workers are more likely to have received acute doses. Based on Devanney's posts it seems really likely that LNT is either non-existent or non-provable below about 20 mSv acute doses
This is interesting in this case because you are talking about a 30 mSv acute dose. While LNT is likely to notably overestimate the risk at this level it is reasonable to think an elevated risk exists. Interestingly, one of Devanney's critics in his comments does not defend LNT but does argue that acute medical doses have a slight cancer causing effect. For most things it is again potentially unmeasurable but 30 mSv might be in the measurable range
In his "The LNT-is-not-inconsistent-with-the-data Argument" post Jack has a graphic of about 30 dose profile cohorts that are prominent in the literature and history. The only ones comparable to 30 mSv acute seem to be the nuclear bomb survivors:
14,000 with 5-20 mSv acute dose showed an insignificant decrease in solid cancers
6,000 with 20-40 mSv showed the same as control
11,000 with 40 - 125 mSv showed an insignificant increase
16,000 with 125+ mSv showed a significant increase
Leukemia numbers were similar except the insignificant decrease group was from 5-150 mSv
We've also done a lot of experiments in fruit flies to demonstrate that radiation effects on health are non-linear in them as well. But nobody knows where they start to go non-linear in humans and the dreaded bioethicists would surely prevent any good experiments determining that. So in the absence of good data we must make do with the simple rule we know is wrong for legal limits etc.
I've wished I could do this for years, but thanks to a life-saving, kidney-wrecking medication I'll be on in perpetuity both of my kidneys will be needed by me. I saw the headline "my left kidney," correctly guessed the topic, and immediately started sputtering about my own bad luck. Congratulations Scott, I am happy for you, your donor, and to see this issue publicized in a forum where I'm sure it'll get traction. Happy, and a little jealous.
Of course now I'm sitting here stewing on whether I'm a really a 200-in-a-few-hundred-millioner who would really go through with it or just a 25%-er with a fond intent and a pat excuse. It does feel like the easy, obviously correct choice--a life you can save that will be practically right in front of you--but now I'm very suspicious of this little fantasy and the role it plays in my psyche, with no skin (er, organ) in the game...
(If anyone else is worried they just have a hero complex and their heart isn't entirely in the right place, don't let that deter you from putting your kidney in another one. We all appraise ourselves in creative ways.)
Unless tests reveal some unusual asymmetry, they take whichever one has longer blood vessels that are easier to manipulate surgically, which is almost always the left.
How does it feel knowing that your evil kidney is likely now directing some poor stranger to turn to the dark side? The writer that you are, that kidney may be too persuasive for them to resist...
My immediate reaction to the apparent mystery of : "25-50% of Americans say they *would* donate a kidney to somebody in need..."
I think those 25-50% are thinking of a scenario somewhere in between
-rushing to pull people out of a sudden immediate fiery car crash right in front of them
- donating or volunteering in a natural disaster
- John Cleese showing up at their door asking, "Could we have your kidney, then? Won't be much trouble for you."
When the choice or opportunity is suddenly presented, and following through is relatively simple, logistically, people and Americans in particular have almost no limits or thought of risk/cost. In the scenario of a crash/wreck I am sure 95% of people would risk their life for a total stranger without a moment's thought.
The barrier to high leverage humanitarian intervention is not courage or selfishness but attention span. Even you, a person who thinks and cares about doing good, who inspires others to likewise try to improve the world, and an MD with major cheat codes for Health Care and Medical melee combat, you were discouraged and almost gave up. Until a Mysterious Mentor suggested a Surprise Approach, One Weird Trick of trying another donation pathway, tvtropes etc.
Leaders can be described as getting people to do good stuff they should do anyway. Personally, I always tell people that when thry ask somebody for a favor, make it *AS EASY AS POSSIBLE* for that person to help you. The path to better more effective Altruism, and government as well, should keep those things in mind.
Sounds like we need to recruit a corps of door-to-door proselytizers, then, and maybe lock a bunch of bioethicists and con artists in a room together, unable to escape except by agreeing on details of a training program for professional kidney-donation-facilitators which somehow threads the needle of making the process easy enough to actually complete for people who should be donating, without misinforming or coercing people who shouldn't.
As it stands, nobody goes through the process from the donor side enough times to become an expert on it, and the skill-set of making things easier for a customer is valuable enough to be in demand elsewhere.
Could just lock all the bioethicists in a room, throw away the key, and try to reassure people that they around to hurt you anymore, you can do medicine now!
And sadists! Suffering is a sign of virtue, so therefore by making people suffer one can increase the amount of virtue in the world. Just look at all those stories of people who went through adversity and came out better. Who wouldn't want to have moral justification? Any reluctance on their part is simply akrasia. (Or at least, that's what my PTSD says.)
> Would, if what?
Quite possibly, if my life were more together. But thanks for writing all this.
I've been torn about the prospect of donating a kidney for over fifteen years. On the one hand, I see it as a really worthy form of altruism, and I recognize that in absolute terms the risks are quite small. On the other hand, I'm quite vulnerable to anxious intrusive thoughts, and the anxiety of having only one kidney, when evolution saw fit to equip me with a spare, feels like the sort of thing which would genuinely weigh on my sense of well-being for the rest of my life.
Do you think you might be open to a literature dive on the pros and cons of donating regenerable organs and tissues, like liver or bone marrow?
Anxious intrusive thoughts about only having one organ were a concern for me too. I tried telling myself I would do some healthy things (stop adding salt to food, go to the doctor more often) that would probably make up for it, and that sort of helped. So far I haven't felt too anxious-intrusive-thought about it, but partly that's because I'm still in the more acute kidney failure stage of recovery where I'm expected to feel bad, and I don't really know what the future will bring there. Ask me in a year.
Scott has written before about not really being a fan of food in the sense that a lot of people are, and I suspect there's a general trend of this kind of underrating general experiences (even coming from the guy that wrote "what universal experiences are you missing.")
I know there's a renal diet for people with kidney disease/on dialysis (mainly be very careful with potassium and if you eat potatoes, you have to twice-boil them which reduces them to a mush that is difficult to eat so you may as well cut them out altogether).
Seems there is a diet for kidney donors; moderate protein, reduce salt intake, be careful with supplements:
I looked into liver donation after getting denied for kidney donation and the risk is way, way the fuck higher. Something like 1% fatality risk in the immediate aftermath. I was comfortable accepting "twelve hour drive" risks to save somebody's, or multiple somebody's, lives, but not "die at any point in the next year or two" risks. If you do survive without issues, your liver returns to full function.
There is literature suggesting that missing-spare-kidney intrusive thoughts are a real risk, which is why they reject people with OCD. So 1) maybe kidney donation isn't right for you, and 2) if you decide to do it, you probably don't want to disclose your concern to your donation team. Like Scott, I was rejected for mild OCD, and I really wish I hadn't been so honest in the psych eval.
I personally think it's not for me, because it's not just that I'm generically prone to anxious intrusive thoughts, there are specific things that cause me anxiety which aren't necessarily intuitive to other people, but I find predictable in advance. For instance, I have no problem engaging in martial arts sparring, but I refuse to ski- I can't help envisioning myself rolling down a ski slope with a ski pole stuck into my eye. I can forcibly fight down anxieties which I know are irrational, but it doesn't make me comfortable, and I don't want to spend the rest of my life doing it.
Conversely, some things that other people worry about don't bother me at all. I'm not paranoid about the dangers of a routine surgery, for instance, or low-level radiation exposure. I'd be happy to be able to bring my kidney-anxiety down to a level where it's proportionate to my other worries, but I don't think I'm actually able to do that.
Yeah, sounds like it - and I hope you don't concern yourself over the question "should I donate or not." You have a contraindication and it isn't reasonable to sacrifice your own well-being.
I get how anxieties can be different, but predictable to those who have lived them. My anxieties are around ethics, i.e. am I doing right by others; if others aren't doing right by me why doesn't anyone else notice and does it mean there is really something wrong with me. And I can be OCD about the uptime and quality of software systems I build. Besides that, I don't have much in the way of intrusive thoughts - which is why I was pretty confident I wouldn't experience the without-spare-kidney anxiety.
Yeah, the anxiety caused by the risk of dying later on due to donating would make me significantly worse off. Imagine how crappy you'd feel if you died because of that! You'd feel so stupid and like such a sucker! "If only I hadn't donated," you'd think. Anything would be better than having that kind of regret and fear your whole life!
As an aside, I'm surprised that you read Scott's piece and concluded "the risks are quite small" - I found this article scary.
I did some sort of thing where I gave my dna via cotton swab to some charity and said email or call me if anyone needs something I’ve got. It seemed legit, but no one has ever contacted me. And I assume my superior Slavic-Irish-Norwegian ancestry would greatly enhance a normal mortal life.
Asking because I suppose this group would know: Is that in fact a real thing? Or did I give my DNA to skynet? I swear I got it from a flier at a hospital.
Maybe they don't actually share DNA information about different kinds of prospective tissue donations? (which I guess would be kind of wasteful, if not)
As Seth said, bone marrow data bases work like this. For a bone marrow transplantation, you have to screen millions of people to find a match. So they build huge databases (for example 7 millions just in Germany, ~10% of the population), and only contact you if you are a match for someone in need. The chance of ever being contacted is less than 1%, but the system only works because of the huge DNA databases.
I did this for my local bone marrow bank. They contacted me a decade later and told me there is a potential match, but never reached out again, I presume they found a better match.
Scott, have you thought about meeting the person who got your kidney? Of course it might be awkward, meeting a stranger whose life you saved, and you two may be so different that you're each incapable of comprehending the other's take on life. And yet you had a meeting of the minds and kidneys when it comes to saving the person's life. I'd want to shake their hand or hug them and say, "I hope that kidney makes possible all kinds of wonderful things in your life" -- or something like that. Maybe just "enjoy the hell out of that kidney."
There's something about direct giving to strangers that feels utterly different from EA. It's profoundly satisfying, and makes you want to give *more.*. Maybe the way to think of it is as a spiritual practice, one that people practicing EA need to do to stay in touch with the point of helping others?
Anyhow, bless you, Scott. And if it would make you feel any better about the Uber incident, I'd be willing to piss myself in an Uber for you.
But why be sure they'd loathe each other even under ordinary circumstances? Scott himself could be called a real stickler by some, and they'd have a point. In the most recent open thread I showed some people Scott's kind-true-necessary, 2 out of 3, guidelines, and the people had a low opinion of them -- saw them as suppressing free speech, suppressing justifiable expressions of rage at various actors in the Palestinian-Isaeli situation, so vague that any judgment could be defended, etc etc. And is what people eat really such a big deal? Anyhow, even if Scott and Stickler would have loathed each other in other circumstances, having a moment of intense shared emotion is all the more special then. And I'm guessing that even most meat-eating sticklers aren't so hard-boiled that they are not moved by someone having saved their life.
Almost certain both of those people were joking, implying Scott's Kidney went to someone he wouldn't like and who makes the world worse, in a sort of "accidentally saving baby Hitler" scenario.
There's probably no way *you* could look up Scott's Kidney recipient, for medical privacy reasons (Scott might be able to, not sure).
i think in some cases you are allowed some contact with the kidney recipient via email, but it has to be completely anonymous and is reviewed by censors before being forwarded on.
Yes, that might be. Seems pretty micromanagerial to me, sort of like the bureaucracy that would not let Scott be a donor because he's had mild OCD as an adolescent. I have seen articles about people who donated a relative's heart meeting the person who received the heart. Donors meeting recipients seems like on the whole likely to be a very positive experience if both parties would like to do it.
Seems very disturbing. What if you didn't like the person? Here you made a significant sacrifice, giving up your health, and it was for this person?
And what about the power, obligation, control, and guilt issues? They meet you, and they feel like they owe you something, or you feel like you owe them something ... really disturbing. Seems like it would be hard to relate to them as normal humans with such a huge debt there.
You'd always resent them for having one of YOUR organs that belongs in YOUR body! You'd get angry every time they did something you didn't like, or disagreed with you, since they basically owe you everything! Just an unhealthy relationship.
I'm sure many donors and recipients would not want to meet. But there are all kinds of ways a meeting like that can play out. The ones you imagine are only a subset of the possibles. Some people's take on the process may be one that protects them pretty well from going down these grim paths. If had donated a kidney I think I would want to meet the recipient. I'd have assumed when I donated that the organ would be going to someone who does not share my attitudes, beliefs, politics, taste, etc. After all, most people don't. I think my feeling of connection with the unknown person who was going to get my kidney would have been that, like me, they want to stay alive, keep seeing the people they care about, keep doing the things they enjoy. Part of the specialness of charitable giving is that you are letting go of all your angry stuff about the many many groups of people who believe and do things you think are pointless or evil -- at least letting go of it to the extent that you believe they do not deserve to suffer. So if when I met the recipient they were wearing a campaign button for some candidate I didn't like, that wouldn't matter. And I don't picture having a big get-to-know you meeting with them -- just talking over the thing we have in common -- the experience, how we're each doing, and wishing each other well.
As for their gratitude -- of course they have to say thank you. Etiquette sort of demands it. But I would try to get across to them that "thank you" doesn't exactly apply in this situation. If I had chosen them as my recipient thank yous would be in order, but I didn't. I gave the kidney to humanity at large. It was luck that sent the kidney to them in particular. So I would tell them that, and tell them that giving it had given me a lot of pleasure, in fact made me sort of high, so in my own way I had benefitted greatly from the experience. Maybe add something about how I I gave the kidney to humanity at large -- if they feel they owe a debt, they can work it off by giving something to humanity.
So there's a 1 in 10,000 chance of dying during the actual surgery, but there's a 1-2% chance that you'll develop kidney disease later on in your remaining kidney and think "boy, I sure wish I still had that extra kidney right now". BUT, you'll be put at the top of the list for the next kidney. BUT, kidney recipients typically only live an extra 5-7 years anyway. BUT, under these kidney disease circumstances you might not have been okay with a second kidney anyway. Nonetheless, your chances of dying due to kidney donation seem to be higher than 1/10,000 due to the whole lack of redundancy thing, probably very much greater than the 1/660 risk you were concerned about.
"Dying" isn't a very good binary variable. I think there's a 2% chance you'll die six months earlier than you would have otherwise, but multiply that out and it loses you 1.2 days of life. Dying during the surgery seemed important to me because it loses you a lot of life as opposed to shaving off the very end when you have no GFR left anyway.
Doing this properly would involve how many DALYS you expect to lose. I think I looked at someone's calculation and it was in the range of a few weeks, probably so much that the variation in length of your recovery period is bigger than the amount contributed by early death or early disability considerations. I think the Tom Ash post I linked might have those numbers on it, although I might be misremembering.
Okay but this is all "present rate no singularity", yeah? If you have a reasonably high probability of a good singularity, then dying a couple of years early in the coming decade might lose you many, many more highly enjoyable years than a naive approximation would suggest.
(IIRC from your old cryonics post you don't care *that* much about your mortality as distinct from suffering? Which, fair enough. But I would assume that most people worried about life expectancy post-surgery are not like this, so it feels worth mentioning.)
The bit about how you can get five other people get bumped to the top of the list if they ever need it is a REALLY convincing point. I didn't know that: I heard about how you personally get bumped up the list, but that's the bare minimum, not a good deal.
Worth noting that this is not very gamable, and they make it really clear that the set of you share a priority-claim on up to 1 kidney. From the look of things, once someone uses it, the others do not have the priority mark anymore.
Thanks for pointing this out. Then it's a non-obvious tradeoff between a larger list of people you care about to whose kidneys yours are compatible, and a smaller list (five people) which could include incompatible people. That's … decidedly less convincing now.
Not sure if this untangles the non-convincingness, but from what I understand, you can "donate a kidney to a loved one" even if you're non-compatible. What happens is that you donate your kidney to a compatible stranger and in return they ensure a compatible stranger in a symmetrical situation donates their kidney to your loved one. I think this is commonly the way it works.
Re the people who say they would donate a kidney to help a stranger:
I think most people answering the survey question are imagining a case where they're uniquely morally responsible for it in some way, in which case they'd do it.
Going by your numbers, the actual number of undirected kidney donations required to plug the gap is about 0.01% of people per year. So IRL people are probably morally responsible for about 0.01% of a kidney donation per year (probably more in practice because some people can't or wouldn't donate, let's say 0.04% for safety), and going beyond that is superegatory.
I'm on the list of people who'd answer "no" on the kidney donation question (I do feel bad about it). But I would sign up for the service that picks 0.04% of people who sign up at random each year to donate, if it solved the kidney shortage. I wonder how universal this is.
(This does raise the question of why I don't just make my own service by throwing a random number generator from 1 to 10,000 and donating if I get under 4. I did do this before posting and got 5,143, so that's my new excuse for not donating. But I don't know if j would have gone through with it if I actually had gotten a number under 4, so I don't feel great about it).
Your comment got me thinking - I would probably also sign up for such a list, if it existed and - I think this is important - if a lot of other people also signed up, so that my odds of donating were "fair".
But then it occured to me that something similar already happened in the UK. A few years ago we switched from opt-in organ donation to opt-out. Essentially that means that if you die, you are now assumed to consent to organ donation unless you explicitly said you don't consent.
In a way that is similar to drawing lots, since we can assume I have some chance of dying randomly in the next year and some chance that my organs are suitable for donation. I am not sure that enough people die in the right way to fill the gap, but I suppose it should do something (especially as each suitable person would be able to donate both their now unused kidneys, plus other organs like hearts, lungs and livers).
Unfortunately I can't find much saying it has really had an effect. Partly that seems to be because it was introduced just before covid, which has muddied the numbers. In essence, though, the number of people on organ waiting lists seems to be pretty much unchanged or even slightly higher.
The difference between opt-in and opt-out is notable, but does not change the order of magnitude, unfortunately. Looking at different countries who changed one way or the other, the number of donations may increase by 30-40%. (Less if relatives still have veto rights, which they do in some countries.)
In practice, most donors are young people who die in accidents, like bikers. Most of them haven't declared their will, so usually relatives are asked to find out their will. In most countries it boils down more or less to the same decision for the relatives, regardless whether it's opt-in or opt-out.
30% more makes a difference! The supply is not THAT much smaller than demand. But it is still not enough to get enough organs. The number of people whose organs can be used (who die young from accidents) is just small, and the number of people who would need organs is pretty high.
A thorough literature review with in-depth discussion for Italy, France, Wales, Greece, Chile and Singapur is here (in German, so you need an auto-translator)
I am also on the list of people who'd answer "no". But on the other hand, I did register for bone marrow transplantation. There they screen huge databases for the best match, and you are only contacted if you are a best mathc. Which happens for less than 1% of registered potential donors.
This system works very well. If you are contacted and told that they particularly need your bone marrow because there is this one person who needs it, then I do believe that many people would say yes. Perhaps the 25-50% who answer yes in the surveys.
In principle, this could also work for kidneys. Build a huge data base, for each patient try to find the best donor, and ask them whether they would help this particular patient, because their help would work better than anyone else's.
It's almost a shame that kidneys are compatible between so many different people. Because that might be the main reason why the solution doesn't work. (Even if chosen, you are not really a much better pick than many other people.) So the ethical pressure is diluted. We might have much less trouble to find kidney donors if they weren't so widely compatible.
Or the solution does work, and we just need to try it.
Agreed. "There they screen huge databases for the best match, and you are only contacted if you are a best mathc." Also, there is (or was? this was over a decade ago) a secondary screening where they take another sample and check more antigens. I was contacted as a potential marrow donor at least twice (I forget if there was a third time), and I think I was the most probable donor at least one of those times, but they never actually took my marrow. I don't know exactly what happened to prevent it. ( I've aged out of the registry at this point. )
Interesting. I have no idea what was going on for you.
Funnily, I was chosen by them, too... as statistical twin to a real donor. That's why I never forgot about it, I get a form once a year to tell them if I am still healthy.
I have the vague recollection that something had changed on the recipient's end, but I wasn't told whether it was positive or negative (which is perfectly reasonable for their privacy). I too got a contact once a year (till I aged out of the registry) asking if I was still willing and able to donate.
Overall, it was a very positive experience and I would recommend that folks sign up for the registry if they can (for the US, it's "Be The Match"; for the UK it's "Anthony Nolan")
Hey Silas, thank you very much for taking the courage of writing your experience down! I was always a bit nervous about whether I would really say Yes if I was ever matched. But after reading your post, I am now a lot more confident that I would go through the whole process. As you say, reading about personal experience adds a lot to all the statistics which say you'll be fine. Thank you for sharing!
You might've stumbled on a back door way to financially compensate kidney donation (in expectation): it's probably not illegal to pay people to sign up for such a service as long as they have the ability to back out if selected. Conditioning the payment on passing screening could do multiple duty of (a) weeding out low-intent volunteers, (b) keeping the average quality-as-a-donor on the list high, and (c) enabling payments amounts large enough to actually incentivize sign ups.
I don't think there is an official age, and it probably depends on your health, but I think being older than 50 probably changes the risk calculus to a point where I would be reluctant to do it, though this is just a gut feeling and I haven't looked into it too hard.
Was there really a need to tell the whole world about the good deed you have done? Performing good deeds for social affirmation is generally considered to detract from the goodness of the deeds. Yes, I do understand that your intent is to encourage more performance of such deeds. But conventionally, performing good deeds for external rewards like social approval or money is considered suspicious, for some poor reasons (like the masochism you mention) but also the tendency toward self-deception and institutional corruption by those rewards.
This directly ties into the castle thing. Perhaps it's true that the castle actually would encourage more good deeds be done. However, it's also true that if you start talking yourself into buying comfy castles that actually do good, it becomes easier to talk or trick yourself into comfy things that don't do good, and you start to attract people into your organisation who will talk you into buying comfy things because they are solely into comfy and not good deeds at all. We can try to be less wrong here, but can we be sufficiently less wrong that this risk is worth running?
1. If you tell other people about your good deeds, you feel good and get benefit from them, which is an incentive. People do things that are incentivized more often than they do things that aren't incentivized.
The castle thing seems like the opposite of people being corrupted by social approval; they did a genuinely good thing even though they knew everyone would hate them for it. I have immense respect for that. I agree that if (unlike them, but like me) you do something that you could get social approval for, you have to resist becoming a social approval slut rather than being focused on what's really good, but I think it trades off against other considerations. And I think that if you think about that *too* much, then at some level you start becoming an actual masochist who is optimizing for your own suffering rather than make anyone better (Should I help this orphan? No, I would enjoy seeing the smile on his face. Better whack myself in the head with a cactus instead!) and that the point where I worried about posting this for those considerations would cross that line.
I'm finally reading Elephant in the Brain, which unsurprisingly is very fascinating, but the most fascinating thing so far is that 95% of (monetary) donations people make is due to solicitation (as opposed to unprompted decision). For organ donations the percentage would likely be even higher, and a respected public figure leading by example is up there in terms of effective mass solicitation.
This is an impressively calm and polite response to an infuriating comment. If I were in your position I would probably be banning myself from my own blog right now.
Congratulations on making such a big (& effective) altruistic sacrifice. Any warm fuzzies & reputational benefits you get from this are very well deserved!
I'm fairly sure that in a couple of years time they're going to end up selling the castle because they'll find that they're not using it as much as they expected, and the upkeep costs are way more than they imagined.
This doesn't mean they are not good people, nor am I saying they are not. Just that the castle decision is not a good one.
If they end up using it below capacity for their own purposes, they don't necessarily need to sell outright to recoup the cost. Could simply rent it out to others similarly dissatisfied with pre-existing conference-center venues, then spend net revenue from that on EA. That would effectively mean they were now working at least partly in the real-estate-management business, but if that's where the big money is, and the money still ultimately gets spent on saving lives as efficiently as possible, why shouldn't they?
I would be interested to see a good argument in favor of buying the Abbey being a good idea.
To my understanding, the case for is:
>CEA (Now EVF) hosted conferences, and aspired to host more and more regularly, and owning a permanent conference center would be more economical than renting every time.
>The Abbey was a large, seemingly suitable property in a good location, and on the market.
>Open Phil wanted to invest in the movement by spending money.
The case against:
>Horrible optics.
>Other properties were apparently available for cheaper.
>It is a Grade 1 listed building, as such any modifications become significantly harder should they become necessary, compared to other properties which could have been cheaper.
>Is it really worth buying a $15m Abbey, or even any sizable real estate, instead of just more malaria nets or something?
Arguments made in favor that I don't think are actually in the case for:
> The Abbey purchase was made with a specific grant with funds earmarked for it by the donor. However the donor was Open Phil who presumably could have been nudged towards another purchase, not some eccentric who would only give money to EA for specifically the purchase of the Abbey.
> The Abbey will retain value and can be sold later. I don't think it has been, despite the dramatic changes to the EA funding space after FTX, so I am a bit skeptical this was ever a pro.
My impression is that Lighthaven has gone very well, and the people involved (including me) still endorse their donations and work on it, even though money is tighter now.
(also, awkward to talk about now, but FTX promised every EA organization approximately infinite money in 2021, and if you're the conference-arranging organization and have just been promised infinite money, something like this seems like a pretty obvious next step).
I looked through the thread, and the purchase of the Rose Garden Inn seems like a much better idea than the purchase of the castle.
The Wytham Abbey is a Grade 1 Listed property with all sorts of difficulties in renovation and maintenance. It's gone through a mix of being a private residence and used to host 14 apartments for Oxford. It has terrible optics for being purchased by a charity. The justification appeared to be that it would be used for far more events in the future than had been hosted by CEA in the past, including having residents stay there rather than stay at hotels and commute to a conference center, and would therefor come out ahead, but I am not sure how to find any information on how it has actually been used.
The Rose Garden Inn was a hotel. A nice looking hotel to be sure, but it does seem much more suitable for being the workhorse of an organization that will regularly be hosting large groups of different people. It has much better optics, I don't think anybody has complained about ' charity org buys hotel/conference venue for people to stay at for conferences', or would to the same magnitude as 'charity org buys castle to turn into conference center'. It seems like it's up and running, and is offered for cheaper compared to traditional conference center per day per person costs that I saw thrown around in the Abbey threads. I think it was a good move. It is an actual event venue good for running events that is already being used for running events and may actually be profitable to own.
I wouldn't mind CEA buying a normal hotel/conference venue, quickly turning it around, making it available for use for likeminded groups at a cheap/subsidized? price. I think that's what the goal was with Rose Garden Inn and it worked out really well. Instead, CEA bought Wytham Abbey, which has terrible optics, seemingly less capacity, more building restrictions, less liquidity as such a specialized property, and while I haven't been exhaustive the original post about it was edited on 9/1/2023 and didn't add any information about it currently being in use.
Reading more about the Rose Garden Inn has only more convinced me that the Abbey purchase was a mistake, it seems like after 'Step 1: It would be a good idea to own a permanent conference center' they diverged drastically.
To be clear I don't know much about either transaction but I do have much stronger priors against charities buying castles
Are you worried about people lying about donating kidneys to appear virtuous? Or being peer-pressured into donating kidneys when they don't really want to? Neither of these seem likely.
If you're virtuous, people *ought* to know it. Transparency existed in (paleolithic/metaphoric) Eden. We abhor it today because we don't trust others to follow suit and therefore fear society judging us uniquely anti-virtuous, thereupon becoming subject to the tender ministrations for which the mob is so rightly famous. The consolation of such correctives being administered in the news and courthouses rather than on your doorstep fails to assuage the perturbations of most minds.
But a standard of openness? Why that would be lovely. And it might just help us choose the right people for leadership too.
On a personal note, I consider it a moral virtue to share about myself that I donated two kidneys and also that despite lacking the normal executive skills of even your average 10 year old, I managed against seemingly insurmountable odds to save the life of an old man who was being tortured to death in Chechnya.
EDIT: I did not actually donate any kidneys. The most I did in this regard was speak about Zell Krivinsky for 3 days straight on my radio show after after he donated his own kidney.
But yeah, in an improved society we would definitely be taking into account the red's "needs and abilities" thing, and thus through public discussion come up with a means for resolving (among other things) the distribution of kidneys.
Ideally we'd manage it with a lot less force and at least a touch less gulag.
Instead we might, I don't know, accord honor and love to those who enjoy utilizing their abilities to solve the needs of their brothers?
While my claim of having donated ≥ 2 kidneys is apocryphal, my claim to have rescued an elderly, terifed, abused and doomed stranger is 100% true.
Months earlier I had achieved something like total self abnegation wheresoever my own comfort or pleasure could be keeping me from doing al I could for the life and happiness of my fellow human beings.
I'm sure it sounds mad or bad but it wasn't. It felt good and was good. It was eventually necessary to transcend and to reacquire a biased interest in the individual human unit in whose body I happen to live, but I do not regret having achieved what I imagine very few people have ever achieved. I mention it because it's the only way that something so far beyond my own ken could have even come to my attention, never mind be resolved by me.
When it came to my attention I immediately swore off food, mattress, small talk, etc. and set about informing the various relevant powers and authorities, which turned into negotiating betwixt them which turned into the realization that he was going to be murdered on Adolf Hitler's birthday unless I find a way to free him myself. And, God (or whatever name you might call astonishing Reality) helped me save his life.
All his teeth had been drilled out and he was missing fingers. He had been starved and made to suffer incomprehensible tortures but because of me and only because of me, an old Jewish man was not murdered on Hitler's birthday but was instead rescued on the first day of Passover.
And, much as I was trained to believe and act otherwise by sklavenmoral's third rail, I now believe that it is good for people to know this about me and I am acting upon that belief right now.
I can't tell if this is a joke, fiction, satire, or what, but what on earth are you talking about? Who did you rescue, what was the total self abnegation, and what is sklavenmoral's third rail?
But if even if you tell no one, you'll still know yourself, and it will affect your future behavior. This is the missing factor that causes the "ice bath" solution to rise to a score of 3, tying with the Weill center. By having charitable deeds thrust upon them, the donor can remain uncorrupted by virtue.
And even nobler would be to force yourself, against your own will, to shudderingly harvest other people's kidneys and donate them to save people whom you'd rather be trolling.
Or even better, blackmail or take hostages to get someone else to do the unwilling harvesting! We can keep adding extra layers of rabbinic fences to protect us from the horror of altruism.
Come to think of it, this is probably how a D&D Lawful Evil society arranges to do things that are socially useful but which also count as "Good".
Isn't that the same kind of ethical dilemma as the trolley problem - the surgeon who can kill one patient to save five others, or however it goes?
If it's the superior choice to pull the switch on the trolley, then becoming a surgeon so you can harvest organs from non-consenting (because you never asked them, because if you asked they might refuse) donors is also the superior choice!
Hey David Khoop, does the same go for mean-spirited gotchas? I mean, isn't it more dignified and pure to hit the recipient with them in private? If you do them on a forum like this, there's a danger you'll slide into looking for an angle to gotcha from just for the pleasure of being seen biting somebody's butt in public.
Was there really a need to tell the whole world you are a human faceache?
People were wondering even last night as to where Scott was or what he was doing. Now he's told us. And he's told us about how to go about donating a kidney if we want to do so.
This is not the charity of the Pharisees, this is informing us about the need for organ donations and the way to go about it, and the likely obstacles in your way. This is not "look at me, how virtuous I am" - which, by the way, is how *you* come across; "I would *never* tell anyone about my good deeds, amn't I so special?"
Like the apostles complaining about the ointment that could have been sold and the money given to the poor, yeah, you're so specially good.
Buying a castle is self-serving. Donating a kidney is not.
My wife is in kidney failure and is on dialysis. We have the same blood type, and when she becomes eligible for a transplant (she currently has other conditions that make her ineligible in the United States), I intend to offer one of mine, assuming I'm qualified to donate.
I'm happy for you! My apologies for complaining about the lack of posts just yesterday.
As a PhD student, I used to grow kidney organoids - small clumps of kidney tissue derived from embryonic kidney progenitor cells (or Yamanaka-factors induced stem cells). They were amorphous in shape and couldn't grow past a very small size limit: there were no blood vessels inside, and the center of the organoid would begin to necrotize from lack of oxygen. Growing a full-sized kidney in a lab would require a much better understanding of vascularization during embryogenesis.
A cool workaround I once saw in a Finnish lab was to literally 3D-print a microchannel tree, and populate it with thousands of mini-organoids. I haven't been following the field since, so if anyone is aware how close we are to a 3D-printed kidney, let me know.
Also, whenever I told my casual dates what I'm working on, they used to ask "Are you going to steal my kidney?". I would have to explain that I'm literally the least likely person to steal kidneys, since I can just grow them in the lab.
How important of a limiting factor do you think is the risk of it collapsing under its own weight while half-grown?
I've got a weird, tenuous-but-hopeful theory that artificial organs being dependent on microgravity for some key assembly stage might be the key factor that makes early stages of a city-sized station in low earth orbit economically viable. i mean, what else is there that's both high value per kilogram, and has high-volume demand which can't be met more cheaply by building things closer to sea level?
I don't really see the potential advantage to making those in space, or how they'd lead to creation of thoroughly human-safe environments which could then build secondary services. Also, saturating low orbit with communication satellites will reduce demand for ground-based fiber - speed of light through air is faster, so a "bent pipe" relay can actually have shorter ping times across continental distances despite the longer path.
Not sure about scale though. I'm imagining quite a small facility, as part of a mostly whimsical idea for a system where the cables are created as giant lengths trailing out the back of the space station before being parachuted perfectly into position on the Earth's surface!
Ah, of course, diffusion without convection for uniform alloy mixes. Still, that sounds like microgravity is only making certain industrial processes easier and cheaper, rather than "possible at all," and in relatively niche applications.
If artificial organs and tissues overshoot demand for life-saving transplants, retooling into luxury food might be relatively trivial, and there could plausibly be upwards of a billion people who'd eagerly make room in their weekly grocery budget for a few kg of vegan beefsteak.
My only connection to this issue is that I have a friend who attempted to donate a kidney to a stranger through UCSF, and I think ultimately also got rejected or else long-term deferred, for a reason that seemed to also be like "we reject everyone who has an issue that falls into this bucket" rather than "it's plausible that you would actually be endangered if you donated your kidney".
This makes me wonder if UCSF is like super-paranoid about approving kidney donors.
Another thing that could fall under point #7: I think the kidney donation charities or maybe insurance companies are also willing to pay some expenses of a friend or family member to support you in connection with the kidney donation. So you might be able to, for example, take a significant other with you at no charge to you, even if you had to travel for the surgery.
Not sure. If a certain ex-boss of mine got the kidney: Nope. - But you got me thinking: What is the second best use of Scott's body tissue to better the world? (The best is his use of his brain to write.) Obviously: sperm. Most likely the UCSF would turn him down - If I were female, I would not. Now I wonder: Why I do not see offers like this more often in the comment section (I saw one on ssc)?
Ah, I see, this is a "trick desperate or low-intelligence people into serving the greater good" sort of deal. That's the only way to describe someone who would actually act upon a promise by the government not to screw them over using the tax code for the next 11 years.
Huh, I distrust the government in a lot of ways but this seems like the opposite of the usual failure mode. Would you like to make a bet on whether the first person to get promised this gets their full payout? Feel free to name the amount and any other terms you find relevant.
My model of DavidC would be reluctant to take the bet. The *first* person to get promised this might get a lot of media attention incentivising the government to do everything smoothly, even if ten years down the line, when the program has faded into normalcy, we expect things to regress to a mean where the government casually screws later donors over.
I understand it's illegal to pay someone for their kidney, but maybe it's not illegal to offer someone an insurance policy against changes to the tax code? Then maybe there's a solution for folks who trust some private insurance company more than the government. (And if the pro-donation organizations are allowed to compensate you for airfare and lost wages, maybe they can also pay your tax-change-insurance premium too?)
Like if the government did some funny business that meant the amount of taxes you needed to pay went up by $10k per year, you would still get the full payout of $10k tax credit per year, but you’d still be paying the same amount of tax overall
Also if you get $10k of tax credit you’d be encouraged to do stuff that might increase the taxes you owe by $10k per year so it’d be hard to separate self-inflicted funny business from state-inflicted funny business for the sake of a bet
Just the people receiving the tax credit, I expect it’s normal behaviour for people receiving tax credits to spend more & thus be taxed more
I don’t have confidence that tax credit recipients would be targets for sneaky tax increases from the government(probably the opposite since those receiving tax credits presumably have lobbying power to negotiate tax credits and that lobbying power is probably good at preventing tax increases too)
At least in the US, you're taxed on income, not on what you spend, so spending more would not lead to being taxed more. If you spent it on tax-deductible things, you'd get taxed less.
I missed this because of substack weirdness. My first thought is that I think it unlikely such a scheme would ever go into effect in the first place, with a higher degree of confidence than my claim about what would happen if it did. That's poor grounds for a bet.
But what Edmund said is probably my better second answer. It'll go until it doesn't; I expect the same thing from SS just like everyone else in my generation[0].
[0] Generalization not guaranteed; use caution when handling this hot take.
refundable tax credits are super normal and common. there's a huge program where low-income people get them (EITC), plus various rich people and businesses get them for all kinds of special programs. i don't think it's politically or legally tenable to mess around with them in a general way, although Congress or a state could pass a special law targeting altruistic kidney donors, which also seems extremely unlikely.
We find it acceptable to financially compensate women for egg donation. Not sure why tax credits for kidney donation should be controversial. I believe Iran offers direct payments for kidney donation which carries a higher risk of undue inducement.
I wonder what the actual free market value of a kidney would be. Probably much smaller than $100K because there's plenty of people desperate enough to do it for $10K... although many of these people would have issues (drug addiction) that would disqualify them.
Not sure. I know we pay $7-10,000 on average in the U.S. for egg donation. In Iran, I believe they pay $4000 for kidney donation. I bet it would be a lot higher in the U.S. but probably not $100K. The other question is who pays? The recipient or the health insurer?
I guess it's because egg donation isn't life-saving, and kidney donation is life-saving, and you can't financially incentivize people to do good things . . ?
More likely the reasoning is that egg donation doesn't intrinsically endanger the donor's health... though holding to such a principle consistently would also ban employers from offering hazard pay for riskier jobs at the same skill level.
That and the fact that taking eggs from a woman doesn't impact her ability to produce eggs in the future. A better analogy to kidney donation would be donating an ovary.
Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
FWIW the linear no-threshold model of cancer risk from radiation is strongly countered by parts of the world which have much higher background radiation, on the order of the 30 millisieverts you avoided but every single year, and they don't appear to have elevated cancer risk. Similar with airline pilots.
> In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need.
> This sentence fascinates me because of the hanging “would”. Would, if what?
The answer is a mix of "if they were introduced, perhaps in a superficial 21-minutes-plus-commercial-breaks documentary fashion, to a particular stranger, who was sympathetic and in need of a kidney" and "if it was 'call 1-800-KIDNEYS and book an appointment sometime in the next month, have the surgery and spend a day or two in the hospital recovering' instead of... well, the entire ordeal you describe, minus UCSF's psychiatric proclivities.
It's also a pretty upper-middle-class sort of thing to do, and I think a fair amount of the people answering "yeah, I'd donate a kidney" never have to really seriously consider the question, because if you're not in a position to take a bunch of time off work and life to go fuck around with hospitals and Zoom conferences and piss jugs and then, on top of all that time, take a solid uninterrupted block of time off work and life to go have the thing yanked out and recover then it's really not something you can ever seriously really consider. Not at all trying to sound "check ur privilege, white kidney-donating male" or scoldy. I just mean it in the sense that it's similarly easy for the fox to say he'd easily resist the temptation of the grapes even if they weren't hanging ten feet overhead.
I worry that the Coalition To Modify NOTA is composed to people who are too nice to think of this, so this suggestion might do good: include a provision that the tax credit will not be INCREASED for, say, twenty years. (I don't know if the government is capable of making such long-term commitments though.)
I was wondering if you've considered getting on the bone marrow donor registry, and if you could write about that at some point in the future? Two years ago at the age of 26 I was diagnosed with acute lymphoblastic leukemia. It's the most common childhood cancer, and one that is highly curable in children, but has a mortality rate that increases sharply with age - my prognosis at the outset was about a 60% chance of surviving five years.
For me, and people like me, our best chances at a cure depends on a bone marrow transplant. Leukemia is a cancer of the bone marrow, so the surest thing to do is use chemo and radiation to obliterate all of your bone marrow, and then replace it with a stranger's who doesn't have cancer. But since your bone marrow makes all of your blood, including your immune cells, putting any average Joe's marrow in there would just cause your new blood to viciously reject your entire body, basically. So a recipient and a donor have to be closely matched on a variety of different factors to reduce the chances of this happening. This makes getting as many people on the registry as possible extremely important, and this also means that when someone is contacted about being a donor, you are often the only donor available for the recipient.
Unfortunately, I did not have a match on the registry, so my treatment consisted of chemo only, without transplant. I am in remission but my chances of relapse are a coin toss. Relapsed leukemia is harder to treat, and it would increase my odds for survival if I had an eligible donor were I to have to return to treatment. It would mean a lot to me if you would consider signing up for the registry (it's pretty easy) and writing about the experience. Thank you!
Edit to add a couple of things after the fact: I'd also like to say that unlike many with organ transplants, bone marrow transplant recipients don't have an expected expiration date following transplant. As long as the transplant is successful, and the cancer doesn't come back despite it, a BMT recipient can expect to live for most of their natural lifespan they would have experienced if they hadn't developed cancer, minus the added risk of future cancers that come with the chemo and radiation necessary to prepare you for it.
And, lastly, most people on the registry won't ever be asked to be a donor, but if you are, being a donor doesn't come at much cost or risk: there are lots of screening tests to ensure compatibility (no CTs I think), but it's not as intensive as what you went through for kidney donation. The actual donation process beyond screening consists of the hospital just giving you some drugs that stimulate your body to make extra stem cells, which can make you feel gross for a few days, and then using a machine to run your blood through a filter that collects those stem cells before placing the rest of your blood back in your body. It takes a couple of hours and I've heard it's a pretty cool experience! Plus, if you and your recipient both consent, the registry will connect both of you two years on so that you can meet each other.
I think there is not much to write about until you get the to actual donation part. My registry contacted me once about a potential match, asked me to re-submit my swabs, and I never heard about it again. I hope they found a better match for that person.
Yeah, this is a good idea. I've been kind of scared because I heard it was really painful, but I'll just tell myself that it's a low chance of ever getting called up.
It's not painful anymore! In the past it was, they cored your bone to take some of your marrow. But now they just give you filgrastim (I think) and collect the extra stem cells you now have floating around in your blood a few days afterwards.
I had. Don't remember any problems. Compared to the things I do remember from that time that suggests an upper bound of perhaps 4/10 pain lasting seconds, but more likely just discomfort.
FWIW: I have a phobia around tubes-in-my-tubes so catheters are a proudly horrifying idea to me; even IVs are really upsetting. But when I had to have a urinary catheter during and after abdominal surgery, it bothered me much less than I ever would have imagined a priori. Initially, I was feeling too fragile and exhausted and hit-by-a-truck to care -- these are standard postop feels; painkillers help, even if you aren’t in much pain per se, and it passes -- to be able to muster any f*cks, and when I returned to myself a bit more, it was an already existing situation and causing me literally zero discomfort, so I took a deep breath and focused elsewhere. Even removal was pedestrian. *Extremely* sympathetic about Scott’s bad experience with that.
> It starts with wanting, just once, do a good thing that will make people like you more instead of less.
Then consider this my contribution to the world: I think this behavior is about as admirable as men castrating themselves for religious reasons, or Xhosa killing their cattle for religious reasons.
A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
> I asked them if there was anything I could do. They said maybe I could go to therapy for six months, then apply again.
On the other hand, I find this to be even weirder than the post presents it as being. This remediation makes sense if the concern is that your OCD of 20 years ago might be prompting you to make an unsound decision to donate a kidney today. If the concern is that there's something wrong with your kidney, therapy is pretty well guaranteed not to address that.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
Sometimes the money will do that, and sometimes the kidney won't. The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
As someone who's considered donating their own kidney for a few years (not from EAs), but is on the fence about it, I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'. I also admittedly find your contentious framing not very helpful, maybe you can rephrase in a way more conducive to changing the minds of fence-sitters like me?
> I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'.
I'm not really sure what the contrast you're drawing is. I was drawing a contrast between people who pressure you into injuring yourself financially ("bad") and people who pressure you into injuring yourself physically ("good"). I'm not sure what the opinion of society in general would be about a group that pressured its members into doing both of those things, but I suspect it would lean toward "bad".
My objections here are stronger than, but similar to, one of my main objections to EA in general: I don't think it's a good idea to "make charitable efforts" in the abstract. You should have a first-order goal. If an EA's goal is "give to charities that are rated highly by GiveWell", they are just as vulnerable to their donations being wasted as everyone else is, because there's nothing they're actually trying to accomplish. There is no future state of the world that would inform them whether, when they previously donated to a recommended charity, that worked out well or poorly.
So, according to me, your charitable efforts should be directed at things that you think are problems. The tycoon who funds high-powered basketball contracts for his local team is concretely addressing a problem that he can perceive (and that other people in his community share!). He counts as more charitable than the person whose goal is "donate to the proper charity, whichever one that is, I'll ask someone else".
If your advocacy for kidney donation is based on your need for a kidney, or your personal scars left by a loved one who needed a kidney, I will call it admirable. If you do the same advocacy because you think calling on other people to donate kidneys sounds like the type of thing you should do, I will call it reprehensible.
And similarly, if your donation of a kidney is motivated by the need of someone you care about, I will call it admirable, but if your donation of a kidney is motivated by the need of someone you've never heard of, I will call it stupid.
Your comment reminds me of something I read (I forget where) denouncing "nonempathic altruism." The point was that you ought to CARE about the people you're supposedly trying to help.
> The point was that you ought to CARE about the people you're supposedly trying to help.
But I don't agree with that point. I'm saying you ought to be trying to solve things that are problems for you, and you shouldn't be trying to solve things that aren't problems for you. There are two primary reasons: (1) if you follow this policy, you will be able to tell whether the problems are getting better or worse; (2) the fact that you personally have a problem serves as evidence that at least one person has a problem.
This may intersect with your interpretation in that, if you care about the people you're supposedly trying to help, then their suffering is a problem for you. But the analysis is different. Note that I called advocacy reprehensible (you are setting out to hurt other people) and donation stupid (you are hurting yourself). By my reading of your comment, you think I'm calling donation reprehensible.
If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate? What about if he had the option of meeting the recipient, but for some reason it didn't happen?
Do you have to know them in advance? I've volunteered at a place that feeds homeless people. I knew no one involved when I started, but got to know a few people while doing it. In a way, it was a sacrifice of my time, which is like a sacrifice of my life. But in another way, it was an experience that became part of my life. Perhaps Scott wants this experience to be part of his life.
There was a fascinating EconTalk podcast, almost a decade ago: 2014-07-14, "D. G. Myers on Cancer, Dying, and Living". In it, Myers said something that I think was profound, even though I'm not religious: "[God] didn't *plan* it; this is the history He wanted for me."
> If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate?
To the second question, that would be the difference between trying to address a problem that you have, and trying to afflict yourself with a problem to address. I don't see them as similar.
To the first question, let me answer in a larger scope: the propriety of donating a kidney depends on how strongly you are connected to the recipient. Having met them is not necessary (but would, if the donation were appropriate, almost always have happened) or sufficient.
> Perhaps Scott wants this experience to be part of his life.
That would not be enough to make his decision admirable.
"You don't personally know the person you're trying to help/their scars are not your personal scars" is different from "there is nothing you're trying to accomplish". "Helping people you don't know personally" is a thing one can try to accomplish.
Also, there is no such thing as "making charitable efforts" in the abstract. It requires doing a concrete thing with actual effects, such as picking a particular charity and supporting them. Helping people you don't know is not helping abstract people in some Platonic realm, they're actual people, they just don't happen to be on your list of friends.
Helping only those on your friends list is _very_ limiting. What if my friends are doing OK, but I know that some other people are not? Am I supposed to pretend that those are just stories told by malicious Djinn and the only things that are real are the things I see with my own eyes while personally present, not even a direct video feed counts, because someone might have faked the video? It's theoretically possible that someone might fake any video I see, sure. But I'm not that much of a solipsist. I can even (shock, horror) read a book and believe there's a decent chance the words in it relate to actual things, despite the fact that creating a book that says false things is easier than creating one that says true things. Shockingly, I can believe that the words I read before writing this post were probably written by a real person who will later read my words and be affected by them in some way, even though this is _an Internet comments section_. Admittedly, sometimes I do doubt whether something I read on the Internet was written by an actual person and suspect I'm wasting my time, but for the most part, the conversations I engage in seem worth it. And similarly, sending money or useful goods or services to people I've never met through an organization composed of strangers, based on information written by other strangers about places far away, often just works as advertised, as best I can tell. Sometimes not, but often so.
According to you, my charitable efforts should be directed at things I think are problems. Well, I agree, that's obvious. I just think, like, people dying all over the place in developing countries or suffering because of stupid things that can be fixed for a few bucks _is a problem_, even if I don't know their names. It's a problem I'd like to do something about. And there are means available for me to do that, and requiring me to make new friends first seems like an awful and useless hurdle. And thousands of people waiting on an organ recipient list, is also a problem, and one which there are means to solve. I can see how you might be concerned that someone might spend some money I give them on something for themselves rather than something helpful to the people I want to help, but like, what's the equivalent of that, for kidneys? You can't buy a yacht with kidneys. Most likely if I donate one, the doctors will try hard to make sure it gets into someone who needs one.
Not really, it's more about directness and probability. The kidney goes to a particular person, who has a known high probability of living because a specific thing that was wrong got fixed. The money is fungible, and with regards to "cults", the phrase "hookers and blow" comes to mind.
... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA, they're also quite good at providing the numbers and math for what the money will do, which in this regard puts them ahead of pretty much every other group out there.
> ... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA,
Look at Scott's description of his decision-making process:
> my girlfriend ending up begging me not to donate, and I caved.
> When I talked to my family and non-EA friends about wanting to donate, the usual reaction was “You want to what?!” and then trying to convince me this was unfair to my wife or my potential future children or whatever. When I talked to my EA friends, the reaction was at least “Cool!”. But pretty often it was “Oh yeah, I donated two years ago, want to see my scar?”
> After I submitted the donation form, I was evaluated by a horde of indistinguishable women.
> they all had questions like “Are you sure you want to do this?” and “Are you going to regret this later?” and “Is anyone pressuring you to do this?” and “Are you sure you want to do this?”
On the one hand, you have everyone close to Scott, plus the impersonal medical system, stressing that this is a bad idea and he shouldn't do it. On the other, you have a group of erratic weirdos who like to talk each other into following through on bad ideas, and they provide support, encouragement, and role models for this one.
One could say the same thing about a group of slavery abolitionists 200 years ago.
Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
> One could say the same thing about a group of slavery abolitionists 200 years ago.
I'm not sure what "the same thing" refers to. That they were a cult? That their characteristic behaviors were due to pressure from other abolitionists? That they liked to talk each other into following through on bad ideas?
I don't quite see the parallels there. It would be easier to say they could also be described as erratic weirdos, but I don't really see that as a central theme of my comment above. I included that to form a closer parallel to the paradigm of "cult".
Yes, one could, and I WOULD, say the same thing about slavery abolitionists. And about vegans. And about abortion abolitionists. And libertarians and anarchists. And men's rights activists, and white civil rights advocates. (I made sure to list a few causes I personally support.)
There are many causes that seem (and therefore ARE) righteous to those on the inside while simultaneously insane and/or evil to the vast majority outside.
> Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
Note that this argument is incoherent. Those questions are not important things to ask, unless the action they apply to is recognized as a bad idea. If the cashier at Taco Bell made sure to ask whether you were being coerced before ringing up your order, it wouldn't be possible to explain that by invoking the idea that the question was important to ask, because, obviously, it isn't. Instead, we would explain that by reference to the cashier being mentally unsound.
The premise that asking the questions is important already assumes that the course of action is a bad idea.
"A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?"
Because you're not handing it over TO the cult, duh.
I agree, because the leaders of this movement are installing 90% of donated kidneys into themselves, gaining the ability to filter spacetime itself.
For most people, the problem with giving your money to the cult is that it flows into the pockets of the charlatan at the top rather than toward any sort of greater good. Perhaps you find altruism in general to be a repellant concept; this certainly seems to be the case from subsequent responses. You claim to advocate for altruism that solves some defined problem. Yet Scott's kidney was successfully implanted in someone who needed one. That's a definite, concrete change in world state, unlike giving money to a broad, generic 501(c)(3).
But at least this post was silly enough to get me to register.
I think you genuinely hold this opinion, but are also a troll.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
I'm sure you really do hold values that render altruistic acts like this contemptible, groups that encourage them reprehensible, etc. etc. But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings), followed by a rhetorical question that could not be posed in good faith by someone who had spent more than 5 seconds thinking about it.
Everyone else, please consider following the ancient wisdom and Not Feeding The Trolls.
> It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
This is an interesting contrast with my response to MoonMoth, which he didn't agree with:
> The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
You've come along to argue much more forcefully that what's important to you is that the money recipient is not worthy and the kidney recipient is. That still hasn't been established.
I am noting that the harm suffered by the victim is worse in the scenario we're being called to admire than in the scenario we all politely agree to vilify, and that this is incongruous.
> But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies
When someone makes a big public announcement "I've started cutting myself. My parents don't like it, but I'm doing it anyway because I want the public acclaim" ... when could possibly be a better or more appropriate time to respond with public condemnation and scorn?
> a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings)
This I just see as wishful thinking on your part. They're close analogies. They're not exact analogies.
I think the concern is that OCD can cause obsessive thoughts like not being good enough and needing to do more, scrupulosity, which seems like a bad reason to donate.
I found your very first blog by accident when a book review on native indians you wrote became famous, I read it, loved it, and then went to the first of your posts on that blog, where you described a hike after finishing high school. Loved that and then never stopped reading your stuff since.
Yup. Scott's awesome. I'm an occasional reader and a big fan. Brilliant, funny, knowledgeable, kind, about as honest as one can be in the world of online opinionating and usually correct as well.
Out of curiosity, why? My prior is the opposite (assuming you mean general anaesthetic) so I am metasurprised by your surprise. But I don't know the numbers.
But seriously, I had some broken bones as a kid, and so had my best friend, and then many people I knew growing up (some similar to what Xpym describes, dumb mistakes resulting in unpleasantness) had various surgeon encounters. So I grew up with a prior "most people have been in an OP".
And whose parents don't get swindled to put their 17.9-year-old under general anesthesia to remove ONE wisdom tooth "while your insurance still covers it"?
Several years later, we all learned that wisdom teeth can just as easily be removed under under local anesthesia.
This makes me wonder if this is a UK-US distinction. A quick bit of Googling suggests that indeed general anaesthetics administered per capita per year is on the order of two times larger in the US than here in the UK.
I avoided any medical interventions until my forties when I did have to be sedated under general anaesthesia for an endometrial biopsy. One of my siblings, on the other hand, was sickly from a baby onwards and had several hospital stays. Luck of the draw, I guess? 🤷♀️
I didn't have it until my first colonoscopy. I've also never been hospitalized except for one overnight where it was possible I had had a heart attack but it was acid reflux, which, for those who haven't had the severe form, feels like getting kicked in the stomach.
1. How do you know it was zoom doing it? Maybe they were spontaneously donating body parts and replacing them with UCSF insignia.
2. The Pros and Cons chart is flawed. It weights each factor equally. I, for one, definitely value some more than others. Cornell may not be on top after all.
3. "previous living kidney donors" sounds more Halloweeny than was probably intended.
"I make fun of Vox journalists a lot, but I want to give them credit where credit is due: they contain valuable organs, which can be harvested and given to others."
"I practiced rehearsing the words “I have never donated to charity, and if I did, I certainly wouldn’t care whether it was effective or not”."
"When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month."
"I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria"
I didn't read as far as the 4th section (and shame on you for tricking me into reading what I'd avoided! 😂) but when I read the first one I laughed out loud and wamted to share that but had no other comment to make on it.
I recently came across one of his corrections that read something like, 'whole I agree that (x y z)... saying that Vox isn't absolute garbage may have been overstating it'.
I started typing a comment but I realized it would be so long I might as well work on a "Contra" style article for "Why you should not donate a kidney".
If you are a person that's seriously considering donating a kidney please consider contacting me at george @ cerebralab . com -- so that I may try to dissuade you.
I think this would help me write a better article by having a motivated adversary with skin in the game.
P.S. In case Scott is reading this I'm obviously *not* claiming that donating a kidney isn't an altruistic act. I think that you are a fantastic person as always for doing this, I am just against encouraging people to do it because the uncertainty around outcomes seems immense and potentially bleak. Which still means that on-average you saved QALYs and contributed to social cohesion making you an all-around good person for doing this.
P.P.S Hopefully no new rules around posting emails in comments, if one exists and I'm breaking it, I'm sorry
How transferable is the 'kidney credit'? My wife is at elevated risk of someday needing a kidney, so I always figured I should keep my spare in case she needs it. I would be very upset if I gave it to somebody else now, and then 20 years later found myself unable to leverage my past donation to bump her to the top of the current recipient list.
I'm not sure I understand your question. You could always put her as the only person on your list of people you were giving a credit to. But I'm just guessing here - if you're really interested in this, you should contact WaitListZero (link at the bottom of the post) and ask them.
Sorry for the confusion, I missed your footnote #7, it answers my question -- this is good to know! It actually makes it so that if I gave somebody else my kidney now, I could designate my wife at present to be the beneficiary of some other kidney in the future. It's like kidney insurance -- in the event she that outlived me and needed a kidney when I'm no longer around to give her one (or I'm just too old to be a donor) she could get one on account of my having given one away before. Duly updated!
The only thing that bothers me about this is the opioids bit. When my father had issues with a kidney stone, they gave him morphine, and he was in utter amazement of how effective they were, and came out of the experience saying "I can understand how people get addicted to this stuff." I've heard about how people getting their start on opioids because they're prescribed them following surgery.
When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
It's all well and good that it's a relatively safe surgery, but I'm wary of any unnecessary exposure to opioids and would need to know the risks there.
I was looking forward to trying opioids, in a sort of Ulysses-tying-himself-to-the-mast way: I'd heard so many things about them, and wanted a chance to try them without getting arrested.
I joked in the post about how good I felt, but it was actually just a normal amount of pretty good - hard to bother, comfortably warm, easy to drift into pleasant sleep. I tried a higher dose at home when I had my UTI, and had a similar experience, then very unpleasant constipation for the next few days. I currently have a bottle of unused opioid pills on my desk that I haven't touched for a couple of days despite enough pain that I could easily justify it, mostly because of constipation risk. My guess is I'll continue not to use them until the next time I'm in extreme pain for some reason, even though I usually have a pretty experimental approach to medication.
My impression is that happy people without pre-existing mental illnesses or addiction problems rarely get addicted to opioids in the period after a surgery. Partly this is because people with addictive personalities form a separate group who already know this, partly it's because addiction is an interaction between genes and how good your life is, and if your life is good you need to be very genetically unlucky. Partly it's because you'd normally need higher doses, faster-acting chemicals, and longer timespans than a typical post-surgical course to get addicted. And if all else fails, most people won't have the energy/interest/knowledge to find a new source after their prescription runs out.
I think all of this is compatible with the extent of the opioid crisis. I think I remember seeing some studies that people who die in the opioid crisis mostly aren't normal patients who got post-surgical prescriptions, but the people who stole/bought/cajoled opioids from those patients.
Very similar experience here, minus the constipation. Had several occasions to take them after various surgeries. Warm feeling of calmness and not-giving-a-fig. Zero desire to take them after the pain subsided.
That matches my experience as well, with one difference: I kept taking the opioid as prescribed (as in, take X every Y hours) even though I wasn't in pain (because you're supposed to follow the directions, right?). I ended up stopping because I noticed I was getting very irritable in the hour or so before it was time to take my next pill, and I was looking forward more and more to the warm sunny feeling I would get.
I come from a family with a history of alcoholism, so when I realized I was getting irritable I threw them away out of an abundance of caution. Sure did feel good though.
Oh I absolutely ignored the prescription timing and took it only when the pain became really "not ok" (I don't know... 7 out of 10? I never understood this scale, is the 10 "the worst possible"? how would I know what that meant?). I was worried about sliding into dependency without even noticing it.
I got a few opioid pills when I broke my arm a couple of years ago, even though it mostly didn't hurt if I kept it still. I tried one the first day, and in addition to making the pain go away, it also made my PTSD go away. I promptly stopped taking them and have saved the rest in my closet in case things get very bad,. My prediction is that they'll just sit there and eventually expire. Cannabis isn't as effective, and has more side-effects (the whole "stoned" thing), but also is easy to acquire where I am, and has much less potential to be addictive.
But now I have a suspicion about why heroin and Vietnam were so associated.
> When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
When I had my wisdom teeth out, they told me to take Valium beforehand.
Not for any medical reason. It would have provided no benefit at all. But my father didn't know that and he said I should take the Valium because those were the instructions.
My mother, a doctor in an unrelated specialty, supplied her opinion that the Valium had no purpose, and I didn't take it.
But I experienced far more anxiety over the prospect of being forced to take Valium than I did over the concept of having my teeth extracted.
As you might gather from my comment, I am still outraged about this.
I suspect the reason they told you to take Valium beforehand was to keep you from being too nervous about the procedure. The same thing happened to me when I had difficulties with an IUD installation, and I took the Valium, and I thought it was a good thing in that it helped me be calm and easily compliant going into the procedure.
Obviously if the idea of taking Valium causes you more anxiety than getting your teeth extracted than you shouldn’t take it; but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!), just to help you actually show up and let yourself be strapped down to be cut into.
> but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!)
That's the thing, it wasn't offered. No one said "do you want to take some Valium before the procedure?" Instead, they gave me Valium and directed me to take it.
I didn't take the Valium, but in order to do that I had to specifically violate medical instructions. I opted into a choice that was notionally forbidden to me. I don't find this acceptable.
You really don't think there's any difference between an offer and a command?
I think it's a little silly to treat a painkiller as a "command" having any authority. It's pretty obviously something that's prescribed as needed and clearly intended as optional.
I've taken opioids after major surgery. Their effect on me was to dial down the pain from a full boil to a simmer. That's it--no psychological effects of bliss or euphoria. Now, I was taking the prescribed dose, and probably if I took a lot more the effect would have been different. Once I healed a bit, I had no problem stopping taking them, and in fact still have a bottle of oxycodones in the back of my bathroom closet.
I have had morphine by IV to kill pain from a dislocated shoulder and kidney stones (separately), and didn't particularly enjoy it. It started with an unpleasant, nervous kind of warmth in indeterminate location, which soon faded, taking down the pain with it. The pain didn't go away, but it seemed more like I no longer cared about it.
I have had Norco and Oxycodone, which worked moderately well.
I have had no inclination toward addiction with any of these, which is only, of course, anecdotal, so your experience may vary. I'm not sure taking prescribed medicines as prescribed is "rolling the dice" unless you have some other prior susceptibility to getting addicted. If you feel a need to refill the prescription after the original need for it (such as pain) has gone away, that would be a bad sign.
I took opioids twice in my life. Once, after I got a wisdom tooth out. I was in pain for days, opioids weren't helping, and I took higher doses than prescribed. I felt no effect whatsoever. No high, no anesthesia, nothing. I even powdered and snorted a pill, to no effect. But there was one effect. I must have gone stupid at some point. I pulled out my dissolvable stitches. And then I forgot about it. I remembered that "the doctor will be angry with me" but I could not remember why. Figured, it must be because I ate three weeks of oxys in 5 days. Surprisingly, he wasn't angry. He gave me more oxys, because I guess you get more of the same thing when you say it's not working. But he said to try Motrin, too. One pill of Motrin took the pain away completely in 15 minutes. One. Frigging. Pill.
(Half a year later, I watched a medical show. On the show, a doctor cautioned her patient to come back to get the stitches out or else they'd heal like a railroad... and that's when I remembered that I'd pulled out my dental stitches!)
Second time, I used my dental leftover opioids for an ear infection. They worked this time. Again, no discernible effect on my mental state.
Since then, I got a pilot's license. Heard a few horror stories about how FAA will make you submit a book's worth of paperwork to prove you didn't get addicted to those 5 pills prescribed after a surgery. So I never took opioids since.
Asking doctors for "something other than opioids" is like a secret password to getting them prescribed to you by the bottleful. Skin infection? Here's some opioids! Minor surgery? Here's a month supply! Dental nerve dying pain? Here you go, to take the edge off on your 6-hour drive to your root canal referral. My apocalyptic meds tote is 60% unopened opioids and 40% every other prescription I hadn't finished. I once told a doctor that I haven't been taking my opioids because they rolled out of the brown baggie and got lost in the car somewhere... so he prescribed me more!
I don't think I would donate my own kidney, due to various emotional reasons none of which are all that thoroughly-considered... but I would gladly vote in favor of the tax credit. That seems like a rare free lunch in national economics. I hope it gets traction.
Speaking of traction, glad to hear you're on the mend, and great write-up.
Soo, do journalists finally get to claim that AE is a cult that steals people's organs?
ALT
Simpsons did it first (S10E8).
On a less facetious note, I find the data on the safety of kidney donation incredibly unconvincing. Vast majority of donors are elderly and have shared the lifestyle of the recipient for decades (stereotypical old couple situation), so tons of confounders and no good data for young people donating. To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible.
In general, I find myself wishing sometimes transplant medicine would just, dunno, go away. The results I see in my daily practice are always crap (I am the person who gets to stare at the nice little pictures you had taken all day long). It's far from the miracle everybody thinks it to be, and certain subpopulations might actually be worse of getting an organ than without it. There are practically no randomised trials on transplantation, and the devil kidney in me tells me it's because transplant docs know well enough that it would fail when actually trialled in today's population.
The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect.
I hope for your sake this turns out fine, lotsa people with only a single kidney end up as old geezers, but I can't help to think the "advertise kidney donation like blood donation to everyone" moment is a greivous error in the long run and this will fall medicine on its feet colossaly in the years to come. In the short term, this article has demonstrated to me that this blog now espouses values so far from me and mine own that it's probably time to stop reading it.
"To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible."
I think this comment ignores the past few decades of genetics. Figuring out the percent of something which is heritable is vastly easier than figuring out what genes are involved (it's never "the gene responsible", it's usually a mix of hundreds or even thousands). Still, when we do get polygenic algorithms, they've shown that the simpler gene-agnostic methods we used earlier to estimate heritability were right.
Although I agree it's unfortunate that you can't do RCTs for kidney transplantation, statistically adjusted studies continue to show the 5- 7 year lifespan and 20% quality of life gain. Before-and-after surveys of the same people also show the 20% quality of life gain, and people say they feel much healthier. There are obvious practical downsides to dialysis and everything we know about it biochemically suggests it should work less well than a kidney. AFAIK every group of nephrologists and medical evidence-setting body agrees kidney donation works better than dialysis. See for example UpToDate, https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults, ("Kidney transplantation is the treatment of choice for ESKD. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis") and this paper by the National Kidney Foundation: https://sci-hub.st/https://pubmed.ncbi.nlm.nih.gov/18256371/ . Curious if you have any links or evidence supporting your position.
"People don't die from a lack of donor organs - they die from their illnesses" sounds incredibly facile to me - not just "guns don't kill people, people kill people" facile, but "that person didn't die because of the gunshot, he died of blood loss" level facile. Just say that the result of getting one extra organ would be to save one extra life over the counterfactual.
My understanding is that people who are extremely old and decrepit are considered lower down on the list for transplants than everyone else. My grandfather, who was pretty old when he got ESKD, AFAIK was never even told to consider the options.
I agree that we seem to have some pretty irreconcilable value differences.
The main thing we learned from the last decade of genetics is that neither of these methods work. The few diseases that have a strong genetic contribution are practically monogenetic (ApoE4, PCSK9, ...). Whenever a study reports these minimal point estimates for hundreds and thousands of genes, that is essentially the result you would get from a non-genetic disease: hundreds and thousands of genes that minimally contribute to or detract from the overall resilience of the organism. Don't tell the geneticists, though, they'll get upset because they'll loose their funding once the agencies figure it out.
There is a actually a very straightforward reason for the autoimmune kidney disease they found: surgery introduces antigens from the kidneys to the bloodstream, thereby causing immunisation. The mechanism would be the same as in sympathetic opthalmia, where immune-privileged antigens from the intravitreal space get introduced to the immune system at large by trauma or surgery and then cause an autoimmune response to the entire organ system, eventually destroying both eyes. Replace 'eyes' with 'kidneys' and 'vitreal' with 'tubular' and you got yourself a deal, mate.
Re quality of life or survival gains: this is flawed evidence on all levels - without an RCT, the Ioannidis principle comes to mind: in a null field, observed findings are a measure of the prevailing bias. Control groups are likely sicker or historical, i.e. generally worse off. Also, my claim wasn't that this is a negative for all involved or even on average, but that selected subgroups may be worse off with a donor organ. This changes the calculus quite a bit from a medical perspective (you wrote so eloquently about that a few years ago re/ death risk from seroquel), but since no reliable data is being generated, nothing will change for a decade or so at least. When transplantation goes awry, the disease is blamed. When it goes well, the surgery is credited. This is as embarrassing as it has been effective in cementing the practice.
Finally, the argument is not as facile as you would like it to be. There is no moral causality between the availability of donor organs and deaths. Were there, then everybody who is currently keeping their two kidneys for themselves would be a murderer (or whatever your term would be for "person who is obligated to help but doesn't, thereby causing death"). This obligation doesn't exist, though, and previously this was an accepted view amongst medical ethicists. Since the explosion of utilitarianist bullshit in the wake of Singer's success in the academy, this slowly changing, and I dread to think where it will lead us.
I do not think one can compare donating a kidney to someone who needs one to dying of blood loss instead the gunshot. Would you say someone died of cancer, or because we haven't yet found a cure for that cancer?
I do see the point in saying an illness (such as a faulty kidney) killed someone, rather than saying lack of a donor killed someone. The second phrasing seems to me to take away some of the altruistic sense of the kidney donation, making it more of a duty of a donor instead of a freely offered gift.
"The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect."
I don't know, friend; I had a cousin who got a donated kidney and indeed would have died without the transplant operation. He did die several years later, so you could argue that the gain wasn't worth it, but how do you decide the value of "lived extra years to see his children reach adulthood"?
My late father, for reasons we never got adequately explained (I personally think it was due to side-effects of medication) underwent drastic collapse to the point that he had to be resuscitated three times in hospital (and my family was asked, after the first time, did we really want this, with the heavy-handed implication that we should just let him die; my mother refused adamantly to consider this) and was put on dialysis, and eventually sent home from the hospital with the clear, on their part, expectation that they were sending him home to die. He was in his seventies at this stage, so they were going by "well he's had his life, why drag it out?"
My mother and I nursed him back to health, to the point where he was able to be active once again, and was doing so well on dialysis that the hospital considered cutting him down to only once a week (the consultant referred to him as "my miracle man" when doing rounds with medical students, our opinion on that was "yeah this is only because we stopped you guys letting him die"). His eventual death was not due to the kidney problems but a stroke brought on by blood clot due to venous embolism which the casualty department (emergency room) didn't recognise and sent him home with a "sprained ankle". By then he was just starting his eighties, starting to decline, and very lacking in motivation since my mother's death. He was ready to die by then, but he had an extra decade of life because we didn't obediently go along with the hospital about 'let him slip away' the first time.
So while there definitely can be too much intervention where a natural death is better, there's also the opposite where people who could have good remaining years are written off too early.
I will keep reading, but I also definitely realized that Scott's values are dramatically different from my own. But for me, it comes down to the fact that if I'm going to mutilate myself, it has to be a warm decision, and not an output of cold rationality, that is, the kidney would have to be donated to family or someone I love. I mean, I signed the Giving What We Can pledge, but compromising bodily integrity for the sake of a stranger just seems wrong.
However, I wonder if every monastic of every religion in the world could be persuaded to do this, as this would be, after all, consistent with their principles. A quick search suggests this would be 11,000 kidneys, which is nothing to sneeze at.
Flattered to have caught your interest, however briefly. You have mentioned you have traditionalist friends, which is really interesting. You ever tried to read Rene Guenon, who is along many axes the anti-thesis of everything you believe? He is not hateful though, don't get it twisted, even if he believes everything since Descartes has been a mistake.
Basically, he believes the only possible way a civilization can work is in a traditional manner: spirituality, a legitimate spiritual tradition, needs to be at the very core of the civilization. The last time the West had this was in the Middle Ages, and it all started falling apart with Descartes, till we got to the present day, where spirituality is marginalized. He believed the East to be superior to the West for this reason, though he did not get to see the secularization of China and India.
Along all that there is also the perennialist project: to show that all the various spiritual traditions are actually in agreement in fundamental matters, which does not mean on morality (he regards that as secondary to all this), but rather, on actual metaphysics, truths from beyond.
I really like the work of the perennialists actually: the properly spiritual view is to see the harmonies, or at least, don't let the differences make you think there is an irresolvable conflict.
I just wish to say that I am unironically very inspired by "Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
If fucking *Scott Alexander*, possibly the smartest guy I know of, who is constantly genuinely trying to get to the truth and do the right thing, feels that way, well, fuck it. This is just dumb. I thought maybe I felt that way because…well, because they were right. But there's *no way* that *you* should feel that way all the time, so why should I? Fuck that.
Thank you, genuinely, for being you and allowing us to see who you are.
Seemingly we have saints who are patrons of kidney patients (there's a saint for everything!)
First, St. Benedict of Nursia (*the* St Benedict who founded the Benedictines) whose connection seems tenuous; it may have been (pace the British Association of Urological Surgeons) because a king went to Monte Cassino to be cured of bladder stones, or (pace a Catholic website) because his monastic rule was so harsh, the monks tried to poison his kidneys by giving him tainted food and drink:
"Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon Satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology."
> This request didn’t get communicated to the surgeon and he told me anyway - but luckily everything did go well.
Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
***
In countries where it is harder to sue hospitals than it is in the US, are decisions like UCSF's re: OCD less common?
***
Do any kidney-transplanting hospitals publish their full list of medical conditions which rule out a potential donor, either due to risk to the donor from the surgery, or risk to the recipient from a potentially subpar kidney? I would appreciate seeing one.
> Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
I suppose the game theoretical problem is ameliorated because no one (?) donates kidneys more than once, so there's never a chance to figure out an individual doctor's pattern of behavior.
I knew someone with 3 kidneys, at least they said so, but google says there are only 100 cases globally so now I am suspicious. But possibly one of them could donate 2 times.
The Linear No-Threshold Hypothesis of radiation says that every milliSievert increases your cancer risk. It does not. Humans cope and even seem to thrive with a background level of radiation. Prof Richard A. Muller (the Physics for Future Presidents guy) has thoroughly debunked LNT. That the NIH supports it is further evidence that it is nonsense.
1. Without saying outright that I trust the NIH more than I trust some person who is "the Physics For Future Presidents guy", I don't trust the Physics For Future Presidents guy *so much* more that I will totally ignore the NIH's view and not even consider it at all.
2. 100 mSv has been empirically demonstrated to increase cancer risk, so if there's a threshold, it's there or lower. The CT I was worried about was 30 mSv. So to not worry about the CT, you would have to claim both that NIH is wrong and there is a threshold, and also that the threshold is definitely between 100 mSv and 30 mSv (and not, say, 10 mSV). I don't really see any evidence for that, so even if there is a threshold, I'm worried the test might fall above it.
The probability calculation of 1/660 doesn't seem at all correct to me. Every Sievert, you say, raises your risk of dying of cancer by 5%. But that's raising it from *whatever the current rate is*, which is... okay, a quick google says that cancer mortality in men is something like 200/100,000. So 30 milliSieverts would raise your risk by a total of 200/100,000 * 1/660, which is more like 1/330,000. (Or, I guess, raises your cancer risk by 1/110,000).
Came here to make a similar point.The linked article says "5% excess risk of death from cancer" and then has citations I can't reasonably follow; I can't tell whether that should be understood as (5% excess risk of death)(from cancer) [i.e. the cancer risk amounts to 5% increase in all-cause mortality] or (5% excess risk of) (death from cancer).
More glaringly, Scott writes:
"the risk of dying from the screening exam was 1/660. ... I regret to inform you she might be right. ... a 30 mS dose increases death risk about one part in 660."
Two very different statements! Does the scan have a 0.15% chance of leading to your death, or does it increase your odds of dying by 0.15%? The former seems crazily high, but contextually it's being compared to the risk of surgery, where the figures really are about the risk of the procedure killing you.
Anyway, Scott, if you see this, congratulations and good on you - just want to make sure you're not unnecessarily making kidney donation sound scarier!
Huh. I admit I didn't look super closely at the citation last night -- I looked a bit at them this morning and they are hard to follow, though I *think* they might actually mean that they do think a 30 mS dose could give a risk of dying of 1/660. What I mostly came away with is thinking that 30mS is a rather high dosage of radiation -- everything in the chart in the article is much less than that. (Also I came away with the idea that... no one really knows, actually.)
And yes, I forgot to say, congratulations Scott and I think that's really great!
> You don’t need to worry about not having a kidney when a friend or family member needs one. When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves.
This was certainly news to me, and makes me feel better about the whole thing, but doesn't the fact remain that your own kidney is much likelier to be a better match for a family member than some other kidney off the list?
I don't know. It's true that your kidney (because of genetic relation) is much better than average. But it might not be better than the best kidney available to the organ bank with hundreds of kidneys available. (I don't understand how this works well enough to be sure it works like this). It also seems like in some cases (eg spouse, relative with different blood type), your kidney wouldn't work at all, and the bank would be a better alternative (though usually the bank would let you make some kind of more direct trade).
I also wonder (1) what are the odds that they will actually "make sure those people get to the top of the list"; is there any accountability for this promise? and (2) is there any way for me to pay somebody with a blank space to write my name? (We could call this "The Taylor Swift trade".)
also (3) what about the lost optionality? It'd suck if your True Soulmate only comes into your life after you've made your list, or if someone on your list dies for unrelated reasons. Really they should just give you a fungible "Good for 1 kidney" token (which you could then trade on the open market because it isn't itself an organ!). (Plus, then maybe they could offer 0.9 tokens for a slightly-substandard kidney. )
I found this post somewhere in my newsletter, and i was surprised that anyone would give precious part of the body to a stranger.
I have kidney disease (they dont work anymore to be honest), located in Europe - and here i never heard about 'random' donors.
Moreover, i personally never asked (and probably will not ask in the future) my friends or family for organ donor. Im overwhelmed about idea asking anyone for something that big and important.
Congrats, you make 30+yrs old man to cry like a baby :)
I really wish you everything best and i admire what you did.
You don't mention where in Europe, but depending on country, it might make sense that you haven't heard of undirected donations — they're illegal in France, for example. I am duly furious about this.
I thought about donating in Germany, but they are also illegal here for some reason (I blame Catholics), luckily I could also probably donate in the UK if I ever want.
If this estimate of increased risk assumes the linear no-threshold theory (LNT) -- and a quick look at the cited paper suggests it does -- it's nonsense. Read Jack Devanney's substack on nuclear power, where you will find demolitions of the LNT theory.
My usual admiration for Scott. Even higher than usual if possible. Glad he is alive, was considering open a manifold market: Is Scott in hospital? - Had hoped for an even better reason to be there. And feared for worse - The beginning freaked me out: "As I left the Uber, I saw with horror ..." One of my few wishes left is: May I die before Scott does.
Cheers for NOTA! To keep up the pressure, I shall keep my organs for now. (From an MRI I assume the one kidney is not fine enough to donate, and the fine one I intend to keep.)
It took me a while to register that Scott was giving an accurate account of what was going on in his life rather than offering a thought experiment or a short story.
I AM a naive reader* and accept most the authors may throw at me. Scott's fictional texts signal early enough what they are + while his life stories are so true, it may hurt. Most his posts are non-fiction (esp. if one discounts the bay-area-parties, we know now). And after such a long break from posting, I was ready to expect a story involving a hospital. The Q of my YL has gone up much by reading Scott. So I care.
*I assume nearly all are. To do better, eventually, reading Bryan Caplan may help me: a) Caplan writes some libertarian stuff, I buy it all. b) Caplan gets into a discussion and lets the other side explain their position. I buy this now 90%. c) Caplan writes why he still disagrees with them; I buy 70%, d) They get one last say: Now I am kinda undecided and have to make up my own mind. ;) Right now at stage b) https://betonit.substack.com/p/sehon-responds-on-socialism
I wonder whether a policy to give a tax deduction rather than tax credits for kidney donation could receive less political opposition. Because it seems the main concern opponents of compensation for kidney donation have is that poor people will donate kidneys for financial reasons in a way that seems morally icky. Whereas with a deduction, due to the existence of the standard deduction, the financial incentives would become active at some level of income while not influencing the behavior of people poorer than that, right? Does anybody more familiar with US taxation and organ donation policy know if there's some number at which such a deduction could be set to alleviate the US kidney shortage while not influencing the behavior of the poorest, say, 1/3 of Americans toward kidney donation?
I think paying them the same amount is good. Another person thinks it's bad.
It's like reading two comments on abortion and observing, "Abortion is bad, but banning abortion is bad. You can't win!" Such is life on controversial issues.
I happen to live very near the "castle" and aside from a one week event for college students when they first bought it, it seems like they haven't actually run any conferences there yet over the last two years, but have continued to rent other venues for retreats and so forth since.
Old buildings can be money holes. I suspect, though don't know, that there are either transportation issues (there's a year+ long road closure on one of the main routes there) or maintenance issues that have prevented it from being used for any conferences as of yet. It's kind of a red flag to me that Oxford University owned it but then sold it as they didn't think it was financially feasible to hold on to. Though to be honest I'm glad it's back in university-associated hands rather than as a private building, as the university owns the rest of the adjacent land. It's a lovely area.
It's in Oxford, which is nice if you're a person living in Oxford, or attending Oxford University, or a professor there.
If you want to attract Business People and International Interested Persons, then London is always going to be a much bigger and better draw (same over here with Dublin versus the rest of the country). Easier to get to for most people, has the infrastructure and associated supports and other companies, entities, state and private organisations, and is just the first place someone would think of, rather than trying to get to a nice little historical village outside of Oxford.
I'm fully expecting it to be a money pit and ending up sold off again in a few years. Reading the defences of the decision to buy it, it seems to me to come down to (1) we had a shit-ton of money and no idea what to spend it on and (2) one particular guy was pushing hard for it and seems to have swayed opinion.
Again, I don't think they're bad people, just people of a certain socio-economic class who don't necessarily realise how their actions will look to the general public. Same as Just Stop Oil having a vegan-catered banquet in a (former?) church premises with accompanying harpist laid on - why did people laugh and cheer on the disruption? Because they're working-class/lower middle-class people inconvenienced by the protests blocking the roads when they're trying to get to work, and they certainly aren't going to be serenaded by classical harpists at work:
And of course they look exactly as you'd expect (boots with summer dress) and are humourless: "must be paid by the Daily Mail!"
They want to solve global climate change by stopping oil, which will be easy-peasy to do, everyone just stop using oil - but getting a few balloons down from the ceiling is a very difficult problem, so hard!
Purely anecdotal evidence: I was at a workshop in the castle this month, and the same organizers had done one event there already and were planning to do two(?) more.
Also, a nitpick, as far as I understood, CEA didn't technically buy lent it for the next 100 years.
Kudos to you. Though I am suspicious your evil voice will learn to adapt to the new circumstances, perhaps encroaching on your good voice's turf in the right kidney, or, if the "left" part is important, perhaps claim your left lung?
I looked pretty throughly into kidney donation and even signed up for the first level screening but I ended up chickening out. However, I heard at one point that a screening question that’s commonly asked during the kidney donation process is “do you donate blood?” and I realized it was silly that don’t, given that I was likely eligible and that it’s a much lower risk but also life saving intervention. So I started donating blood and I encourage anyone who’s not quite comfortable with donating a kidney to try donating blood or platelets! The FDA has recently changed screening guidelines so that some previously deferred groups in the US (including gay men who haven’t had a new partner recently and people who have lived in the UK) are now eligible to donate.
Small note: the article you cite from Tom Ash was actually written by Josh Morrison and Thomas Kelly, according to the preface of the post.
Thanks for writing this. I donated as well, and found the experience to be a weirdly effective self-signal. I try to do various altruistic things, from donating money to choosing high-impact jobs, but good signals are costly, and these just aren’t all that costly for me.
That’s probably a bit counter intuitive - what could be most costly than my literal time and resources? That’s all I have! Here’s my thinking: after donations, I still live a life of extreme wealth and comfort compared to the average human, so the opportunity costs of donation are kinda trivial (like, maybe if I didn’t donate, I would buy the new VR headset that just came out, but I don’t suffer greatly because I haven’t done so). As for my job choices, these have coincidentally (suspiciously I might add, in my moments of doubt) been things I find challenging and interesting and rewarding in and of themselves. On top of that, there’s the point you mention that lots of my preferred ways to do good aren’t actually seen as good at all by plenty of critics (and, like, many everyday people too). I’m somewhat prone to imposter syndrome, and it’s easy for me to doubt my own motivations and impact on the world.
Donating a kidney was not only a costly signal of my values (the right balance of costly - annoying but still worth doing), but it also carried a lot of metaphorical resonance for me, since I have a typical secular worldview in which I am nothing over and above my body. Now, when I look at my body in the mirror, I’ll always notice and be reminded that it has a couple faint scars from the time I literally changed it - changed myself - to try to help someone else in a small way. It serves as a reminder that I can do annoying things because I value them, and I can literally change who I am in the process.
This reinforces my identity as someone who wants to do good things for the world, and serves as a healthy reassurance when self-doubt creeps in. So, for strictly non-altruistic reasons related to my general self-image and the narratives I want to tell about my life, I rate kidney donation pretty highly. All the altruism stuff is a great bonus on top of that 😉
Probably, but I don’t see how that’s relevant — the goal of this comment is just to share an unexpected benefit, not to tell anyone it’s the right choice for them on net.
"Also from my spicy [version of the "Effective Altruism As A Tower Of Assumptions"] essay:
Q: All possible forms of assistance, financial and otherwise, just make recipients worse off, for extremely complicated reasons. There are literally no exceptions to this. I promise I’m not just looking for an excuse not to do charity, I would love to do charity, it’s just that literally every form of charity is counterproductive. Weird, isn’t it?
A: Even kidney donation?"
Now that's what I call putting your kidney where your mouth is! (don't eat your kidney)
Castles need TLC as well, such as repointing stonework as needed, and weeding small trees and other foliage growing near or on walls, or even retiling roofs assuming the place isn't a complete roofless wreck. So the group who bought the castle also deserve some credit for maintaining it, assuming they do so adequately, for the benefit of future generations.
> Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons.
I was vaguely uncomfortable reading part IV - the one about the castles and the fuzzies and the utilons - and I guess this footnote made it clearer why.
Ten years ago, you wrote that "in all situations, the government of Raikoth will take the normatively correct action." In those ten years of life, having accumulated the moral wisdom that you did, would you say you've gotten closer to embodying these words - not in the sense of *knowing* the correct action, not even in the sense of *actually doing* it, but in the *knowing that you know* sense?
My impression is that 2023!Scott is, if anything, more reticent about this stuff than ever. This is a problem when Guardian opinion columnists are constantly whispering dread outside-view incantations in his ear, demanding that he give up his left kidney, and generally holding his sense of satisfaction hostage. That seems even worse than the state of nature, which is getting fuzzies from Meaningful Human Connections™. Those, at least, are fake in an obvious way.
(not that I'm saying it was wrong to donate the kidney; just that this post is pretty depressing, like watching someone fill out taxes, except it's not even a morality tax like the GWWC pledge, it's a tax on *having a morality*.)
What do you mean by saying Guardian columnists are demanding he give up his kidney and holding his satisfaction hostage? I see that as his inner sense of shame and scrupulosity. I agree it is a sad post - I wish he did not need to take such drastic steps to feel worthy.
Hi. CT scans have been around now since the 80s as well.
The whole brouhaha started with Brenner's paper in the AJR in 2001, which was modeled on radiation from Hiroshima and Nagasaki, which itself is not a fair modeling example, because the radiation profile is different and you can't just extapolate the risk from 1000mSv to 1 mSv (CT scan would be between 1-10 mSv). Until then, no one talked about diagnostic imaging and radiation risk.
So the burden of proof lies on those who say that radiation from diagnostic imaging (< 50mSv one time dose) increases risk of cancer, not the other way around. There is no data showing this in adults. Those who believe in the hypothesis have moved to children, where if at all (and no one has accounted for reverse causation), for every 10,000 CT scans of the brain, there is one increased brain cancer risk, that's it.
Modeling is just that, modeling. All of the references below say "There is no evidence that low-level radiation from medical imaging causes harm and below 50-100 mSv of exposure, the risks are too small to be observed or non-existent".
1. Amis Stephen. Radiology 2011: 261: 5
2. Position Statement of the Health Physics Society, Jan 2020
Unlike with so many other medical interventions, where our follow-up data is in the range of a few years (statins is now 35 years), with X-rays we have good solid long term data. Remember that from the 20s till almost the 90s, patients were also exposed to barium studies, IVU studies, where the radiation was in the same range sometimes as CT scans. Some observational study from the NHS or from the Scandinavian countries that track all their patients would have shown some causation. But there is nothing.
Casually bringing up your disdain for journalists in the absence of an occasion to criticize them creates more heat than light and annoys my NYT-reading fiancée
This still gets my hackles up. Let me fumblingly try to articulate and explore why I feel this way, in a way that hopefully sounds valid.
-----
Let's imagine for a second that this was written by someone other than Scott, someone who I haven't spent years reading, and whose thoughts I don't understand as well.
The text of this article is "I donated my kidney". The message, partly stated but mostly implied, is "You should do so too." (With caveats of "I'm not telling you to do this, just giving you social permission to do it if you were already inclined.")
Most people trying to get you to do something this drastic and unusual don't have your best interests at heart. They stand to benefit in some way or another. That in and of itself is a pretty big barrier to convincing people.
How can someone benefit from kidney donation to a random stranger? They don't have to benefit directly. If they have a value system that thinks your actions improve (their conception of) the world, they'll usually try to argue you into it anyway.
Does this actually improve the world? Probably, at least to some extent. Does that extent justify the health risks?
Scott's a doctor, I'm not. With my limited knowledge, my heuristics are, generally speaking, "Keep things related to body, health, and diet as close to natural as possible, doing medical interventions only when necessary, or where the problems are accumulating enough to justify it." I assume that the redundancy in my kidneys is there for a good reason and am inclined to keep it.
This has had some benefits to me: I have a friend who, during a rough time of his life, went deep down a psychiatry rabbit hole, culminating in a breakdown that left him dependent on benzos and unable to work. While we were talking about his issues, I told him my heuristic, and he admitted that it was probably a good one. That's not a knock on the people that need medications—some people really do need it—but the point is even for something like medication, I usually have to convince myself to use it, and err on the side of avoiding it.
So you say the risks are small. Given that I'm this risk-averse, is your definition of "small" the same as mine? Probably not. The weird testicle thing alone would probably be enough to put me off. I have no idea what could cause that, how hard it is to treat, or what kind of long-term damage it could do.
And that's even assuming you're telling the truth. Since you already have a motivation to argue the side that convinces me to do this—look how many QALYs you can bring to the world by convincing me!—you might have a motivation to lie. Or if not lie, then at least do the subtle not-lies that might convince me anyway, like tell a one-sided story; cherry-pick bad evidence; or ignore, neglect to mention, or handwave away some of the risks.
Then I start wondering: hang on, how far will this guy take this?
"You should do this" seems to imply a moral norm: you're a good person if you do this, you're a bad person if you're not. Is he on the onramp to a moral crusade? We've seen a lot of those in politics lately. He's got all those caveats to his message, but does he mean them? If he does mean them, then for how long? Will he still be as forgiving when kidney donation is commonplace or even expected among his friends or ingroup?
Is he trying to make him and his friends look good, to have him and his friends accepted as the morally virtuous subculture, at my expense?
With that gut reaction firmly in place, I start probing my moral philosophies, against both the weaker explicit message and the stronger potential one. I start thinking of bodily autonomy, and abortion: does this line of thinking imply that it's morally correct for women to bring their babies to term at the expense of their own (similarly likely minor-to-moderate) health risks? If good people are morally obligated to give their own kidney, how much else of their life and literal bodies are they morally obligated to give as well? How much marginal risk or pain is one person supposed to take for a marginal improvement of someone else's life?
And then I come into the comments and argue.
-----
Okay, taking a step back: this isn't quite how I reacted to this article.
The big reason for that is because, like I said in the beginning, I've been reading Scott for years. I know, to some degree, how he thinks about medicine. I've read some of his writing on moral obligations, which makes me think he's being honest about mostly just sharing his story and giving people who were already on the fence social permission to go ahead and do it.
Because of that, my actual reaction to this article is that it shifted my opinion very slightly, enough to maybe freak out a bit less in the unlikely case that a friend of mine decides to randomly donate a kidney.
I would probably still freak out a little bit, and this article is very far from enough to convince me to do it myself. My heuristics are too strong, and my self-awareness in my lack of knowledge too great. Figuring out whether I even want to do this is not a way I want to spend my time, energy, or health, so I default to "no".
-----
So why am I rambling about this here? Because I expect that this kind of thought process happens in a lot of people that have a negative gut reaction to EA. I expect it happens almost instantly, and likely subconsciously.
A lot of EA writing is a Rorschach Test.
The gut reaction you have to something like this depends a lot on your past experiences, how much you trust the author, your exposure to Effective Altruism, and how often you've had people try to pull one over on you at your expense. These all feed into your personality, heuristics, and priors. That's why you get reactions ranging from "Nope, you're a crazy liar" to "Interesting, tell me more".
IMO, the only way to reach the defensive ones is to advocate for more common-sense, lower-risk actions whose benefits are more easily explained and apply across different moral systems. I've written about this here:
Though I understand that's probably not who you wrote this article for.
-----
Anyway I'm glad it went well for you and I'm sure whoever got it from you was immensely grateful.
(And sorry for taking a soapbox to this personal story. It just got the gears turning.)
Despite my ramble above, I can't help but think of another blogger I loved to read, Shamus Young, who was diagnosed with end stage kidney failure in 2022 and died three months later. Actions like yours could have made a difference in his case.
I agree with some of your points, I've definitely noticed that sort of negative gut reaction from some of my more suspicious friends and your explanation makes their reaction make a lot more sense to me. I used to be very all-in EA, but while I admire Scott immensely for having the courage to take a step like this, it's also given me the same sort of gut reaction - the reaction of how far should we take this, and how much against our common sense should we go?
Thanks for your comment, definitely helped my thinking a lot!
> I think of society setting the targets for “good person” a lot like a CEO setting the targets for “good vacuum salesman”. If they’re attainable and linked to incentives – like praise, honor, and the right to feel proud of yourself – then they’ll make people put in an extra effort so they can end up in the “good person” category.
I don't get the "you should do it too" vibe from Scott's article, he did point out that kidney donations are not very effective as far as EA goes. As a person who was kind of on the fence on the decision, I feel like reading this article both increased and decreased my desire to donate (learning that you can put 5 friends and family on the priority list was a big plus). Getting support for the tax credit idea is probably far more impactful than warming up individuals to the idea of donating themselves.
- Veganism has a big lobby which creeps into EA, organ donations don't have that, so I don't think it's fair to bunch them up.
- That there are other articles by EAs criticizing EA practices, and no notable criticism of kidney donations in EA, is a stronger signal that kidney donations are actually a good thing than if there were no articles at all.
Not sure which way the utilitarian calculation goes. The additional ACX time, either now or 25 hence, is probably still fairly valuable, e.g., David Friedman is still cranking out interesting stuff while old. But not sure how to quickly compare intellectual output to additional QALYs now.
Huh, and here I wasn't sure if I was just imagining "haven't seemed to get many SSC emails lately, what's up with that?" Worth the wait - always really enjoy posts about your own life. Skin in the game and all that, now you've Got The Receipts in a very concrete way. Someday if we get excellent generative AI for shows, it'd be cool to dramatize this essay as The Alexander Kidney. Or I'll try to recast you as the hero in Angel Beats!
...which segues into, I can't really imagine spontaneously donating a kidney to a __complete__ stranger? Maybe a family member, probably a friend, definitely a SO, some sort of handwavey Inner Ring calculus involved. Bad experiences with involuntary donations make me react really poorly to bodily-autonomy-integrity violations, no matter the utils involved. (And that was just for hair!) OTOH, being on the standard organ-donor registry that everyone signs up for with their driver's license - yes, of course, it's not like I'll be around to miss them at that point. I think I read somewhere on your old blog that such organ donations went down as cars got safer, actually, and It's A Problem...?
Description of the actual process and surgery...retroactively reassures me I made a correct decision to cancel [other elective surgery], even if in theory there's financial reimbursement available. I do think there's definitely some above-replacement Happy Price which would change my mind - $100k is several years of wages for me, that's Not Nothing, money is fungible - but other illegible costs like time and logistical hassle can't be "repaid". Wonder if there's any potential in streamlining the approval process - does it actually need to be several months? (I also don't understand why homeopathic levels of mental illness would be disqualifying, unless it was of a variety particularly prone to driving rash decisions?)
B: Thank you so much for writing this. This piece is going to reach a ton of people, make waves, cause a bunch of new donations, and probably save far more people's lives than your actual donation did.
I've chatted with Dylan Matthews about this, but there's an *extra* massive reason for public influencers to donate their kidneys. Dylan has probably, no joke, caused hundreds or thousands of extra donations via his articles and advocacy. The actual impact of his specific kidney is a rounding error to the attention he's drawn. I suspect that with your platform, the impact your donation will make is at least 100x the typical donation.
So thank you for donating, and thanks for being vocal about it. And thanks for supporting the Modify NOTA campaign!
First off: congratulations Scott! A tremendous thing to do, and I admire your speaking openly about it and encouraging others to do the same.
The CT scan/risk of cancer struck me as unbelievable! I do try to avoid CT scans on patients younger than 40, but I always put the risk as closer to 0.05% - 0.1% per scan rather than nearly 0.5% as your girlfriend calculated. I did a deep dive into this once for pregnant women and I remember the 5% per Sievert thing coming up there (risk to the fetus of childhood cancers, if Mum gets a CT.) Are we definitely sure this is for adults? I did a quick Google just now and clicked on the usual suspects - Scientific American says "a single CT scan increases the average patient's risk of developing a fatal tumor from 20 to 20.05 percent." WebMD: "the chance of getting a fatal cancer from any one CT scan is about 1 in 2,000." Memorial Sloan Kettering: "0.05 percent, or less than one in 2,000 — of possibly developing a future cancer."
Obviously I would love to see a deep dive into this topic!
A multiphase abdominal CT is 30 mSv, compared to 7 for a standard chest CT, so if the upper end of your number is right for the average CT, my number is approximately right for the multiphase abdominal that I was considering.
1. Kudos on the Vox journalist line, made me genuinely giggle uncontrollably at work.
2. Kind of strange, I've been involved with EA for awhile, donated a lot of my (meager) income to charity, and, given the opportunity, would happily take some risks for altruistic purposes. But I still haven't got past kidney donation to a stranger sounding absolutely ridiculous. You can do something just bloody horrible, slightly dangerous (possibly including a bunch of risks you're not taking into account), not at all fun/ exciting, with lower altruistic cost-effectiveness than working and donating to an effective charity... If the effectiveness calculations looked incredible, I would be at least persuaded that it's a morally good idea, but as it is, it feels more like the kind of socially contagious masochism that EA should be trying to avoid.
3. When I was travelling in Northeast China near the Korea border, I spoke to a cleaner in a cheap hotel. He asked me: "Where are you from?" "The UK", "Ah, can you sell kidneys in the UK?", "No, there might be a black market, but it's illegal", "Ah". Then the conversation ended.
I think people really differ on how comfortable they are with different risks - I'm planning to donate my kidney, but I just can't bear to part with much of my income. I value the comfort and security I can buy much more highly than the health risks of donation. Also, kidney donation is way more fun to me than work. It's weird, you get to go to different places (I learned a lot about which jobs in the area don't require drug testing, courtesy of some guys who sounded like they needed that). I am kind of hoping my work fires me for trying to take time off to donate, because then I will gleefully tell that story in every interview. (Somehow I don't want to quit or be fired, but I don't want to have this job.)
I inferred that he was either considering selling a kidney, or that he was suffering from seller's remorse, torturing himself about the idea that he hadn't got the best deal.
Well, first of all, congratulations! There's kidney disease in my family, and yes my cousin died several years down the line after a transplant, so it doesn't mean you can live your normal lifespan. But without it you'd probably be dead, so better a few more years of life than nothing, right?
"They found 34 extra cases of ESRD (end-stage renal disease, the most severe form of kidney disease) per 10,000 donors who were related to their recipients, compared to 15 cases per 10,000 for donors who weren’t (the difference wasn’t statistically significant, but I think it’s still correct for unrelated donors to use the unrelated donor number)."
I imagine if you're donating to a relative, that means there's already a higher risk of kidney disease in the family, so the risk would be increased. As for the risk for donors overall, that may well be because if you have two working kidneys, and then down the line one of them conks out, the other can pick up the slack. But if you only have one working kidney and it starts to fail, then you develop the problems faster and worse.
But it truly was a charitable deed so well done!
I'll only take this one little pop at the Brits, so the castle was the cheapest option? Perhaps, but did they factor in (1) the bad visuals this would produce, so hampering their efficacy because this will turn off the public from donating to them and (2) how do other organisations manage? Are they all out there renting/buying castles, or do they somehow manage to find some kind of conference centre that won't rip them off? I have a feeling that the British EAs had too high an expectation for what they would find acceptable in a conference centre, and coming across a castle they may have found ways to justify "wouldn't it be really cool if we had our own castle?" Boring, bland, beige big room in a hotel may not be anywhere near as glamorous, but I find it difficult to believe it would be that hugely more expensive. I do feel there has been some creative accounting of the "sure, it *seems* like a huge expenditure, but if you take it that over the next twenty years we'll be hiring conference centres at a cost of £X,000 each time, and you multiply £X,000 times Y conferences to get a total cost of £Z00,000 then by comparison, a one-time purchase comes off cheaper".
Yes, you're not paying £X,000 a go for each conference, but now you have a castle to maintain and upkeep, and that's gonna cost.
"I thought I was going to be able to do a good deed that I’d been fantasizing about for years, and some jerk administrator torpedoed my dreams because I had once, long ago, had mild mental health issues."
That's hard. But on the other hand, you live in America. The most litigious nation in the world. Where cities sue car manufacturers because their cars are too easy to steal (Chicago, Baltimore and New York bringing lawsuits against Kia and Hyundai). I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
You could swear up, down and sideways that you really want to do this and you're a grown and sane adult and you are doing this of your own free will, but they have no guarantee that five weeks after the operation they won't get a solicitor's letter looking for zillions in damages because they took advantage of a mentally vulnerable individual. Hence, the magic therapy requirement: it's covering their backsides in case of legal action so they can point to "we required him to go to therapy to make sure he wasn't crazy", not for your or any other potential donors' welfare.
> I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
I friend of mine blew up at me for saying almost exactly this. I could see this getting generalized in very weird ways.
I suppose yes, if all other automobile manufacturers have incorporated anti-theft devices and Kia and Hyundai haven't, then they do bear some responsibility.
But cities going "We have too many criminals who can roam freely and do as they like, this is *your* fault" doesn't make the car manufacturers look bad, it makes the state of life in your city look bad.
I think the major divergence of viewpoints here is that Scott knows of the type of people who altruistically donate kidneys, whereas I know of the type of people who made a living out of insurance fraud (hence the lawsuits) 😀
There's an ambulance chaser law firm in my town which makes a speciality out of "Dear me, you tell me you had a trip and fall on badly maintained pavements? As did seven other members of your family? Tsk, tsk, let us sue the local council for their neglect of repairing the streets and road surfaces!"
Well, maybe the local council could afford to repair the streets if they weren't being sued every ten minutes by you guys, just saying?
I was going to say exactly this! They're not concerned with your well-being in some "paternalistic" way, they're avoiding being sued. Most likely, some organ donation program in the state was once sued for that reason and lost, and now the malpractice insurance companies all require this protocol. As a diagnostic, I notice that a program in NYC doesn't have this requirement, and that's likely because nobody has won such a suit in New York state.
I imagine they also didn't give any therapy recommendations for much the same reason Scott doesn't give medical advice/recommendations to queries on here.
If they suggested "do such-and-such a therapy for so many weeks", that'd be catnip for the lawyers. "Why did you recommend my client do this particular therapy? Are you a licenced psychiatrist?" "Well, no, but - " "Aha! Manipulating a vulnerable person! That's another zillion in damages we claim!"
"Here’s a list of countries with the highest number of lawyers per capita:
1. U.S. 1 lawyer for every 300 people
2. Brazil: 1 lawyer for every 326 people
3. New Zealand: 1 lawyer for every 391 people
4. Spain: 1 lawyer for every 395 people
5. UK: 1 lawyer for every 401 people
6. Italy: 1 lawyer for every 488 people
7. Germany: 1 lawyer for every 593 people
8. France: 1 lawyer for every 1,403 people
While it’s true that the U.S. has a large number of lawsuits crowding its courts each year, it barely cracks the Top 5 of most litigious countries in the world. In his book, “Exploring Global Landscapes of Litigation,” Christian Wollschlager notes that the litigation rates per 1,000 people shows that European nations top the list of the world’s most litigious countries.
Here is a list of the top 5 most litigious countries by capita:
I've noticed dozens of typos in Scott's posts over the years but have always felt awkward about bringing them up so I never have. (This is not at all a criticism of his writing; nor do I really care about typos. I'm just the type to pick up on tiny aberrations like that.) I'd feel less weird about it if there were a way to submit GitHub-like pull requests on writing so I could just submit a patch that could easily be merged.
You might find it interesting that some sites do, or at least one that I know of - the online web serial site Royal Road has almost exactly this system where you highlight stuff, make an edit and then there’s a ready way to paste it in the comments with auto formatting.
it was interesting to read about the low risks of kidney donation as well as the thought process you went through. What I am sceptical about is wether paying people for kidney donations would actually be the best systemic solution for dealing with kidney failure. I don’t have numbers on the following and you are probably much better at doing the research on that, but as far as I know most kidney failure is related to other diseases (like diabetes II or hypertension) the genesis if which is closely related to lifestyle/ living conditions and can well be prevented. Do wouldn’t the best systemic intervention be to create living conditions that allow people of all classes to make healthy choices without additional expenses? (like modifying taxes on certain foods or forbidding them once they have been proven to be harmful - like high fructose corn syrup - or reorganising supermarkets and advertisement in a way that doesn’t ruin lives for the profit of certain industries…) Or even investing more money on alternative treatments for infectious diseases that would allow to use nephrotoxic antibiotics less often?
Those are just some naïve thoughts of a European, but I would be curious your prognosis on those interventions vs. paid kidney donations.
Slow chronic kidney function decline is almost universal with aging, as is true of other chronic cardiometabolic problems. How bad it gets, and how early it gets bad, is highly multifactorial and can’t be cleanly ascribed to lifestyle. There is a complex interplay among different aspects of the metabolic syndrome, as well as their best-practice treatments, such that the causality arrows don’t always fall in the places and orientations you might assume. The subset of severe kidney failures that occurs in young people with really obvious lifestyle risk factors certainly exists, and is very visible and salient if you are looking for it. I question whether health policymaking should treat it as the conceptual starting point for thinking about kidney failure management.
I think from the examples you suggest that you aren’t yourself very prone to a punitive gatekeeping mindset, and I don’t want to impute one to you, but I don’t trust broad policy strategy to be developed without one if pursued along these lines. Rather than little tax nudges or occasional judicious ingredient regulations, I foresee non-judicious ingredient regulations (ie, proliferating sweeping bans: as an American who is now German, food and drug regulation strikes me as already overzealous here; the 180 degree opposite of wrong is not always right) as well as draconian treatment eligibility crackdowns, which to your credit you don’t recommend but which seem to me fairly likely results of a broad shift toward this kind of approach. I don’t even think you’re wrong. I just worry about it.
Well, I do think that prevention is one of the best strategies (one if the cheapest, as well, long term). I’m not sure what you find overly zealous about food regulations in Germany and think that the health of the German population would also benefit of higher taxes on sugar and lower ones on vegetables. Also healthy and cheap meals in school canteens as well as public canteens offering meals at a reasonable price might be a way to go. Generally, improving living conditions and wealth of the people on the lower end of the spectrum (maybe through raise of minimum wage) has an impact on improving their long term health along with it.
on food, the US is a weird mix of over- and under-regulation (remember that funny article about the bucatini shortage that turned out to come down to regulators obsessing over the precise composition of an imported pasta recipe? but also, having lived in both US and EU and eaten ad lib there with sharply differentiable n=1 outcomes, i suspect there really are a few odd ~toxic ingredients and practices in the US that demonstrably could just be eliminated with a different policy apparatus. do i trust anyone to fix it? no lol but still)
on drugs, US is most definitely over-regulated, but at least you can order baby aspirin on the effing internet there. like. you don’t even know.
This feels like trying to solve school shootings by making everyone a good person who would never kill anyone else, as opposed to realistic solutions like security guards or gun control. It's obviously the right solution, but nobody knows how to do it and we shouldn't let it hold back things that might actually work.
"Make everyone eat healthy and exercise" isn't a solution so much as a fantasy. The government (and other sectors of society) have been trying really hard to do that for decades, and if it was possible to succeed I would have expected to see it by now.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
As someone who started looking into thuisbankier reading Mathews’ article and was then beset by akrasia, I want to give this another go. Does Waitlist Zero have counterparts in Europe (specifically the Netherlands)? Their contact form asks for a US address.
Wow, amazed at the quality of writing here. that one blew me away. i had no idea, but have known many in my life who both donated and received kidneys... and i think i knew one whose left one was stolen. But as a non-Dr, and with a RN Nurse sister, I can say this for others, "We don't trust u." Flat out. No trust. Nada. Not for giving blood anymore and not for anything while alive. Sure, harvest everything you can once I am brain-dead, but stay the F away from me until then. Yes, it's that bad. I've been here almost 70 years, and seen shit I still can't believe happen in field hospitals to the best America the world can offer. And now ya got your AI to cut with, so I'm out just from that point alone. You should be really aware about what goes on in the medical-device industrial-complex before you let one of those things tear into ya. FDA? ha. They have better inspections here in Nepal, even with our ragtag group of clipboards and ink stamps. Hate to break ur bubble, but great writing, nonetheless!
Not really, I don't care to discuss, and I didn't bring this up, the author did, but since I am always complaining about people not talking to each other, let me try communicate my truth online again. (This is not gunna go well folks.) Gamereg, I DID say WHY: TRUST. Simple human fear, based on experiences. That's it. And very little reassurances coming from the medical community (in the west) to belay that fear.
However, first responders, top notch. Nurses and medical techs, brilliant. Old school Dr. from an old school university, well, there we begin to have issues. Private MD strapped for cash, or worried about bottom line, more problems. Corporate greed in the Insurance-Medical Industrial Complex, even bigger problems. Keep going up the money chain, and it gets progressively worse by the time you get to Wall Street.
Some might say the above is not a logical reasons to NOT donate blood or kidneys. Yet some just say FU to that. And then many are just wary, confused or ill-informed when entering those big gaping hospital doors. I would think it would be the medical community's responsibility to ease those fears and distrust, somehow. I'd give them a failing F grade in that regard, after the Covid fiasco. And after the Aids fiasco, and all the fiascos between those two black swan events. Hell, throw in earthquake responses I've been part of, and throw in WAR as well, as it's hell and I know no medic can be held responsible for that, but bloody hell, triage in a war zone is not FDA approved. But WAR is approved, so there is that.
That's a long answer for someone I don't know and was never properly introduced to; I guess it's the same at your end. I hope you know me a bit better now, and for whatever reason you chose to reply above, thank you for that and I hope this answers your query.
> No matter how contrarian you pretend to be, deep down it’s hard to make your emotions track what you know is right and not what the rest of the world is telling you.
This sounds to me like it was written by someone with an very different internal experience than me.
Do you actually feel like you “know what’s right”?
My experience is I often have conflicting notions of what is or isn’t right, and “the rest of the world” isn’t telling me one thing or another - it’s a confusing mass of shouting from different groups of loud, confident, intelligent sounding people all explaining why the other groups are stupid and evil.
Sometimes, I’ll see someone do a thing, or be a certain way, and think, wow, that seems right and good and noble, and I want to imitate that way of being. But to me this is like a non deterministic Turing machine that cannot find the truth (it takes too long!) but is sometimes capaable of recognizing specific instances of it.
- what do you mean by not right? Not right for you, like you don’t want to? Not right for anyone? But what does that feel like?
- what do you mean by “rest of the world”? Are you imagining some aggregate function over the emotions of some set of people? Which aggregate function - something like mean or sum? And which people? Anyone alive today? Adults?
I get the impression that lots of people use the same kind of language you are using, but these claims don’t map to my experience, because “it is wrong” for me is a thought that usually translates it to emotion like anger or contempt towards a thought of a person doing that thing.
The notion of “the rest of the world” used to make sense to me as a concept into i tried looking directly at the concept in a way that tried to add some modicum of precision, and the concept itself just collapsed.
I guess it feels, or looks, like watching someone make a mistake.
Definitely no anger or contempt - I suspect this is coming from thinking of a very specific kind of wrongness.
When you see someone not standing up for himself, that is clearly wrong, but it seems more likely to trigger sadness and frustration. That's more the type of wrongness I meant.
By "rest of the world" I meant what most people alive in the world would think.
If you want to save multiple lives and not discover that falling GFR in older age is twice as bad with one kidney (it is, obviously!), donate blood and get on the bone marrow database. You really can make a huge difference. I'm alive today because a delightful young man in Germany gave me some bone marrow stem cells. Yes, that makes me biased, but it's a no-brainer! I used to be a blood donor back in the UK, but here in Canada they didn't want my blood as I'd lived in the UK in the early 1980s - risk of mad cow disease. Moo! They wouldn't take it anyway, now, having leukemia.
I'm also banned from blood donation because of Ireland in the early 2000s and mad cow disease. Somehow never came up with the organ donation. Good luck with the leukemia.
I lived in the UK in the early 1980s and was banned from blood donation, but they recently (earlier in 2023) relaxed this restriction in the US. I'm still in the debating-long-and-hard stage for kidney donation, but I'm signed up to give blood for the first time tomorrow.
Quick update, I went to the blood donor center, made sure to tell them I'd lived in the UK, and finally gave blood! I'm not 100% sure what applies to 1980s UK applies to 2000s Ireland, but I imagine it's similar. With the exception of my vein being pricked with a needle, the process was completely painless.
> (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint.)
“Assume a virtue, if you have it not.
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery
That aptly is put on. Refrain tonight,
And that shall lend a kind of easiness
To the next abstinence; the next more easy;
For use almost can change the stamp of nature.”
― Hamlet, William Shakespeare
Having said that, there's one thing that the article never went into that you'd kind of think would be front and center in any talk about transplants: rejection and management thereof. If you give someone a new kidney but at the same time condemn them to a lifetime of immunocompromise, how much have you really improved their quality of life? The more you look at transplants, the more they look like a really terrible thing that we only do because it's the least-bad option available at the moment, the kind of thing that Dr. McCoy would scoff at and accuse us of being barbarians living in the Dark Ages for practicing.
Out of curiosity, (I genuinely don't know and would be interested in finding out if anyone's looked at this,) has there been any research done on questions along the lines of "would it be more effective to donate a kidney and help one recipient, but we know it works, or to fund stem cell research into own-organ cloning which could end up solving the problem for everyone but is currently hypothetical?"
1. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors.
Over the longer term, I'm highly optimistic about bioengineered human-compatible kidneys grown in pigs.
2. I was getting worried when Scott didn't post much over the last few weeks. Now I know why! And it's a very commendable reason. Thank you Scott for donating!
Personally, I've donated blood and sperm (and I'm due for another blood donation next week). I thought about kidney donation but decided it would take too much time away from my research, and I'm worried about its negative effects on me.
For what it's worth, I know two people who have recently gone through the process. One dropped out late in the process, and the other successfully donated their kidney. This is in the last ~6 months.
The one that dropped out felt very pressured by friends and family, and realized they were not in a good life place to take the time off of work. I think they were scared as well.
The one who donated seemed to have a fine time and was back at work well before expected.
Both reported that a charity was going to pay their expenses, including lost wages. For the one that went through with it, that seems to have worked exactly as advertised.
Kind of related. I’ve always thought that “opt-out” (instead of opt-in) organ donation on driver’s licenses for example, would help increase the supply of organs including kidneys. But when I’ve talked to healthcare economists about it, they say it’s a bad idea because it would bankrupt the health care system given the high cost of these surgeries and the aftercare. Thoughts?
That objection doesn't make sense to me - each kidney donation saves money over the counterfactual dialysis alternative.
I have heard healthcare economists say opt-out doesn't seem to help much in practice because most cadaveric organ donations involve careful negotiation with the family of motorcycle crash victims with the specific box they check being only one input into the family's (and legal system's) decision making process. I don't understand the details here well enough to overcome my common-sense confusion about this not being a bigger deal.
Obviously the castle people could have found cheaper, drabber options, and guests would've been fine with it. I doubt there's a warehouse shortage. It seems EA folks haven't learned much from FTX.
"Hi Senator. Please attend our conference. You'll have to sleep in a bunk bed with the President of Belgium, and there's only one bathroom for fifty people, but please come anyway, it's the right thing to do." Sure, that'll go over well.
More relevantly, you can't accuse EA of not learning anything from FTX because this happened before FTX.
There are decent hotels near industrial areas. Moreover, if I had a lot of money, I would be impressed by the sheer rationality of a simple and cheap meeting room near an area with unassuming hotels (of course taking into account safety, convenience, etc.).
My accusation was not at the castle-dwellers, but at the fact that someone like you can't see how bad and ostentatious a castle looks for the EA movement. A pinnacle of public FTX disgust was the contradiction between the video of SBF signaling his EA bona fides by showing off the meager car he drives while later revelations showed his ostentatious mansion.
Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands.
"Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands."
Continuing to use a castle they own is not the same as buying a castle. If they sell the castle now, people will continue to point to that time and EA organization bought a castle, only now they will cite the fact that the castle was sold as proof that the arguments for buying the castle were bullshit. At the same time, they would presumably lose money on the sale.
It's hyper-rational to admit a mistake and align with long-term goals, even if there are short-term costs.
If the way they differentiate themselves to investors is hyper-rationality, then they can signal that by saying, "We over-rationalized a childish indulgence but we have aligned our investments more rationally and instituted new processes to avoid similar mistakes."
By God, there's a lot of taxpayers in a lot of countries who wouldn't mind seeing the President of Belgium and a senator or similar from our proud nation having to bunk in together.
Anyway - welcome, player, to the multiplayer strategy RPG "Doing Good? or Doing Great!", hereafter referred to as DGDG.
You start off as a starry-eyed idealist of high education and socio-economic class, stuffed with unearned privilege which you are eager to transmute into benefitting the lower types less fortunate than you. Along the way, the choices you make will affect your progress towards one of the two endings:
(1) Doing Good? (for others)
Ultimate Achievement Level: Poor But Honest 😇
(2) Doing Great! (for yourself)
Ultimate Achievement Level: Swankin' Wid Da Big Boyz 🤑
Your progress is measured by your repute (not to be confused with compute, but still important even if it doesn't have a sexy new word) level, on the scale of OPTICS. The higher your repute level, the more you can get away with - but be careful! It is possible to gain NEGATIVE, as well as POSITIVE, repute from the decisions you make, the actions you take, and the consequences of your choices.
Okay, I see you have already completed Act I.
Final Level Achievements:
(1) The Peacock (badge awarded for ostentatious display such as purchase of large, expensive, historic manor house in an agreeable setting in the English near-countryside)
(2) Name Change (reducing confusion or increasing it? both? that's the beauty of it!)
(3) Changing Horses In Mid-Stream (when you pivot from doing what your original aims were said to be, to something completely different)
Congratulations, player, you have now unlocked Act 2 - INSTITUTIONAL BLOAT!
Optics Bar reading:
You have advanced three notches towards À LA LANTERNE. (Warning: if you reach this limit on the Optics Bar, you will be permanently locked out of ending "Doing Good?")
Unlocking this new act enables you to take on side-quests such as:
(A) They Flew To Bruges
(B) Because I'm Worth It
(C) We Always Travel First Class At This Level
(D) The Poor You Will Have With You Always, That's Why I'm Bored Of Them
(E) But We Have To Make A Reservation For Le Manoir aux Quat'Saisons Restaurant, The President of Belgium Expects It
(F) Who Will Roast My Langoustines? (related to side quest E above):
There's an implicit Peter Singer argument in here somewhere. I only have one kidney to give, so by giving it to a stranger, I can no longer give it to a family member.
That's why there's the condition that you donating puts you and 5 family members right at the top of the organ donor list. Plus, you may not be a match for family members, so being at the top of a larger list may actually be a better outcome than saving yours just in case.
Can you try getting the statistics for Israel to get a better idea of the risks? My understanding is that in Israel the situation is reversed, with ~90% of kidney donations being altruistic (unrelated to the patient) so the statistics will be a lot less messy.
IIRC, Israel changed their policy a number of years ago, because there was a lot of religious resistance. The new rule was that in the event of two people needing teh same organ, the one who was previously an organ donor received it. Rates of organ donors skyrocketed.
In Germany it is actually illegal to donate a kidney to a stranger while you're alive. (You can do it when you're dead, but obviously then your kidney won't be as good.) While you're alive, unless the recipient is a relative or at least something like your fiancee, apparently the law considers the dastardly danger of the ever-menacing terrible organ trade mafia too great to allow you to save the DALYs of a fellow human.
> Das Spenden eines Organs, das sich nicht wieder bilden kann, ist zu Lebzeiten für Verwandte ersten oder zweiten Grades, Ehegatten, eingetragene Lebenspartner, Verlobte oder Personen, die dem Spender in persönlicher Verbundenheit nahe stehen, möglich.
And this article² makes a statement to allow for altruistic donations, so it seems like Daniel Böttger is unfortunately right.
For a moment, I thought that the "special personal relationship" permissive rule could be bent ... - but it definitely rules out any case where you don't know the person you donate to at all, as well as anonymous donation.
Here's hoping someone will listen to these doctors' public statements (I found sth similar published by the Federal Ministry of Health (BMG) in October 2021).
Eff tax breaks, why not help the people that need it more? Organ donation for get out of jail cards. Not for murder and rape. But surely we can find it out heart to forgive those people who downloaded a bunch of songs on Napster or something. Next time someone wants to make an argument about how they made a terrible error in judgement and learned from it, there is a way to directly demonstrate that. Hell, kidneys for green cards might just be the kind of proposal both sides might just accept.
I'll grant that 30mS increases risk by 1/660, but that's not the same thing as a 1/660 risk of dying. If your risk of dying of cancer is, say 1% baseline, increasing that by 1/660 is like an extra 1/66000 chance of dying (ballparking here). Am I missing something here?
I mean absolute risk; it literally causes a 1/660 chance of death. That increases your relative chance of death by . . . some amount, depending on what it was before, I haven't calculated that.
explicitly lists the 5% figure as a relative risk which, by my calculations, corresponds to a 1/4650 absolute risk. By all means let me know if that's a bad source, but IMO the math just doesn't make sense if you interpret it as absolute. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
There's also the issue that you're comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. You'd have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
The problem with calculating multiplying the number of CT scans with the risk is that a very large number of them are performed on old people or otherwise people whose life expectancy is too low for them to be able to develop a cancer attributable to it.
Wouldn't it make sense for total organ donation to be the default execution method? Lesser criminals could donate a kidney in exchange for reduced sentence.
Elaborate? There's already more than enough prisoners for kidney demand to be saturated, and I'm not sure how individuals who need other organs would be able to increase executions enough to significantly increase their own chance of getting an organ.
"Second: doing a good thing so you’ll feel good about yourself doesn’t seem healthy. "
If you're just taking up space in the world and doing nothing for others, SHOULD you feel good about yourself? And I can understand having greater care for people you know and love, but could this not also be exploited as well? "I know knocking off Johnny makes you all squeamish, but it's for the family. You wouldn't chicken out on your family, would you?"
Those "others" you talk about helping - are they just sitting around taking up space in the world? Why do you feel good about helping people who are "just taking up space", and how is this the best possible use of your time.
Or, alternately, if the people you are trying to help are themselves trying to help other people, doesn't that at some point trade against everybody helping themselves and skipping the extra transaction costs? Particularly if the "everybody helping everybody" thing is pushed to the EA ideal of donating every marginal dollar, because by that point you've run out of low-hanging fruit on the "helping other people" front.
That just sounds like communal living. Everybody contributes, therefore nobody goes without, therefore nobody just takes up space unless they become physically incapacitated. But because it's understood that they would contribute if they could, and everybody is in the contributing habit anyway, it doesn't feel like a burden.
1) Scott knows that. Jeez, do yoou think that’s news? Donating a kidney and engaging in effective altruism are not mutually exclusive. He can engage just as energetically in EA with one kidney as with 2.
2) You don't quite get the feeling good thing. It's not feeling virtuous. It's not the ethical equivalent of feeling smart because you just got your LSAT score back and it's really high. It's an *emotion* you get from direct giving to a stranger. The first time I felt it was while I was in grad school. I signed up for one of those "give to the needy" Christmas things, mostly because I was bored. I was given the ages, clothing sizes and modest Christmas wish lists of the members of a family, and I went to the mall and bought all the stuff, plus a few items I thought could not fail to please — one was a baseball-sized Hershey kiss. Later, I felt unexpectedly emotional while wrapping everything — suddenly felt very loving towards these strangers. And for days afterwards I daydreamed about them opening the presents, and hoped they were happy with them. I yearned to watch them unwrap them (but to be invisible, so there were no weird awkward thank you’s.). It was definitely a good feeling, but it was not at all a kind of pride. The closest I can come is to say that it put me in touch with a loving side of myself that I did not know existed. It felt good to manifest that side. I do understand that this sort of direct giving is not an effective use of resources. The $100 or so I spent on presents could no doubt have been used much more effectively, produced much more total human benefit. But I think direct giving, while statistically ineffective, is a good spiritual practice for EAs and others. It puts you in touch with a side of you that wants to give more.
3) Are you aware that you can’t give a kidney to just anyone? You have to be a match on most of 6 (I think it’s 6) different variables — things like blood type. While family members are more likely to be matches , it’s far from a sure thing even for siblings and parents, who are the relatives you share the most genes with. With them there is I believe about a 50% chance that you will be a half-match (match on half the variables) which is decent but not great. Once you get to aunts and uncles and cousins, the chances drop pretty low. So let’s think about the numbers, as EA’s do. Scott is 38. He has 12 more years before he’s too old to be a desirable donor. He has 2 parents & I believe one sibling. Regarding kids, let’s think large and assume he will father 3. So he will have 6 relatives with whom there’s a decent but not great chance he’d be a match. And what are the chances one of them will need a kidney in the next 12 years? Just looked up what percent of population currently has end stage kidney disease. It’s about 1 person in 500. I'm sure the majority of them are adults, and half of Scott's 6 future relatives in our model will be children during the 12 years when he is young enough to donate. So overall it’s quite unlikely that one of Scott’s close relatives will need a transplant in the next few years, and even unlikelier that somebody will need one AND he will be a match. Given all that, does it make sense to hang on to his spare kidney on the off chance a close relative will need it in the next 12 years?
He said in another comment that it's just overall health, but he'd think twice after 50 or so.
At least in Britain (? Not sure about country) they have a system where you can "trade" for optimal kidneys, where, say there's several donors with incompatible relatives with failing kidneys, and they keep getting matched up with another incompatible donor compatible receiver pair, until s eventually someone comes in and completes the chain, so then all the recipients get an appropriate kidney and all donors have donated.
And what if the person you may have wanted on that list is a spouse you haven't yet met or a child who has not yet been born?
Not even to mention that (AFAIK) organ transplants to blood relations have a measurably better prognosis than ones to unrelated people.
Yes, it's already a thing: https://en.wikipedia.org/wiki/Kidney_paired_donation
I’d love to know if other women have considered this and have better info on the risk of being one kidney’d for future pregnancies. I know pregnancy taxes your kidneys more than ordinary life, and since I have a history of miscarriage I’ve been reluctant to add any new risks.
(I’m also curious if having one kidney means being risked out by eg a birthing center or a midwifery practice).
I think it's a fair consideration? At a skim this turns up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747242/
They did note some pregnancy-associated risk increase post-donation, such as a higher likelihood of fetal loss (19.2% vs. 11.3%), gestational diabetes (2.7% vs. 0.7%), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and preeclampsia (5.5% vs. 0.8%). Also, a lower likelihood of full-term deliveries (73.7% vs. 84.6%).
These outcomes were more likely in people's post-donation pregnancies, than their pre-donation pregnancies. Sounds like they tried to model age in, but they admit that it is hard to be fully sure they factored out age effects. Kidney donation screening seems to have meant the pre-donation baseline started out at better than genpop, and they characterized the post-donation numbers as similar to genpop and lower than individuals with kidney disease? Looks like a risk-increase, though.
Based on those numbers I would recommend to delay donating until you are done having kids.
Those numbers seem pretty bad, compared to Scott's numbers. Maybe better to leave the donating to those with less risk.
Now that I have two kids, I wouldn't actually do it.
One of my kids is disabled (autism) and even a tiny increased risk of death or shortened lifespan is too risky for me, because he's probably going to need life long support from me.
It's also reduced my donations to charity significantly for the same reason, I need to save all the money I can for after I die because he's unlikely to be able to have a job in the future.
In retrospect I should have skipped having kids entirely and done kidney donation instead, but hindsight is 20/20.
I am stoked about using IVF with embryo selection to select the embryos with the fewest risky variants and the fewest de novo mutations. Reducing the rates of de novo mutations and risky variants by 1SD each generation is a huge boon to health. In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient.
"In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient."
Even cheaper and more convenient if regulators get out of the way and just allow the crips and 'tards to be aborted, right? IVF etc. is expensive and time-consuming, just dump the failed attempt and try again, and if your genes are too mucked-up to produce healthy kids, stop trying to have kids. That's the sensible solution, yes?
Yes, and I say that unironically. I don't want to get into an abortion argument because those are tiresome and repetitive, but I'm curious about your counterargument to this: "if your genes are too mucked-up to produce healthy kids, stop trying to have kids"
What's wrong with people voluntarily choosing not to have kids to spare them horrible suffering?
Sure, if it's a disease that causes horrible suffering. I'm not sure even acute enough autism to need lifelong support inflicts "horrible suffering," to go back to the conversation starter.
We actually had both our kids fully sequenced and the polygenic score for autism is actually higher in my neurotypical kid than in my autistic one. At the current level of technology it's clear the power is just not there yet.
a lot of the variation in autism is de novo mutations that won't show up in a PGS
I remember talking to someone in this field a while ago who suggested that it is in fact still better to have natural conception if possible vs pre-screened IVF because of an inherent lower risk of mutations as seen in (some?) studies. I think this is something that people might want to look into before deciding to pursue genetic screening for embryos.
parental age (especially the father's age) is the biggest modifiable risk factor for de novo mutations. IVF users would tend to be older and sicker than natural conceptioners so it's probably just an artifact unless they explicitly controlled for that. But anyway they can just measure the number of DNMs in each embryo after the embryos are made and factor that into the choice of which embryos to use.
also the paternal age DNM problem could be completely avoided if dudes freeze sperm when they're 16. Providing that for free would be 100x worth it for a country with cradle to grave nationalized healthcare.
have you considered secondary guarantee life insurance?
I remember looking into this before I donated my kidney, and the only risk that I recall there being solid evidence for was a slight increase in the risk of pre-eclampsia. That said, it's totally reasonable to wait until you're done having kids, especially if you've had problems in the past.
In the realm of anecdotes: I had an uncomplicated pregnancy and now I have a beautiful, healthy one-month-old!
Out of curiosity did you donate your kidney to a stranger like Scott did?
My guess would be that "donating your kidney without a known recipient" falls in to the category of things that males are far more likely to do than females.
Obviously my theory is untestable if indeed there are greater risks for women (either for their bodily health or reproductive health), but simply based on my limited knowledge of male and female psychology I would imagine that (unless it became the social norm or otherwise "cool") the number of men donating kidneys to unknown participants compared to the number of women donating kidneys to unknown participants would be at least 5 to 1.
Like I said though, if indeed there are greater risks to women then my theory can be proven wrong (if indeed there is greater parity than 5 to 1) but can't be proven right (because rational concerns wouldn't be gender equivalent).
I did donate my kidney to a stranger, actually. Let this be a lesson to you about making assumptions about people based on their gender, especially when those people are rationalists.
Hey, I hedged every which way to Sunday! 😂 Hell, my comment was even an attempt to CALL FOR MY CORRECTION!
Let that be a lesson to YOU about making assumptions about a stranger. 😉
I am 100% certain that what I did was as close to truth-seeking and overcoming bias as is possible to one of flesh and blood.
All that said, text fails to convey... pretty much everything. So let me say that I'm writing this with a sly smirk on my face as a friend joshing you because I'm reading your comment as coming from the same intent.
If you're serious though, I'd be glad to have an octagon death match of unbiasedness. We could make a youtube video attempting to uncover each other's irrationalities. Uncovering my own bias is like my favorite thing!
All that said, A. I still assume that the numbers are 5:1 in cultures where it isn't considered within the bounds of normalcy (it amazes me to learn that there's a community where it IS considered normal! and B. Bravo!!!!! 👏👏👏❣️❣️❣️❣️❣️❣️❣️❣️❣️❣️ A thousand or million times bravo What you did is absolutely amazing. You are a wonderful beautiful person. As a human on this planet I *personally* thank you for contributing to us and wish you snd your family every single happiness. Really, may there be more people like you. 🙏
If I could live my life over again, I'd donate a kidney at age 20-25 —i.e., old enough to be an Official Adult but too young to have kids. That seems like a good option for women who intend to have kids, to balance out the risks of potential pregnancy which will probably happen at 25-40 and the risk of an aging kidney being less useful.
I (25F) donated this year (also at Weill Cornell!), and my personal calculation was that because I'm already at very low risk of pre-eclampsia due to various factors, I could stomach being at slightly higher risk. My medical team told me that if/when I get pregnant, the pregnancy will automatically be treated as a higher-risk pregnancy, and appropriate precautions will be taken. That being said, I've never been pregnant, so my "calculations" were based on vibes. I also figured it would be much, much easier logistically to donate before I had kids than after. Also - I personally would be fully open to adoption in the event I was unable to have kids biologically, so for me personally it didn't necessarily feel like any of my options were being taken away.
Other than in the immediate hours after donating, when I was in a good deal of pain (and until I heard that the transplant had gone well and my recipient was recovering, which, like Scott said, put things into perspective), I have not regretted my donation for a moment. It is in all likelihood the greatest thing I'll do with my life (in an optimistic way!).
Thank you for donating, and that's a very helpful comment! I have sought out practices (midwives, birthing centers) that take an aggressive approach to "risking out" patients and banning them. Attempting a VBAC got me risked out from a group of birthing center midwives and accepted by a group of hospital midwives (it worked!).
To me, this suggests that it's not a good idea for women to donate a kidney if they suspect they'd strongly like to try home births, birthing center births, low intervention births and the lack of a kidney means they'll be risked out of compatible practices.
I'm more confident the increase in risk would lead to being dropped by those practitioners than that it *should.* But it's rare enough that I suspect many will not be up to consider the risk and run the numbers but will simple say "that's non-standard risk and we don't do it."
As a post pregnancy x2 woman, I would advise waiting until you have had children. There are just so many surprising changes to one's body during and following pregnancy that if healthy offspring with a healthy mom are your priority, holding off on adding an additional possible complication seems wise.
I think I'd have been very excited about donating a spare kidney when my kids were elementary school age if that had been at all a thing I knew about and if I'd been in a different relationship (my husband so objected to my donating blood that I stopped, even though I'd been doing it with no noticeable problems for 15 years, and went back to donating after we separated, again with no problems).
I believe that bodily integrity has a value in and of itself, independent of any utilitarian calculation around whether you will need a particular organ. (I don't mean "integrity" in some metaphorical sense. I mean it in the literal sense of keeping the physical phenotype in accord with its basic genotypic design.) Obviously, there will be a thousand and one exceptions in practice. (Fair warning: if you respond by giving me examples of such exceptions, I will be extremely unimpressed.) Every time one gives oneself a paper cut, one is violating bodily integrity in some small way. Of course. But I try not to do that on purpose, except perhaps to treat some greater medical ailment.
If you insist on utilitarianism, I suppose you could justify my position with some kind of rule-utilitarianism as opposed to act-utilitarianism. But I'm not a utilitarian at all.
I guess I don't understand what it means to assert a strange moral rule that there's no a priori reason to expect, admit that there are many exceptions where it's not true and you can't explain why, then continue to assert that it's a moral rule rather than a heuristic.
A: "I went to the park yesterday"
B: "What? You should never go to things beginning with P!"
A: "But don't people go to the port and the parlor and the palace all the time? And you never object to that?"
B: "Yes, obviously there are a thousand and one exceptions in practice. But you shouldn't go to the park. That's just how moral law works."
I don't know how you could possibly argue with B at this point, it just doesn't seem like there's any positive reason to believe him.
Keep your bodily integrity, if you must, and celebrate those who save lives in real time in the real world! If Sam bankman Fried just gave a body part instead of his soul, we’d all be better off
Is "keep one's body intact" really a "strange moral rule?"
Your story about "not going to places that begin with P" is the kind of story I'd expect a utilitarian to tell. And yet, "keep my body intact" doesn't seem anything at all to me like "don't go to places that begin with P."
Why might that be? Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant. But it seems to me that such factors, especially in regard to matters of the body, sex, and relations, might be very important indeed.
To ward off annoying evangelical utilitarians, you just tell them that you have a utility function different from theirs (I think that's actually just true, even if you reject the label, but I might be using the term idiosyncratically). They ought to know they can't argue with that.
You're right –– but only in the trivial sense that any norm can be reproduced by sculpting a custom utility function for it. I understand that, but consider it an unhelpful exercise.
Yeah, I agree: I don't think it's a useful exercise either. It's just that "utilitarianism" is as meaningful a name of the doctrine as "do-the-right-thing-ism," when it usually means something like "maximize-the-total-global-QALYs-ism" which doesn't correspond very closely to mine. (The alternative doctrines that try to describe themselves without reference to to utility functions strike me as either incoherent or downright evil, so this kind of trivial description is the best I've got. The detail is then in WHAT my utility function is, loyalty, honor, duty, etc.)
That's one of many reasons I don't consider myself a utilitarian. You can game the system to come up with any outcome you want, and it gives you the freedom to justify that. SBF probably still feels justified, even with the outright fraud.
If you posit that there are more utils in murdering people, you can justify that too. Maybe you're the Punisher, killing the worst people that the law can't handle. Or you've done the math and some people's lives just aren't worth living, so it's worth the hit to your utils to save them.
I'm a deontologist, so I just say that murder is wrong.
I think the example of SBF has been too quickly and too defensively bracketed. ("Oh, it turned out that he was just a fraud, not a *real* EA." Hmm, not a true Scotsman, you mean?)
My reading of SBF is that he was sincere, in the sense of sincerely following his Maximum Expected Utility, as he calculated it, and that led him to disregard ethical norms that did not accord with the latter.
In fact, AND THIS IS THE CRUCIAL BIT, like Scott, he would have demanded that those ethical norms be justified in terms of Maximum Expected Utility, and then dismissed them as "strange" when they were not.
In Sweden, we have a huge problem with "people the law can't handle," and a fair share of the populace is ready to applaud any such Punisher killing them off in the name of total utility. If so, we'll see where that takes us (Nazi Germany or El Salvador?). However, it will have to be compared to where we're heading now (probably Mexico).
Deontologically self-imposed limitations might eventually face ethical opportunity costs that make you want to reconsider them. Then the cultural evolutionary selection processes will undergo some learning that includes selecting away the principled. This is not a normative point but a descriptive one.
Any one person's ethical stance will, of course, be that particular individual's decision. The bigger issue is what norm will prevail, under what circumstances.
There's a complexity about that which is about comparison of utility between people and aggregation of utility across populations.
Most kinds of utilitarianism say that you should aspire to maximize total or average utility (or some variant of those meant to address paradoxes and counterintuitive results), of "everyone". In that case your different utility function would mean that *your personal contribution* to total (or average or whatever) global utility would be weird or hard to predict, but that doesn't change the utilitarian goal of trying to maximize something globally, nor the utilitarian moral intuition that *you, too* should being trying to maximize something globally!
(There's a whole set of criticisms of utilitarianism based on the conceptual difficulties of how to compare or aggregate utilities between different subjects-of-experience.)
This is called consequentialism-but-not-utilitarianism.
A more considering stance would recognize that humans don't have complete degrees of freedom in their divergence in values, and so while there can be a legitimate underlying value difference, it can be exacerbated beyond the value it would have on reflection! So it can still be worthwhile to talk over it.
"I want to keep my body intact because it feels right to me" is perfectly fine and unsurprising.
"As a moral rule, one ought to keep one's body intact" is weird as hell and you haven't even made an attempt to justify it. The only way I could even imagine making an attempt to justify it would be through some form of divine command theory... but if you think you have a decent justification, I'm all ears.
Exactly. My first thought was of the now-defunct proscription in the Catholic Church against cremation and the revulsion of Catholic parents at the thought of ear-piercing or any other body modification. The point was that Christ was going to want to resurrect your whole body on Judgment Day. That was their strong argument for keeping one's body intact. It's a belief, nothing more. OK for you if that's how you feel, but not compelling to anyone who doesn't share that feeling/belief.
> Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant.
There's a bunch of posts on the EffectiveAltruism forum and LessWrong about considerations like these, acting like EA is just naive utilitarianism is just a strawman imo.
You can infact have a higher value for bodily integrity than others! It just does actually seem like an odd value to settle on, especially when its qualified with a bunch of exceptions, which is what Scott is getting at. This is still compatible with consequentialism, and would just mean that you have a higher personal-cost for certain kidney operations.
I agree that having my body altered is significant, but that's primarily due to a combination of the unpleasantness, cost, and the possible problems that come from it (Scott's description of how the surgery before and after made my mind rate the cost for donating a kidney higher than I thought it was from vague thoughts before the post). But also, while it would be very uncomfortable to get a cybernetic eye that works better than human eyes (once we have them), I'd still be very interested to get them. It would just be worth the cost.
I think what Scott is getting at is that your form of bodily integrity value is an odd sort of rule, that makes less sense than other rules that are common (such as do not lie, do not murder). It makes sense as something to prefer, but doesn't make sense as something that tries to be set down as a law like 'do not lie' often tries to be.
Yeah, maybe; how do you feel about blood donation?
Or lifting weights? Footraces? Tattoos? Haircuts?
* Blood donation (as commonly practiced) impairs no function, as blood is renewable within the body. In fact, if anything, it's mildly good for you.
* Lifting weights and other forms of exercise straightforwardly improve natural function.
* Haircuts, etc. are indifferent.
"Keeping one's body 'intact' has intrinsic rather than instrumental value", which was what you said originally (slightly paphrased but I don't think misrepresented), does seem a bit strange, yes. Granted, the word "intact" has positive connotations, typically if asked if I'd prefer thing x to be intact, I'll say yes for most xes I care about. But when you try to figure out what the nice-sounding-thing "keep your body intact" means in practice, there's plenty of room for disagreement about what it should mean and whether it would be good.
If the meaning you intend by "keep your body intact" doesn't ground out in it being functional and healthy (which a body can be after an organ donation, in the same way as it can be after things I imagine you were thinking of as silly counter-examples, like hair loss and clipping your nails), and doesn't draw the line between an intact body and say a broken or improperly divided one in a way that recognizes the value of being able to function well, then I think whatever your definition of intactness/integrity is is likely on the wrong track, and would be strange to treat as a moral good. Also, if your values of bodily-intactness are selfish and don't recognize the goodness of giving something of your own body to help someone else's body function well and be more intact than it was (if, in other words, you wouldn't endorse trading a little of your body's intactness to help someone else a lot with theirs), then, I mean, ok, that's what you think is good. Seems strange and unconvincing to me.
If, however, you define bodily intactness with reference to bodies with parts that function well together, recognizing the physical fact that we're all ships of theseus, and if you are willing to agree that more people with intact bodies is better, and giving a bit of your body that makes you only very marginally less "intact" than you were to someone so theirs can be more intact, would be a good and generous act because of the effects on bodily intactness, then there really isn't a disagreement here, just a confusion in use of words. But it seems like you think organ donation would be bad by your moral values because it means you're no longer intact, so there is ovbiously some more substantive disagreement here, I guess.
I would agree with him that keeping your body intact has intrinsic value. That doesn't mean there aren't other values - helping others is another value. That does mean there is a trade-off, and you lose something above and beyond the inconvenience and pain and risk of complications.
OK, that's fine, I suppose. I am a left leg below knee amputee, so on thinking about this more it occurs to me that it is possible that my sense of whether and why bodily intactness matters relies less on intuition and more on explicitly thinking about my situation than most people :D. And so thinking that intactness matters might be something that a lot of people think, and I just don't, unless there's an impact on functionality, and it seemed strange to me because I'm just different. But actually, if we're just talking about intuitions about what is valuable, I can also see why "don't remove bits of me" is a fairly good heuristic generally, and this was emphatically more true before modern medicine. Sometimes the modern environment means our intuitions about what is good, formed in a very different environment, can lead us astray.
Do you feel like you lost something valuable, over and above practical difficulties and medical issues?
Shorter and more to the point than my earlier post: valuing keeping one's body intact as an intrinsic good absent any reference to its function and health would be a strange moral rule, yes.
Valuing an intact body because of how it's functional when intact is not strange, but it is also not incompatible with organ donation.
The fact that you find organ donation goes against your moral value of intactness, strongly suggests you place a strange value on keeping yourself "intact" even when you don't need to for health and function. One wonders what other things you might object to on grounds of bodily integrity.
I mean... keeping the phenotype in accord with the genotype's design? First off, your genotype wasn't designed. But secondly, why do you care about that? Would you care about that even in the case where your genotype included Huntington's or some other thing that made your life bad? If you had the gene for increased risk of breast cancer, would you object to surgical intervention, in that the integrity-respecting thing to do is die of breast cancer?
Unless your "integrity" value grounds out in a healthy and functioning body, then yes, it would be strange.
I kind of agree with SA that your point here is put pretty weirdly, but I want to draw attention instead to this weird tactic you are using of only contrasting your theory with utilitarianism. "It is intrinsically good to keep your body intact" is a specific rule, "utilitarianism" is a specific theory. It is true that utilitarianism does not include this rule, but you can't defend this specific rule by contrasting it to one specific unpopular theory. Lots of non-utilitarians will also find this rule unpersuasive, you are setting yourself up for too easy a job by shrugging at disagreement and going "I guess the utilitarians are at it again". It's fine if you don't have some specific justification you can give, lots of people bottom out parts of morality in basic moral intuitions, but you should, in that case, admit that you are losing anyone who does not share your intuition, not merely anyone who is a utilitarian (and of course if you do have some more basic foundation, you should give that rather than just picking on the utilitarians).
The "strange moral rule"s you're talking about are usually things backed up strongly by moral intuitions. You know, those things that everyone recognises but that utilitarians seem to make a herculean effort to pretend don't exist. They're certainly not remotely arbitrary rules.
One may not share those moral intuitions for particular Rules, but they're invariably held far, far more widely than the intuitions for many of the things utilitarians advocate. Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever. Utilitarianism at its worst literally tells you to execute innocent scapegoats to appease a mob.
That's just one of a half dozen crippling problems for utilitarianism (where it gives not just a non-moral answer, but the anti-moral answer). Another crippling problem: it's pretty clear, and all commenters agree, that you, Scott, did a really great, heroic thing. And you did. Yet under utilitarianism, you just did the bare minimum you're obligated to, and in fact fell far short of that if you're not living in a cardboard box and donating everything you don't literally need to survive. And you apparently don't deserve any praise at all.
The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
You're greatly overestimating how many people here subscribe to the sort of pure utilitarianism you're describing. Plus Scott and anyone else who's read the sequences is unlikely to be that sort of utilitarian, by virtue of how the sequences focuses on the ways overly simplistic moral theories lead to abhorrent consequences if actually taken to their logical extremes.
>Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever.
Do you seriously not know the basic textbook criticisms of deontology? Like how a universal prohibition on lying when put up against a tyrannical government, forces you to not lie about hiding dissidents in your basement?
1. I was a bit reluctant to turn a celebration of Scott doing a good deed into an argument about utilitarianism. But this is the first EA/utilitatianism-related post for a long time, so I'm doing that. I'm in awe of Scott's principled and compassionate greatness though.
2. I am just a bit sick of something in this community that may not be an actual motte-and-bailey, but functions a bit like one. When asked or challenged, most people here disavow utilitarianism in its pure or even substantial form. And then, when no one's challenging it, many of them fall back into talking as though it's obviously true, obviously uncontroversial, and then some indeed get very angry at the existence of people who criticise or oppose Effective Altruism. This part *is* a basic motte-and-bailey: when challenged EA is merely giving more effectively, when not challenged it's full-throated utilitarian dogma (at least for some people). It's also depressing when a charity discussion comes up and I think "finally something everyone can agree is good, and come together on", and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that. Much like a Christian charity spending a bit on distributing food and a lot more on distributing bibles, or worse actually because the latter probably brings *some* benefit to real people who actually exist.
3. I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing). I also find a lot of it's terribly written (bad and unclear argumentative structure, even occasional bad grammar). I can't for the life of me understand its popularity around here, but I guess that's a whole other discussion. I certainly can't see what substantive insight people get out of it
4. That objection is to Kantianism specifically, not deonology generally. The major advantage of deontological theories is there are so many of them (Kantian fairness-based theories, rights-based theories, contractualist theories), and each form itself is very flexible and debateable, allowing them be molded to actually fit common moral intuitions instead of violating them. The lying example is Kant's own interpretation of his theory, but it could be interpreted differently depending on how you understand the "maxim" you are following in that particular axe-murderer edge case, and to what cases it's precisely universalised.
In any case I'm not saying other moral theories don't have problems, but I think utilitarianism has far more of them, and they seem to be often ignored when not being directly challenged.
"I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing)."
<mild snark>
For another contender, read Galt's speech in Ayn Rand's "Atlas Shrugged"
</mild snark>
> I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing).
If you find mistakes, feel free to point them out. Simplicity itself is not a bad thing (unless it introduces errors).
> I can't for the life of me understand its popularity around here
Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess.
"If you find mistakes, feel free to point them out."
I plan to do so (to some extent) in an open thread at some point. It's a big discussion.
The "simplicity" I'm talking about is mostly the writing style, not the arguments. Really, I find that there mostly are no arguments, or at least not clear and explicit ones. Maybe I haven't read enough of it or I'm misremembering what I have read, but my impression is that it's generally either all-over-the-place rambling (leaving me thinking "what the hell are you trying to say? could you be so helpful as to write out your conclusion, and preferably your reasons too, in clear sentences?") or asserting as "obvious" significant and very much non-obvious philosophical claims about reality.*
But its popularity around here (especially among fans of such well-written, lucid and clearly argued writing as Scott's) makes me wonder if I'm missing something.
"Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess."
And most Continental Philosophy has the same problem: very rambling and unclearly written, and seemingly deliberately so. I think the 19th century German stuff (Hegel, Nietzsche) isn't *as* bad as the 20th century French, but on the whole both it and stuff by EY seem to have an ideological objection to clearly laying out their arguments.
*As a general example that I'm not sure was said by EY in so many words, but that comes across to me strongly in his writing: we obviously can't learn anything about reality by just thinking about it. Or, with a circular argument instead of no argument: the reason we know you can't learn about reality by thinking, is that if you're just thinking you're not testing your observations out in the world, and obviously that's the only way to learn about reality.
The reason we know empiricism is true, is that obviously empiricism is true.
It sounds like your perception of a motte and bailey is partly you lumping together people with very different levels of sophistication in their views.
I think the most serious rationalists who've put much thought into moral philosophy and read the sequences tend to be moral antirealists.
You're somewhat conflating between people who are just naive utilitarians who almost certainly haven't read the sequences, and people who view moral philosophy as primarily useful for guiding your moral views towards internal consistency.
Though people also often confuse things with very non standard conceptions of utilitarianism: like the idea that if you can rank the desirability of potential worlds in a non-circular manner then that constitutes a utility function.
>and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that.
You're confusing moral philosophy with epistemology here. If you think AI is liable to change the world dramatically in one's own lifetime, then that will necessarily inform your behavior under any nearly any moral framework.
> And you apparently don't deserve any praise at all. The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
On the contrary, you're the one who isn't quite grokking utilitarianism here. You're trying to graft a non-consequentialist account of moral desert to a consequentialist account of moral obligation: of course it's not going to make sense.
Utilitarianism does not say that only saints deserve praise; it has no special rules for issuing praise or blame at all. They're just ordinary actions, subject to the same imperative as any other. If the consequences of praising someone are good, do it. If they're not, don't.
Yes, that's my exact problem. It's blindingly clear to most people, as a matter of basic moral sense, that people who do good deserve praise and people who do evil deserve punishment. Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished! Both of these are grossly offensive to what morality actually *is*, as we have a sense of it.
It also implies that among the people praising Scott, those who are utilitarians don't actually mean it and are just speaking strategically to manipulate others to act. Which is a nasty thought.
> Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished!
Sure, naive utilitarianism.
But a proper discussion would include costs like 'it is often better to provide positive incentives' + 'being truthful is a good'.
... but also if the benefit was high enough, I would shame them. I don't have a hard rule that I won't do that. However shaming tends to generate a terrible culture that feeds on itself and/or self-flagellates enough to be damaging. It is also hard to evaluate whether that would really be better.
And for the murderer, you have the issue that you want to disincentivize murders. I'm pretty sure Scott has a post on this, but I failed to find it. If you strictly thought about the direct impacts of your choice, then if you let him go free then the murderer lives a decent life, but if you put him in prison then someone lives a bad life (ignoring that you imply he'd murder again). So you release him.
If you consistently follow this rule, then you've essentially given a Get Out of Jail Free card to anyone who can commit a bunch of murders (or other negative crimes), gets caught, and then can say they'll never do it again.
The proper analysis of this would be that you need to provide a disincentive. If you murder someone we throw you in jail. This makes so people are less likely to commit murder or stealing or whatever because they know they're likely to personally gain less from it.
This is similar to the analysis that some people give for the classic 'Doctor could save five lives by taking the organs of this one mostly-healthy person'. If you expect that an institution people can legibly trust (predict) to heal them and not do anything else would then help more people, than it is better than the alternative institution where you have to worry about getting your organs harvested and so you're less likely to go in because you broke your leg.
These do become deontology-like, but that's because I agree that deontology captures some ideas of our moral rules! However, I think that the utilitarian analysis lets you decide when it is reasonable to break them or shift them - if you do a proper analysis, which is hard! I see rules like 'Doctors will not harm their patients' as useful ways to be legibly trustworthy and reliable. The punishment of law is also about disincentivizing it from occurring in the first place.
As well, utilitarianism/consequentialism doesn't stop you from inherently wanting to punish others,
I don't really understand what you mean in that last paragraph. If some person praises Scott in order to manipulate (persuade) other people to do the same thing as Scott, what does it mean that this person might not "actually mean it"? If she is a utilitarian, she is doing that manipulation because she thinks that Scott did something that was a net good.
Do you mean that she needs to feel emotionally that Scott is to be praised, in addition to just calculating that donating a kidney is a net good? Like, she has to be emotionally sincere?
I've come to think I was too snarky and aggressive in the above comments, trying to simplistically refute utilitarianism, when other moral theories do indeed have problems too and there's a clear balancing act required. And utilitarians (especially those like Scott) are actually doing good in the world so who am I to oppose them?
What I do stand by is my point above that some utilitarians, including some commenters here, not only take it completely for granted but react with disbelief or worse that anyone could not be a utilitarian. I thnk *those* people specifically need to have all the many problems with utilitarianism shoved in their faces when they exhibit that attitude. But most probably aren't like that.
As for your question, I think what I was getting at was that if someone expresses praise for a deed, that should *necessarily* correlate with her thinking that deed was good. At least in theory, a utilitarian acts and speaks only to maximise good outcomes (not truth per se), and thus you can never be sure if she's speaking truthfully. But you make a good point that in the case of praise, the outcome and the truth are likely correlated. So my objection was perhaps not very coherent.
One hard case is whether you should let dictators have comfortable retirements or punish them if you can.
Maybe letting dictators have comfortable retirements will get more dictators to retire. Maybe punishing them will make them hang onto power as hard as they can. (Actually, no maybe for that one.)
But maybe punishing them discourages other people from becoming dictators.
I'm not sure consequences really apply here.
There are so few dictators and the circumstances under which any dictator comes to power and leaves power are so unique, and dictators by definition change or subvert the entire system including any precedents or previous incentives.
Also people who become dictators already know that they're risking death if they ever get deposed and know not to trust any promises of a comfortable retirement.
I am not sure I really follow. So you would deny LASIK, acl reconstruction, bariatric surgery?
All of these are not strictly necessary, so I expect your logic says you should not do them
Those are all procedures that restore normal phenotypic function.
I had LASIK to treat myopia, which was a phenotype caused by my genotype.
Genetics certainly play a role in obesity, and I wouldn't bet against genetic predispositions towards torn ACLs (or at least predispositions towards the foolhardy things we do to tear them).
I got evaluated for LASIK. (Sadly, I turned out not to be a good candidate.) LASIK pretty straightforwardly restores a normal function (seeing). It doesn't impinge on bodily integrity in the functional sense I have in mind.
Sure, it ablates tissue at the micro level. You can press that point if you like, but I'll consider it a kind of quibbling that doesn't interact with my actual position. Ditto with similar examples of medical repairs.
It seems to me that the principle you believe in is not really bodily integrity (because there are so many exceptions you accept), but something like "a person has an obligation not to damage his or her body's functioning".
Piercings, tattoos, circumcision, sterilization/vasectomy, hormonal contraception, abortion, breast implants/reconstruction, cosmetic surgery, sex reassignment surgery, anabolic steroids -- what is your opinion of these?
Does donating a kidney to a spouse or a relative also violate your principle?
Integrity and function are closely linked: removing an otherwise functioning organ is usually a sure way of impairing or destroying its function.
It's not really that I accept "exceptions" to damaging integrity as if they were special carve-outs. It's just that many such things are trivial (e.g., donating blood that will soon be renewed) or done precisely to restore function (e.g., LASIK or similar reparative procedures). I don't really view such things, properly understood, as "exceptions" at all.
I definitely disagree here. I share your view that bodily integrity has some intrinsic value, but I intuitively feel that LASIK violates that, which is why I would never get it.
LASIK is not so straighforward. It's a risky and experimental procedure, in that we still don't know the long-term effects of it. LASIK "restores function" (in some cases) by destroying tissue in ways that weaken the eye and the body as a whole, and there are just too many horror stories and too many risks for it to be justified.
In my view, this is not a coincidence or a flaw that can be corrected by a better procedure, but rather an inevitable effect of anything that harms bodily integrity.
You may well know more about LASIK than I do. If we have a difference here, I suspect it's about the facts of what LASIK does, not about the ethical principles to be applied.
Kidney donation restores someone else's normal phenotypic function. Does that count for anything?
So does a kidney transplant! Not saying that you should value other people's bodily integity as highly as your own, but presumably it should factor into your decisions if it is indeed something of value? I'm not saying anyone should do it, I'm still pondering it myself, but we come back to weighing up the loss to you (both definite and potential) against the gain to others.
If you don’t care whether others do it, and just regard organ donation as too risky/dangerous to consider for yourself, isn’t that just a matter of personal risk tolerance? Or would you advocate for shutting down voluntarily organ donation programs and the like, and enforcing strict restrictions on various surgical procedures?
I personally have very low risk tolerance for surgery (ex/ avoiding LASIK) but don’t think there’s a generalizable *moral* principle there.
So what *is* your justification for this belief?
The justification is that he doesn't want to donate his kidney but he also wants to continue feeling morally superior.
There's nothing terrible about not wanting to donate. I'm not planning on doing it. But trying to tear down people who do an obviously altruistic thing is very weak in my opinion.
No, that’s your hypothesis as to his actual motivation. Which may or may not be correct, but the principle of charity would seem to indicate that we should give him the chance to explain himself first.
Did you ever trip and cut your knee at school? Bye bye bodily integrity...
I have a fair bit of metal in my body from motorbike accidents and some polymers in my spine for other reasons.
Bodily integrity would seem to rule out even simple surgery or even something as crucial as the removal of a ruptured appendix.
We're a bio mechanical machine, parts are removable and hot swappable, within reason. I don't see any advantage to the pure state you are alluding to.
Neither deontology not utilitarianism would favour rules that are unenforceable.
"bodily integrity has a value in and of itself" sounds like something that would guide decision making without being a rule.
There's something very interesting going on with this section of the concept space. I can't quite puzzle it out. It's worthy of further consideration, but perhaps of a style better suited to Sam Kriss than Scott Alexander.
I agree. I find it interesting that there is good deal of psychological resistance to considering this possibility.
When it comes to morality, my experience has been that almost everyone including me decides what they think/feel is right, and then finds a rationalization. They know the answer they want to get before trying to think it through logically, and logic is then used to justify the felt-correct conclusion. If a particular logical argument is shown to have a hole, another will be found, but the conclusion won't change, unless it is shown that two moral values are in conflict. Before I was aware of this happening to me, it happened 100% of the time. Now I aim for a lower number, like 90% :)
Considering the idea that organ donation might be bad because of "bodily integrity" is going to be hard for people who have read Scott's post and decided that what he did was very good.
Similarly, I expect that you feel some negative feeling (I'm not you so I won't try to describe your internal feelings in detail) around some of your organs not being in you any more - it feels wrong for that to happen, and all your inside-bits being inside you seems straightforwardly right, and logical consideration of whether "bodily integrity" is a coherent concept on which to base a moral view is informed by the fact that yes, obviously your inside-bits should be inside you, that's not really up for debate.
I've tried to make logical arguments in favour of organ donation and against an overly restrictive definition of bodily integrity that would forbid it, while allowing a less restrictive definition so you can have your core intuition respected, but I don't expect that to like, work. :D
I don't feel negatively toward Scott or his decision on a personal level. I assume his decision was motivated by subjectively positive feelings, just as he mentions in the post. I see part of the value of norms being that they help guide decision-making independently of such feelings.
What "norm" are you advocating for here, exactly, and why? Based on what I've read you post here, I am genuinely unsure. It seems like different things in different places.
At first I thought it was something like "keep the bits of you together, and don't pierce your skin, although little cuts like a papercut are OK, and there are other exceptions which are obvious to me and I will be unimpressed if you bring them up" (if I was to put it in simple terms as best I can). But then you said something along the lines of "let your genes express themselves", and then "be like a normal human". The last two things seem to be getting further and further away from what I've heard anyone else call "bodily integrity", and to contradict each other if you have rare genes.
Feel free to disregard what I thought you meant and just say what you actually mean, and why you think the norm you are advocating for is good.
I agree with your basic premise, but would phrase it slightly differently. I think that moral facts are experienced by intuition and emotion.
We can try to come up with logical explanations, or theories, that try to take all these moral facts and explain them, but no one has ever done this in a satisfactory way.
So, no, your conclusion should not change because someone pokes a hole in the theory you make up to try to explain it. The conclusion is a moral fact - it is what needs to be explained, and if the theory is unsatisfactory or defective, you need a new theory to explain it.
Hmmm.... depending on what you mean by "moral facts", I may or may not agree that such things exist. I view the moral emotions such as guilt and moral outrage and the desire to punish offenders and reward good behaviour, as, well, emotions. Although certainly they're socially useful emotions which help us operate more effectively in groups, not just random things we feel. And the rules we make up when we operate in a social setting must take account of those emotions, because otherwise nobody will buy into the rules. But sometimes, moral reactions can cloud our thinking, and if we were thinking from a more dispassionate perspective about the situation, we might take actions that our future selves (who have gotten some distance from the situation we're reacting to) would think are better. For example, what seems clearly fair and right in an almost-factual "this is how reality is" sort of sense, right after you have been wronged, might seem unkind and unfairly harsh and unwilling to take into account factors outside of the wrongdoer's control, on future reflection.
To me, the basic idea "moral reactions are social emotions that benefited us in the ancestral environment" seems a satisfactory explanation for why our moral emotions, our felt-certainties about right and wrong, are what they are. And that way of viewing morality, something like Jonathan Haidt's Moral Foundaations theory, as opposed to the "everyone is given a conscience which is a moral compass built into us by a higher moral authority, and every sane and mentally intact person's conscience agrees on what is right and what is wrong" I was raised with, does a much better job of explaining the behaviour of the people I see around me.
With that said: On general principles, it seems bad to decide what the answer to a question is before you've applied your ability to reason, and then use your ability to reason to find post-hoc justifications that sound reasonable.
But _why_? Is it about outcomes? Sure, ”don’t do weird things to your body for no reason” could be a fine heuristic, but the whole point here is that there _is_ a reason. So that doesn’t seem to work.
But if it’s not about outcomes, what _is_ it. about? Aesthetics? Some unusual theory of value where your bodily integrity is _inherntly_ valuable but the life of a stranger isn’t? And how did you arrive at this highly unusual and ideosyncratic moral system?
Aesthetics maybe. So far as it being idiosyncratic I do note that Einstein declined life-saving surgery on the basis that it was 'distasteful'. I think he was 76 though so he may have felt he wasn't losing that much. But it does suggest that this style of objection is not necessarily super rare. Nonetheless, it seems mostly irrelevant ... we don't need to convince the 20% of people who have weird non-utilitarian objections, we just need to get 0.1% of people on board...
I don't find it unusual at all. He's expressing that there is value to integrity, not saying there is no value to the life of a stranger.
I suspect you are just exercising a value judgement. For example, you are probably against getting ears pierced, but have no problem with daily glucose checks for diabetics, which involve a finger prick. You can heal effectively immediately and with no distinguishable effects from a finger prick (not even a scar, very likely) so your "bodily integrity" is restored.
One has no need for ear lobes, but I can see feeling something missing, a lacuna to use Scott's (new to me) word, if one or both were removed.
If you feel this way, feel free to keep your organs. I don't see, however, how this should apply to others who don't currently have the visceral reaction you have. Why try to convince others of it?
What is a "basic genotypic design"?
If someone is born with a malformation of some sort, is a surgery that brings one closer to the median aesthetic appearance aligned with your rule? Because that person's "genotypic design", as far as I can make sense of the term, would be to have that malformation.
The very fact that you can identify something as a "malformation" indicates that you recognize a human norm from which it deviates. I'm talking about that human norm, which I do not put on an equal footing with the deviation.
But humans vary wildly. Leg extension surgery to extend height will bring you closer to the norm in The Netherlands, but further from the norm of pygmees.
So you do not care about the person's genotype, but instead about an idealized notion of an "ideal human form" which, in your view, all people should aspire to. Is that it?
I'm curious what the implication is of this remark - just pointing out something missing from what the post thinks through, or is the idea that this means that people should not donate kidneys?
This seems connected with Haidt's Purity or Sanctity values. I share the intution that bodily integrity has inherent value.
Just out of curiosity, did you have anything resembling a strong form of this belief before trans issues became a popular part o the culture war?
Or are you mostly back-filling from that?
My belief in this regard long predates the prominence of trans issues and is not significantly changed by them.
I'm kinda surprised they prescribed Tylenol instead of Ibuprofen honestly. Anybody know why they did? I had anaesthesia for a cortisone shot to help with postpartum osteitis pubis, so no painkillers really needed, but I can't remember the last time a doctor prescribed me Tylenol when I wasn't pregnant.
NSAIDs acutely decrease kidney function, and people immediately post kidney surgery don't have any to spare.
I always tell people that the single way in which my life has changed post-donation is that I now take acetaminophen instead of aspirin.
That's it. That's the whole list of things that changed about my life.
Hey Jeremiah, thanks for your podcast episode on donating. I shared with my wife, and we're discussing for me.
How do you feel about recent research suggesting acetaminophen may be little or no better than placebo? This is a serious question for me - I suffer from frequent mild migraines, and being able to pop an advil or two ~weekly is pretty big for my quality of life.
A couple thoughts, keeping in mind I am not a doctor:
My understanding is that having a couple advil a week wouldn't really be that harmful. If you were doing 4-6 advil per day for weeks/months on end, I think that would be bad. But in moderation it's probably fine?
Other than that I'm unsure about the acetaminophen/placebo stuff. It seems to work ok for me, but it could just be that I'm very placebo-y. I also am lucky to have never had any real medical issues, so I had nothing to really consider like that.
What I tell people a lot is that we don't need *everyone* to donate. If 1 in 1000 people donated, the kidney shortage would end overnight. If you seriously consider it, and conclude that it's not for you, then that's ok.
Also, ibuprofen is a mild blood thinner, and as such is probably not ideal for someone recovering from surgery.
I was hospitalized a few years back for a possible brain bleed (head injury with an ambiguous CT read), and I was specifically not given ibuprofen because of the blood thinning effects. Between that and having an intolerance to Vicodin (unknown whether of not this extends to other front-line opioids), they apparently decided that my only two painkiller options were Tylenol or Fentanyl.
Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
>Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
Yes, I'd imagine so. For most drugs you can simply compensate by taking more orally than you would IV, but if the liver gets too much paracetamol it breaks it down wrongly and kills itself, so that's a non-option (hence the warnings on all paracetamol packages to not do this). Hadn't actually considered it before, but it makes perfect sense.
It also gave my the idea of buying the oral dissolving powder form of Tylenol and taking it sublingually in hopes of getting similar effects. It isn't as dramatic as IV tylenol, but it does seem to kick in faster and work at least a little better than swallowing pills.
I'll be expanding my at-home medkit with that, thank you. I never knew that existed. It makes sense, just never crossed my mind.
It depends. Ibuprofen is routinely used for post-op pain where the surgical procedure is not associated with any specially elevated bleeding risk. Possible brain bleed is very much the opposite situation!
Reading about all these studies reminds me of this classic SSC post https://slatestarcodex.com/2017/08/29/my-irb-nightmare/ and the thought I had while reading it - why aren't there places that make medical research more frictionless in order to benefit (somehow) from everyone being incentivized to do their research there? You know, like the Delaware or Switzerland of medical research? Could some similar kind of clustering benefit organ donation as well as the attendant research? I'm sure there's a reason why this doesn't happen, but what is it?
Partly this is because most medical research is done with an eye to eventually pleasing regulators in a specific country, and those regulators want the studies to be done in their country by their rules. For example, to get a drug approved by the FDA, you need to show them studies done in America.
Some people advocate testing a drug in another country to see if it really works, and then, if it does, doing the study in the USA to please the FDA. The advantage there is that if it doesn't work, you can avoid the expensive US trial entirely.
But another reason is normal human and systematic limitations. If you are an ordinary medicine professor at (let's say) Harvard, and you want to know whether some heart thing you do in the hospital every day is beneficial or not, you probably don't have the money or capacity to get someone in China to study it on a Chinese population. You might just want to study the thing you're doing, in your own hospital, to see if it works, and then write the paper yourself.
To this topic, it’s worth checking this out when you have a minute and sufficient energy to get angry about the kafkaesque inefficiency of US clinical trials recruitment. https://open.substack.com/pub/bessstillman/p/please-be-dying-but-not-too-quickly
Participant population becomes an issue if you try to cluster like this.
I think if you had a population of a city where every non-rich citizen was participating in 5 different medical trials at once, because the city set favorable terms that brought every medical trial in teh world to their doorstep, that population would no longer be a meaningfully useful control group.
Why not?
Because someone who is on 4 experimental medications before entering your study is likely to have unusual readings at baseline and unusual reactions to your new medication.
My Goodness! I found this quite moving and overwhelming. Nothing but love for this man.
Even if one thought UCSF's screening criteria were reasonable, they sound badly out of order. If a history of childhood mental illness is potentially disqualifying in their eyes, they need to ask about that history very early in the process and not proceed with CT scans (for most), nuclear kidney scans, or even time-consuming and expensive investigations until they decide if that history is a dealbreaker for them. Asking a candidate donor to incur risk, meaningful expense, and/or serious inconvenience before addressing disqualifiers like this just isn't respectful.
I've been thinking about this. Their current method is "do all tests, including psych tests and radiologic tests", then "convene committee to see if any tests are disqualifying". You could imagine a two-step process, where they convene the committee once for the psych tests, then a second time after all tests. I'm nervous demanding this because I imagine it makes things more expensive and longer for everyone to catch a tiny number of people in this situation.
Perhaps they could develop a system where anything potentially disqualifying gets flagged before they continue the testing. At the testing level that could be a checklist, which isn't good, but then they could convene the committee or a smaller sub-committee to evaluate.
It really doesn't make sense for them or especially the donor to go through a bunch of other tests if they can tell that the person is going to be disqualified earlier.
Roughly speaking, shouldn't they be doing the potentially disqualifying tests in order of increasing "cost" per unit probability of being disqualified? ( By "cost", I'm pretending that medical risk (e.g. the ionizing radiation in a CAT scan), time, financial cost etc. can be scaled somehow and combined into one number per test.)
That's a reasonable concern, although the number of people disqualified for _any_ non-radiological reason after incurring risk, meaningful expense, and/or serious inconvenience might be more than tiny. And it shouldn't take a committee to tell the candidate that issue X could be a dealbreaker and what the program's general attitude toward issue X has been historically. Given the facts you presented, I doubt the UCSF committee's serious concerns could not have been reasonably anticipated by staff. I think my irreducible minimum would be informed consent -- the candidate needs to know that there is a strong possibility of rejection based on the information on file before incurring additional risk, meaningful expense, and/or serious inconvenience.
This certainly seems like it's scheduled for the benefit of the committee members, at the cost of the would-be donor, and the medical practitioners associated with the tests.
I think a "Coordinator" or a "Patient Representative" probably has more pull with the executive committee of the hospital than a doctor.,
If something as small as 'distant history of childhood OCD' is a disqualifier, then I'd imagine that it is NOT a tiny number being caught, and they absolutely need to do the psych evaluation first. About 20% of Americans have a mental health *diagnosis* let alone symptoms of a mental illness in the past that might be disqualifying. I have few friends that would pass that screening.
It can't be that consistent of a qualifier or it would probably eliminate the vast majority of EAs attempting to donate.
I'm saying that if this is the case at UCSF, then they absolutely need to do the psych eval first before making people go through the rest of the medical testing.
Ah, gotcha, yeah. It should be a first/early step rather than a last/late one.
This reinvigorated my desire to donate a kidney, thanks Scott.
Good luck!
I'm very happy for you, and completely unable to evaluate this rationally because a friend of mine died donating her kidney to her dying husband.
If you asked her in the afterlife, she'd probably be OK with the choice, but the incredible guilt that her husband felt afterwards is almost unimaginable.
Once again, I am being irrational and this should not dissuade anyone else; I merely was triggered to share my story.
I'm sorry to hear that. You're under no obligation to give details, but my model expected this to be pretty rare, so I'm interested in hearing any details you feel okay providing.
I never heard the exact nature of the complications, so I can simply relate that she was an extremely healthy ~50-year-old woman and she died on the table.
Yeah this is what I was thinking the whole time reading this article. Like, great, you have a bunch of studies and stuff (you know, the things that are constantly being dinged here for being full of fraud or just plain old incompetent) telling me that having my body cut open and removing an organ I'm using isn't a problem.
And I don't believe them. Sorry, but generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it (modulo the appendix?).
That's why people don't donate kidneys unless it's to their family. It's clearly risky. A bunch of discredited health people saying it's not risky isn't gonna change that - COVID showed clearly that they are the sort of people who will lie at the drop of a hat if they think it'll make people behave in ways that are somehow more "pro social" regardless of actual risk.
I agree with this. I've had supposedly 'low risk' surgery proposed for my own benefit and turned it down on the basis that I want an in-tact peritoneum without scar tissue, and that anesthesia itself is not entirely safe. I don't think the studies saying donating a kidney is fine make any sense, unless you consider maybe it's a selection effect - IE, anyone with any questionable medical issue at all is screened out first - so the comparison to the 'general' population is not a fair comparison. Really you would want long term randomized controlled studies comparing only perfect donation candidates who were assigned to undergo surgery or abstain. Anyway, it's a selfless thing you did, which is great, but I still think organ donation is an ethically tricky thing, and it's not clearly a slam dunk. I think it makes sense to really make sure the donors don't feel pressured in any way. It's not clear that having the option to donate makes all people better off.
> generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it
Epistemic status: I read this somewhere
One argument I find convincing is that kidneys and livers in particular were built for a more hostile environment than we currently live in (unless you're an alcoholic), and so have excess capacity. The acceptable age (at death) for donating a kidney or liver is higher than for lungs or heart, because they're under less strain.
TBC I'm not donating a kidney and don't expect anyone else to, especially for free. But I think this particular argument is weaker than it looks.
Isn't the appendix now thought to be a reservoir of your intestinal microbiome to facilitate rapid repopulation of your gut after an event (e.g., infection, poisoning) that causes the system to be flushed out?
Congratulations Scott! I became a non-directed donor 14 years ago. I was inspired by a New Yorker article by Larissa MacFarquhar, you may decide whether that's better or worse than Vox.
In addition to the very obvious benefits to the recipient, who is still doing well, I think donating helped me solidify my adult identity. Not in any public way, no one in my current city of residence even knows except my wife and whoever has read my medical file. My experience is that much as the rite of circumcision is meant to bind us Talmud-readers to God, kidney donation binds one to principles of altruism in a way no amount of donated money ever will. Even as I've gotten older and less idealistic, I remind myself that I am a man who once donated a kidney, that I should never let my character stray too far from that of the younger man who was capable of such things. No regrets.
I find that very compelling and inspiring. Thank you for sharing it.
That will also prevent you from reevaluating and changing your mind, if you were wrong, though.
While you might change your mind about what exactly constitutes moral goodness, it's good to have a reminder to strive for moral goodness as you understand it.
>a ritual called “therapy” could absolve one of this impurity
When I read this section, I had the following thoughts in rapid succession:
- As a psychiatrist yourself, you are qualified to perform therapy. And you do mention that OCD is one of the conditions you treat in your patients.
- So could you do therapy on yourself? It would certainly be simpler and more convenient than going to a non-self therapist. Probably not as effective if you actually had an active problem you needed help with, but it seems more than adequate for an exercise in warding off evil spirits.
- Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
- So for mental health professionals who are qualified to perform therapy, does talking to yourself make you more sane, less sane, or have no net effect?
There is a minor psychoanalytic tradition of "autoanalysis" or "self-analysis" but I don't think it gained that much support from most theorists, although it seems like it's not particularly impossible that it could be very helpful to some people. (After all, apparently you can make pretty consequential changes in your own mind in other ways, like meditation practices.)
I kind of doubt that the panel would have accepted anything like "I promise to perform therapy on myself to treat my OCD, if necessary" or "I promise that, as a psychiatrist, I would not currently diagnose myself with OCD". :-(
The effectiveness of autotherapy would heavily depend on the approach--anyone can do a workbook on their own, for example. Some people, professionals and lay, have a lot of discipline and insight and can do this kind of thing very well independently. But not all people, and not for all problems. In some approaches the relationship with the therapist is a functional part of the technique, which can't be replicated alone. Being a mental health professional likely aids a personal quest for better mental health but the physician cannot always heal thyself. In medicine self-practice is at best frowned upon and at worst disallowed, for reasons that also apply to autotherapy. It's difficult to be objective, it's easy to take advantages that hurt you in the long run.
Talking to yourself is not inherently pathological. While "taking to yourself" conures up an image of someone walking around in public muttering to the voices in their head (and that's obviously not a good sign when it does occur) most self-talk is just a way of augmenting thought, with no ill implications.
(Sorry, I know it's kind of a joke, I can't help myself sometimes.)
I think if you switch chairs during a self therapy session that implies a degree of objectivity 🤓
Ah, that would be the Tim-Curry-in-Clue school of psychology.
> Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
By who? Talking to yourself is something everyone does all the time. It's widely depicted in popular TV shows as being completely normal behavior. (And in this case, the TV shows are correct.)
I'm being facetious. The joke is that "talking to yourself" in the literal sense is a common and usually harmless and occasionally beneficial behavior, but the same phrase is also often used as a shorthand for specific behaviors symptomatic of schizophrenia: either disordered ramblings directed at nobody in particular or conversations held where the other party is the product of delusions.
On reading that Scott was turned down for kidney donation on account of having had mild OCD in the past, my first thought was amazement that something apparently so unrelated could be a factor in their decision. He may as well have been rejected for once having an ingrowing toenail!
is it minor?
i think people are assuming it was because it would harm
the recipient, but id wager they also consider the long term mental effects to the donor. Whether or not it might harm their mental state.
Or that it cast doubt on his state of mind in volunteering to donate (i.e., he could have been feeling compelled to donate rather than choosing freely).
yes the donor is going through an irreversible choice. State of mind should be ironclad.
I don't think so, since the OCD points to the possibility that it may be obsessive thoughts causing him to need to donate.
Could you not also attend a Zen retreat for ten days of non-Self therapy?
That would be a Theravada therapy session. Zen would be a "True Self" therapy session.
Enjoyed both your and Jon's comments. Brought a smile to my day. Thanks!
Another thing, hasn’t he had therapy since the diagnosis already, why doesn’t that count?
What was the radiation risk from a "nuclear kidney scan"?
Almost zero, surprisingly!
It's amazing how much radiation dose you get from a CT.
https://xkcd.com/radiation/
I guess the issue is that the radioactive dye in the scan is very specifically absorbed by the kidneys (whereas the CT is just kind of "throwing X-rays at all the tissue and seeing what bounces off"), and also that the nuclear kidney scan is essentially 2-D while the CT is 3-D?
According to
https://www.ncbi.nlm.nih.gov/books/NBK562236/
the dose from the nuclear kidney scan can be on the order of 1/10 that of a CT scan, so it might not be appropriate to think of it as totally negligible, unless they're talking about a slightly different procedure.
The radiation cancer risk argument is just wrong. This is from modelling studies not from prospective or retrospective studies. After 127 years of X-ray use there is not one study in adults that has shown increased risk. The low no-threshold LNT theory makes no sense and even if it were true it should be proven in a longitudinal studies.
Radiologists and others who work with radiation despite protection would have increased risk of cancer because there is always some radiation absorbed. There has been no extra risk reported except in the early days when they did not understand risk of high doses.
X-rays are 1/300th the radiation level we're talking about here, so not comparable. I don't think anyone has been irradiated by CT scans enough to empirically discredit LNT, but I'm interested in seeing any studies you might have available.
I like Jack Devanney (a Thorcon molten salt reactor founder I believe) on LNT
In "Circling the LNT Wagons" he analyses a slightly positive LNT study noting that:
"They excluded the data they had already collected from 12 of the 15 countries because ``of the limited resources and consequent need for efficiency in project coordination." The three countries that survived this project coordination process were France, UK, and the USA. The three countries selected just happened to be the only three countries in the 15 that had nuclear weapons programs."
-https://jackdevanney.substack.com/p/circling-the-lnt-wagons
Nuclear weapons workers are more likely to have received acute doses. Based on Devanney's posts it seems really likely that LNT is either non-existent or non-provable below about 20 mSv acute doses
This is interesting in this case because you are talking about a 30 mSv acute dose. While LNT is likely to notably overestimate the risk at this level it is reasonable to think an elevated risk exists. Interestingly, one of Devanney's critics in his comments does not defend LNT but does argue that acute medical doses have a slight cancer causing effect. For most things it is again potentially unmeasurable but 30 mSv might be in the measurable range
In his "The LNT-is-not-inconsistent-with-the-data Argument" post Jack has a graphic of about 30 dose profile cohorts that are prominent in the literature and history. The only ones comparable to 30 mSv acute seem to be the nuclear bomb survivors:
14,000 with 5-20 mSv acute dose showed an insignificant decrease in solid cancers
6,000 with 20-40 mSv showed the same as control
11,000 with 40 - 125 mSv showed an insignificant increase
16,000 with 125+ mSv showed a significant increase
Leukemia numbers were similar except the insignificant decrease group was from 5-150 mSv
- https://jackdevanney.substack.com/p/the-lnt-is-not-inconsistent-with
We've also done a lot of experiments in fruit flies to demonstrate that radiation effects on health are non-linear in them as well. But nobody knows where they start to go non-linear in humans and the dreaded bioethicists would surely prevent any good experiments determining that. So in the absence of good data we must make do with the simple rule we know is wrong for legal limits etc.
I've wished I could do this for years, but thanks to a life-saving, kidney-wrecking medication I'll be on in perpetuity both of my kidneys will be needed by me. I saw the headline "my left kidney," correctly guessed the topic, and immediately started sputtering about my own bad luck. Congratulations Scott, I am happy for you, your donor, and to see this issue publicized in a forum where I'm sure it'll get traction. Happy, and a little jealous.
Of course now I'm sitting here stewing on whether I'm a really a 200-in-a-few-hundred-millioner who would really go through with it or just a 25%-er with a fond intent and a pat excuse. It does feel like the easy, obviously correct choice--a life you can save that will be practically right in front of you--but now I'm very suspicious of this little fantasy and the role it plays in my psyche, with no skin (er, organ) in the game...
(If anyone else is worried they just have a hero complex and their heart isn't entirely in the right place, don't let that deter you from putting your kidney in another one. We all appraise ourselves in creative ways.)
How do they(or can you decide?) choose which kidney they take from you?
Unless tests reveal some unusual asymmetry, they take whichever one has longer blood vessels that are easier to manipulate surgically, which is almost always the left.
How does it feel knowing that your evil kidney is likely now directing some poor stranger to turn to the dark side? The writer that you are, that kidney may be too persuasive for them to resist...
https://en.wikipedia.org/wiki/Body_Parts_(film)
My immediate reaction to the apparent mystery of : "25-50% of Americans say they *would* donate a kidney to somebody in need..."
I think those 25-50% are thinking of a scenario somewhere in between
-rushing to pull people out of a sudden immediate fiery car crash right in front of them
- donating or volunteering in a natural disaster
- John Cleese showing up at their door asking, "Could we have your kidney, then? Won't be much trouble for you."
When the choice or opportunity is suddenly presented, and following through is relatively simple, logistically, people and Americans in particular have almost no limits or thought of risk/cost. In the scenario of a crash/wreck I am sure 95% of people would risk their life for a total stranger without a moment's thought.
The barrier to high leverage humanitarian intervention is not courage or selfishness but attention span. Even you, a person who thinks and cares about doing good, who inspires others to likewise try to improve the world, and an MD with major cheat codes for Health Care and Medical melee combat, you were discouraged and almost gave up. Until a Mysterious Mentor suggested a Surprise Approach, One Weird Trick of trying another donation pathway, tvtropes etc.
Leaders can be described as getting people to do good stuff they should do anyway. Personally, I always tell people that when thry ask somebody for a favor, make it *AS EASY AS POSSIBLE* for that person to help you. The path to better more effective Altruism, and government as well, should keep those things in mind.
BRetty
Sounds like we need to recruit a corps of door-to-door proselytizers, then, and maybe lock a bunch of bioethicists and con artists in a room together, unable to escape except by agreeing on details of a training program for professional kidney-donation-facilitators which somehow threads the needle of making the process easy enough to actually complete for people who should be donating, without misinforming or coercing people who shouldn't.
As it stands, nobody goes through the process from the donor side enough times to become an expert on it, and the skill-set of making things easier for a customer is valuable enough to be in demand elsewhere.
"maybe lock a bunch of bioethicists and con artists in a room together"
I love that image! Many Thanks!
You are exactly right... there is nothing like a donor-side "facilitator" and each donor navigates the process exactly once. Good insight. B
Could just lock all the bioethicists in a room, throw away the key, and try to reassure people that they around to hurt you anymore, you can do medicine now!
Congratulations!
> And it encourages people to be masochists,
And sadists! Suffering is a sign of virtue, so therefore by making people suffer one can increase the amount of virtue in the world. Just look at all those stories of people who went through adversity and came out better. Who wouldn't want to have moral justification? Any reluctance on their part is simply akrasia. (Or at least, that's what my PTSD says.)
> Would, if what?
Quite possibly, if my life were more together. But thanks for writing all this.
Just find a nearby munch.
I am duly impressed.
My one friend who did this feels like it was the most significant event in his life. And he has lived a very full life.
I've been torn about the prospect of donating a kidney for over fifteen years. On the one hand, I see it as a really worthy form of altruism, and I recognize that in absolute terms the risks are quite small. On the other hand, I'm quite vulnerable to anxious intrusive thoughts, and the anxiety of having only one kidney, when evolution saw fit to equip me with a spare, feels like the sort of thing which would genuinely weigh on my sense of well-being for the rest of my life.
Do you think you might be open to a literature dive on the pros and cons of donating regenerable organs and tissues, like liver or bone marrow?
Maybe!
Anxious intrusive thoughts about only having one organ were a concern for me too. I tried telling myself I would do some healthy things (stop adding salt to food, go to the doctor more often) that would probably make up for it, and that sort of helped. So far I haven't felt too anxious-intrusive-thought about it, but partly that's because I'm still in the more acute kidney failure stage of recovery where I'm expected to feel bad, and I don't really know what the future will bring there. Ask me in a year.
Cutting salt indefinitely sounds more masochistic to me than a one-time surgery!
Scott has written before about not really being a fan of food in the sense that a lot of people are, and I suspect there's a general trend of this kind of underrating general experiences (even coming from the guy that wrote "what universal experiences are you missing.")
I know there's a renal diet for people with kidney disease/on dialysis (mainly be very careful with potassium and if you eat potatoes, you have to twice-boil them which reduces them to a mush that is difficult to eat so you may as well cut them out altogether).
Seems there is a diet for kidney donors; moderate protein, reduce salt intake, be careful with supplements:
https://www.ohsu.edu/sites/default/files/2019-06/Healthy%20Eating%20After%20Kidney%20Donation%2004-25-2019.pdf
https://www.jrnjournal.org/article/S1051-2276(13)00211-2/fulltext
I looked into liver donation after getting denied for kidney donation and the risk is way, way the fuck higher. Something like 1% fatality risk in the immediate aftermath. I was comfortable accepting "twelve hour drive" risks to save somebody's, or multiple somebody's, lives, but not "die at any point in the next year or two" risks. If you do survive without issues, your liver returns to full function.
Do you have some sources to check out on this?
No, it was a while back, I just used Google Scholar and whatnot to look into it.
There is literature suggesting that missing-spare-kidney intrusive thoughts are a real risk, which is why they reject people with OCD. So 1) maybe kidney donation isn't right for you, and 2) if you decide to do it, you probably don't want to disclose your concern to your donation team. Like Scott, I was rejected for mild OCD, and I really wish I hadn't been so honest in the psych eval.
I personally think it's not for me, because it's not just that I'm generically prone to anxious intrusive thoughts, there are specific things that cause me anxiety which aren't necessarily intuitive to other people, but I find predictable in advance. For instance, I have no problem engaging in martial arts sparring, but I refuse to ski- I can't help envisioning myself rolling down a ski slope with a ski pole stuck into my eye. I can forcibly fight down anxieties which I know are irrational, but it doesn't make me comfortable, and I don't want to spend the rest of my life doing it.
Conversely, some things that other people worry about don't bother me at all. I'm not paranoid about the dangers of a routine surgery, for instance, or low-level radiation exposure. I'd be happy to be able to bring my kidney-anxiety down to a level where it's proportionate to my other worries, but I don't think I'm actually able to do that.
Yeah, sounds like it - and I hope you don't concern yourself over the question "should I donate or not." You have a contraindication and it isn't reasonable to sacrifice your own well-being.
I get how anxieties can be different, but predictable to those who have lived them. My anxieties are around ethics, i.e. am I doing right by others; if others aren't doing right by me why doesn't anyone else notice and does it mean there is really something wrong with me. And I can be OCD about the uptime and quality of software systems I build. Besides that, I don't have much in the way of intrusive thoughts - which is why I was pretty confident I wouldn't experience the without-spare-kidney anxiety.
Yeah, the anxiety caused by the risk of dying later on due to donating would make me significantly worse off. Imagine how crappy you'd feel if you died because of that! You'd feel so stupid and like such a sucker! "If only I hadn't donated," you'd think. Anything would be better than having that kind of regret and fear your whole life!
As an aside, I'm surprised that you read Scott's piece and concluded "the risks are quite small" - I found this article scary.
I did some sort of thing where I gave my dna via cotton swab to some charity and said email or call me if anyone needs something I’ve got. It seemed legit, but no one has ever contacted me. And I assume my superior Slavic-Irish-Norwegian ancestry would greatly enhance a normal mortal life.
Asking because I suppose this group would know: Is that in fact a real thing? Or did I give my DNA to skynet? I swear I got it from a flier at a hospital.
I think that's probably about bone marrow?
Maybe they don't actually share DNA information about different kinds of prospective tissue donations? (which I guess would be kind of wasteful, if not)
You’re right. I found the little cards they emailed me in my desk. And here I thought I was open like s buffet.
Open for what?
For people needing spare parts.
As Seth said, bone marrow data bases work like this. For a bone marrow transplantation, you have to screen millions of people to find a match. So they build huge databases (for example 7 millions just in Germany, ~10% of the population), and only contact you if you are a match for someone in need. The chance of ever being contacted is less than 1%, but the system only works because of the huge DNA databases.
I did this for my local bone marrow bank. They contacted me a decade later and told me there is a potential match, but never reached out again, I presume they found a better match.
real thing, I've commented about what it's like (or look up Anthony Nolan, the charity that does that stuff in at least the UK)
Scott, have you thought about meeting the person who got your kidney? Of course it might be awkward, meeting a stranger whose life you saved, and you two may be so different that you're each incapable of comprehending the other's take on life. And yet you had a meeting of the minds and kidneys when it comes to saving the person's life. I'd want to shake their hand or hug them and say, "I hope that kidney makes possible all kinds of wonderful things in your life" -- or something like that. Maybe just "enjoy the hell out of that kidney."
There's something about direct giving to strangers that feels utterly different from EA. It's profoundly satisfying, and makes you want to give *more.*. Maybe the way to think of it is as a spiritual practice, one that people practicing EA need to do to stay in touch with the point of helping others?
Anyhow, bless you, Scott. And if it would make you feel any better about the Uber incident, I'd be willing to piss myself in an Uber for you.
I took the liberty of looking up Scott's recipient. He's a real stickler on an IRB and eats an all-meat diet.
Yeah, I looked him up too. You'd think a writer for the New York Times would have been trickier to track down, sheesh!
But why be sure they'd loathe each other even under ordinary circumstances? Scott himself could be called a real stickler by some, and they'd have a point. In the most recent open thread I showed some people Scott's kind-true-necessary, 2 out of 3, guidelines, and the people had a low opinion of them -- saw them as suppressing free speech, suppressing justifiable expressions of rage at various actors in the Palestinian-Isaeli situation, so vague that any judgment could be defended, etc etc. And is what people eat really such a big deal? Anyhow, even if Scott and Stickler would have loathed each other in other circumstances, having a moment of intense shared emotion is all the more special then. And I'm guessing that even most meat-eating sticklers aren't so hard-boiled that they are not moved by someone having saved their life.
That objection to me sounds like ignoring or not noticing how a 2 out of 3 rule actually works.
But also, the rule is designed for the moderated comments of one persons blog, not a general public space.
There is no perfect system for moderating a space like this, but I think Scott's works well in practice, and I'm happy with it.
Where do you look such things up?
Almost certain both of those people were joking, implying Scott's Kidney went to someone he wouldn't like and who makes the world worse, in a sort of "accidentally saving baby Hitler" scenario.
There's probably no way *you* could look up Scott's Kidney recipient, for medical privacy reasons (Scott might be able to, not sure).
Oh -- duh, of course.
Dudewheresmykidney.net
i think in some cases you are allowed some contact with the kidney recipient via email, but it has to be completely anonymous and is reviewed by censors before being forwarded on.
Yes, that might be. Seems pretty micromanagerial to me, sort of like the bureaucracy that would not let Scott be a donor because he's had mild OCD as an adolescent. I have seen articles about people who donated a relative's heart meeting the person who received the heart. Donors meeting recipients seems like on the whole likely to be a very positive experience if both parties would like to do it.
Seems very disturbing. What if you didn't like the person? Here you made a significant sacrifice, giving up your health, and it was for this person?
And what about the power, obligation, control, and guilt issues? They meet you, and they feel like they owe you something, or you feel like you owe them something ... really disturbing. Seems like it would be hard to relate to them as normal humans with such a huge debt there.
You'd always resent them for having one of YOUR organs that belongs in YOUR body! You'd get angry every time they did something you didn't like, or disagreed with you, since they basically owe you everything! Just an unhealthy relationship.
I'm sure many donors and recipients would not want to meet. But there are all kinds of ways a meeting like that can play out. The ones you imagine are only a subset of the possibles. Some people's take on the process may be one that protects them pretty well from going down these grim paths. If had donated a kidney I think I would want to meet the recipient. I'd have assumed when I donated that the organ would be going to someone who does not share my attitudes, beliefs, politics, taste, etc. After all, most people don't. I think my feeling of connection with the unknown person who was going to get my kidney would have been that, like me, they want to stay alive, keep seeing the people they care about, keep doing the things they enjoy. Part of the specialness of charitable giving is that you are letting go of all your angry stuff about the many many groups of people who believe and do things you think are pointless or evil -- at least letting go of it to the extent that you believe they do not deserve to suffer. So if when I met the recipient they were wearing a campaign button for some candidate I didn't like, that wouldn't matter. And I don't picture having a big get-to-know you meeting with them -- just talking over the thing we have in common -- the experience, how we're each doing, and wishing each other well.
As for their gratitude -- of course they have to say thank you. Etiquette sort of demands it. But I would try to get across to them that "thank you" doesn't exactly apply in this situation. If I had chosen them as my recipient thank yous would be in order, but I didn't. I gave the kidney to humanity at large. It was luck that sent the kidney to them in particular. So I would tell them that, and tell them that giving it had given me a lot of pleasure, in fact made me sort of high, so in my own way I had benefitted greatly from the experience. Maybe add something about how I I gave the kidney to humanity at large -- if they feel they owe a debt, they can work it off by giving something to humanity.
So there's a 1 in 10,000 chance of dying during the actual surgery, but there's a 1-2% chance that you'll develop kidney disease later on in your remaining kidney and think "boy, I sure wish I still had that extra kidney right now". BUT, you'll be put at the top of the list for the next kidney. BUT, kidney recipients typically only live an extra 5-7 years anyway. BUT, under these kidney disease circumstances you might not have been okay with a second kidney anyway. Nonetheless, your chances of dying due to kidney donation seem to be higher than 1/10,000 due to the whole lack of redundancy thing, probably very much greater than the 1/660 risk you were concerned about.
"Dying" isn't a very good binary variable. I think there's a 2% chance you'll die six months earlier than you would have otherwise, but multiply that out and it loses you 1.2 days of life. Dying during the surgery seemed important to me because it loses you a lot of life as opposed to shaving off the very end when you have no GFR left anyway.
Doing this properly would involve how many DALYS you expect to lose. I think I looked at someone's calculation and it was in the range of a few weeks, probably so much that the variation in length of your recovery period is bigger than the amount contributed by early death or early disability considerations. I think the Tom Ash post I linked might have those numbers on it, although I might be misremembering.
Okay but this is all "present rate no singularity", yeah? If you have a reasonably high probability of a good singularity, then dying a couple of years early in the coming decade might lose you many, many more highly enjoyable years than a naive approximation would suggest.
(IIRC from your old cryonics post you don't care *that* much about your mortality as distinct from suffering? Which, fair enough. But I would assume that most people worried about life expectancy post-surgery are not like this, so it feels worth mentioning.)
Even if there's no singularity, it's reasonable to expect medical care to improve.
the “UCSF lost to waking up in an ice bath” chart is absolute gold. Hadn’t laughed so hard this entire week. Who said this community can’t do humor?
The bit about how you can get five other people get bumped to the top of the list if they ever need it is a REALLY convincing point. I didn't know that: I heard about how you personally get bumped up the list, but that's the bare minimum, not a good deal.
Worth noting that this is not very gamable, and they make it really clear that the set of you share a priority-claim on up to 1 kidney. From the look of things, once someone uses it, the others do not have the priority mark anymore.
Thanks for pointing this out. Then it's a non-obvious tradeoff between a larger list of people you care about to whose kidneys yours are compatible, and a smaller list (five people) which could include incompatible people. That's … decidedly less convincing now.
Not sure if this untangles the non-convincingness, but from what I understand, you can "donate a kidney to a loved one" even if you're non-compatible. What happens is that you donate your kidney to a compatible stranger and in return they ensure a compatible stranger in a symmetrical situation donates their kidney to your loved one. I think this is commonly the way it works.
This is interesting, and I wonder if you can change the names later on. I'm thinking about the sorts of incentives this could create.
I suppose "Inside you there are two kidneys" is more accurate than having wolves
Two wolf-shaped kidneys?
Re the people who say they would donate a kidney to help a stranger:
I think most people answering the survey question are imagining a case where they're uniquely morally responsible for it in some way, in which case they'd do it.
Going by your numbers, the actual number of undirected kidney donations required to plug the gap is about 0.01% of people per year. So IRL people are probably morally responsible for about 0.01% of a kidney donation per year (probably more in practice because some people can't or wouldn't donate, let's say 0.04% for safety), and going beyond that is superegatory.
I'm on the list of people who'd answer "no" on the kidney donation question (I do feel bad about it). But I would sign up for the service that picks 0.04% of people who sign up at random each year to donate, if it solved the kidney shortage. I wonder how universal this is.
(This does raise the question of why I don't just make my own service by throwing a random number generator from 1 to 10,000 and donating if I get under 4. I did do this before posting and got 5,143, so that's my new excuse for not donating. But I don't know if j would have gone through with it if I actually had gotten a number under 4, so I don't feel great about it).
I got 7127, so I suppose I am also excused!
Your comment got me thinking - I would probably also sign up for such a list, if it existed and - I think this is important - if a lot of other people also signed up, so that my odds of donating were "fair".
But then it occured to me that something similar already happened in the UK. A few years ago we switched from opt-in organ donation to opt-out. Essentially that means that if you die, you are now assumed to consent to organ donation unless you explicitly said you don't consent.
In a way that is similar to drawing lots, since we can assume I have some chance of dying randomly in the next year and some chance that my organs are suitable for donation. I am not sure that enough people die in the right way to fill the gap, but I suppose it should do something (especially as each suitable person would be able to donate both their now unused kidneys, plus other organs like hearts, lungs and livers).
Unfortunately I can't find much saying it has really had an effect. Partly that seems to be because it was introduced just before covid, which has muddied the numbers. In essence, though, the number of people on organ waiting lists seems to be pretty much unchanged or even slightly higher.
The difference between opt-in and opt-out is notable, but does not change the order of magnitude, unfortunately. Looking at different countries who changed one way or the other, the number of donations may increase by 30-40%. (Less if relatives still have veto rights, which they do in some countries.)
In practice, most donors are young people who die in accidents, like bikers. Most of them haven't declared their will, so usually relatives are asked to find out their will. In most countries it boils down more or less to the same decision for the relatives, regardless whether it's opt-in or opt-out.
30% more makes a difference! The supply is not THAT much smaller than demand. But it is still not enough to get enough organs. The number of people whose organs can be used (who die young from accidents) is just small, and the number of people who would need organs is pretty high.
A thorough literature review with in-depth discussion for Italy, France, Wales, Greece, Chile and Singapur is here (in German, so you need an auto-translator)
https://www.bag.admin.ch/dam/bag/de/dokumente/biomed/transplantationsmedizin/literaturbeurteilung-einfluss-von-zustimmungsmodellen-spenderegistern-und-angeh%C3%B6rigen-entscheid-auf-Organspenden.pdf.download.pdf/Literaturbeurteilung-Zustimmungsmodelle-Organspende.pdf
I am also on the list of people who'd answer "no". But on the other hand, I did register for bone marrow transplantation. There they screen huge databases for the best match, and you are only contacted if you are a best mathc. Which happens for less than 1% of registered potential donors.
This system works very well. If you are contacted and told that they particularly need your bone marrow because there is this one person who needs it, then I do believe that many people would say yes. Perhaps the 25-50% who answer yes in the surveys.
In principle, this could also work for kidneys. Build a huge data base, for each patient try to find the best donor, and ask them whether they would help this particular patient, because their help would work better than anyone else's.
It's almost a shame that kidneys are compatible between so many different people. Because that might be the main reason why the solution doesn't work. (Even if chosen, you are not really a much better pick than many other people.) So the ethical pressure is diluted. We might have much less trouble to find kidney donors if they weren't so widely compatible.
Or the solution does work, and we just need to try it.
Agreed. "There they screen huge databases for the best match, and you are only contacted if you are a best mathc." Also, there is (or was? this was over a decade ago) a secondary screening where they take another sample and check more antigens. I was contacted as a potential marrow donor at least twice (I forget if there was a third time), and I think I was the most probable donor at least one of those times, but they never actually took my marrow. I don't know exactly what happened to prevent it. ( I've aged out of the registry at this point. )
Interesting. I have no idea what was going on for you.
Funnily, I was chosen by them, too... as statistical twin to a real donor. That's why I never forgot about it, I get a form once a year to tell them if I am still healthy.
I have the vague recollection that something had changed on the recipient's end, but I wasn't told whether it was positive or negative (which is perfectly reasonable for their privacy). I too got a contact once a year (till I aged out of the registry) asking if I was still willing and able to donate.
Hey, I know I'm coming to this super late, but this comment inspired me to write up my experience getting matched from the bone marrow donor registry and donating blood stem cells: https://forum.effectivealtruism.org/posts/69kYhMjGnvgHqHP9r/my-experience-donating-blood-stem-cells-or-why-you-should
Overall, it was a very positive experience and I would recommend that folks sign up for the registry if they can (for the US, it's "Be The Match"; for the UK it's "Anthony Nolan")
Hey Silas, thank you very much for taking the courage of writing your experience down! I was always a bit nervous about whether I would really say Yes if I was ever matched. But after reading your post, I am now a lot more confident that I would go through the whole process. As you say, reading about personal experience adds a lot to all the statistics which say you'll be fine. Thank you for sharing!
That's wonderful to hear, thank you :)
You might've stumbled on a back door way to financially compensate kidney donation (in expectation): it's probably not illegal to pay people to sign up for such a service as long as they have the ability to back out if selected. Conditioning the payment on passing screening could do multiple duty of (a) weeding out low-intent volunteers, (b) keeping the average quality-as-a-donor on the list high, and (c) enabling payments amounts large enough to actually incentivize sign ups.
Sort of like reverse insurance?
I suppose it is 🤔
How old is too old to do this? (As in, at what age will they refuse to take your kidney?)
I don't think there is an official age, and it probably depends on your health, but I think being older than 50 probably changes the risk calculus to a point where I would be reluctant to do it, though this is just a gut feeling and I haven't looked into it too hard.
Yeah, I guess I was wondering if this is a good way to effectively buy kidney insurance for the family. I think it might be.
Was there really a need to tell the whole world about the good deed you have done? Performing good deeds for social affirmation is generally considered to detract from the goodness of the deeds. Yes, I do understand that your intent is to encourage more performance of such deeds. But conventionally, performing good deeds for external rewards like social approval or money is considered suspicious, for some poor reasons (like the masochism you mention) but also the tendency toward self-deception and institutional corruption by those rewards.
This directly ties into the castle thing. Perhaps it's true that the castle actually would encourage more good deeds be done. However, it's also true that if you start talking yourself into buying comfy castles that actually do good, it becomes easier to talk or trick yourself into comfy things that don't do good, and you start to attract people into your organisation who will talk you into buying comfy things because they are solely into comfy and not good deeds at all. We can try to be less wrong here, but can we be sufficiently less wrong that this risk is worth running?
Yup!
Edit: the "Yup!" applies only to your question at the end; I disagree with the general thrust of what you're saying.
I think yes, for a few reasons:
1. If you tell other people about your good deeds, you feel good and get benefit from them, which is an incentive. People do things that are incentivized more often than they do things that aren't incentivized.
2. Normalizing donation, as above.
3. Realistically a bunch of people were speculating about where I was (see eg https://www.astralcodexten.com/p/open-thread-299/comment/42439504 and https://www.astralcodexten.com/p/open-thread-299/comment/42504375 ) and it would seem weird to lie to them.
The castle thing seems like the opposite of people being corrupted by social approval; they did a genuinely good thing even though they knew everyone would hate them for it. I have immense respect for that. I agree that if (unlike them, but like me) you do something that you could get social approval for, you have to resist becoming a social approval slut rather than being focused on what's really good, but I think it trades off against other considerations. And I think that if you think about that *too* much, then at some level you start becoming an actual masochist who is optimizing for your own suffering rather than make anyone better (Should I help this orphan? No, I would enjoy seeing the smile on his face. Better whack myself in the head with a cactus instead!) and that the point where I worried about posting this for those considerations would cross that line.
I try to discuss these issues more at https://www.astralcodexten.com/p/the-prophet-and-caesars-wife . I feel like there's an old (Robin Hanson?) post promoting being public about your altruism, but I can't find it now.
I'm finally reading Elephant in the Brain, which unsurprisingly is very fascinating, but the most fascinating thing so far is that 95% of (monetary) donations people make is due to solicitation (as opposed to unprompted decision). For organ donations the percentage would likely be even higher, and a respected public figure leading by example is up there in terms of effective mass solicitation.
This is an impressively calm and polite response to an infuriating comment. If I were in your position I would probably be banning myself from my own blog right now.
Congratulations on making such a big (& effective) altruistic sacrifice. Any warm fuzzies & reputational benefits you get from this are very well deserved!
Hear, hear!
I'm fairly sure that in a couple of years time they're going to end up selling the castle because they'll find that they're not using it as much as they expected, and the upkeep costs are way more than they imagined.
This doesn't mean they are not good people, nor am I saying they are not. Just that the castle decision is not a good one.
If they end up using it below capacity for their own purposes, they don't necessarily need to sell outright to recoup the cost. Could simply rent it out to others similarly dissatisfied with pre-existing conference-center venues, then spend net revenue from that on EA. That would effectively mean they were now working at least partly in the real-estate-management business, but if that's where the big money is, and the money still ultimately gets spent on saving lives as efficiently as possible, why shouldn't they?
Renting it out might be a good idea, but it's more work and cost than it sounds like.
I would be interested to see a good argument in favor of buying the Abbey being a good idea.
To my understanding, the case for is:
>CEA (Now EVF) hosted conferences, and aspired to host more and more regularly, and owning a permanent conference center would be more economical than renting every time.
>The Abbey was a large, seemingly suitable property in a good location, and on the market.
>Open Phil wanted to invest in the movement by spending money.
The case against:
>Horrible optics.
>Other properties were apparently available for cheaper.
>It is a Grade 1 listed building, as such any modifications become significantly harder should they become necessary, compared to other properties which could have been cheaper.
>Is it really worth buying a $15m Abbey, or even any sizable real estate, instead of just more malaria nets or something?
Arguments made in favor that I don't think are actually in the case for:
> The Abbey purchase was made with a specific grant with funds earmarked for it by the donor. However the donor was Open Phil who presumably could have been nudged towards another purchase, not some eccentric who would only give money to EA for specifically the purchase of the Abbey.
> The Abbey will retain value and can be sold later. I don't think it has been, despite the dramatic changes to the EA funding space after FTX, so I am a bit skeptical this was ever a pro.
https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey
https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey?commentId=3cLRAk98q8jMwhrEc
I don't know the Brits very well, but the American side made a similar decision around buying the Rose Garden Inn (now Lighthaven) building, and project leader Habryka has explained his thought process at length (see some of the comments at https://www.lesswrong.com/posts/9iDw6ugMPk7pmXuyW/lightcone-infrastructure-lesswrong-is-looking-for-funding ). I've also talked to him in person about it, and personally donated to the effort. My extension to the British effort is based partly on this comment thread (https://forum.effectivealtruism.org/posts/oP8YDDJtTGjnH8Nnj/the-lighthaven-campus-is-open-for-bookings?commentId=fNTBeB9CnjrqYx36D) an estimate that the two properties cost approximately the same amount, and vaguely knowing some of the British people involved and trusting their judgment.
My impression is that Lighthaven has gone very well, and the people involved (including me) still endorse their donations and work on it, even though money is tighter now.
(also, awkward to talk about now, but FTX promised every EA organization approximately infinite money in 2021, and if you're the conference-arranging organization and have just been promised infinite money, something like this seems like a pretty obvious next step).
I looked through the thread, and the purchase of the Rose Garden Inn seems like a much better idea than the purchase of the castle.
The Wytham Abbey is a Grade 1 Listed property with all sorts of difficulties in renovation and maintenance. It's gone through a mix of being a private residence and used to host 14 apartments for Oxford. It has terrible optics for being purchased by a charity. The justification appeared to be that it would be used for far more events in the future than had been hosted by CEA in the past, including having residents stay there rather than stay at hotels and commute to a conference center, and would therefor come out ahead, but I am not sure how to find any information on how it has actually been used.
The Rose Garden Inn was a hotel. A nice looking hotel to be sure, but it does seem much more suitable for being the workhorse of an organization that will regularly be hosting large groups of different people. It has much better optics, I don't think anybody has complained about ' charity org buys hotel/conference venue for people to stay at for conferences', or would to the same magnitude as 'charity org buys castle to turn into conference center'. It seems like it's up and running, and is offered for cheaper compared to traditional conference center per day per person costs that I saw thrown around in the Abbey threads. I think it was a good move. It is an actual event venue good for running events that is already being used for running events and may actually be profitable to own.
I wouldn't mind CEA buying a normal hotel/conference venue, quickly turning it around, making it available for use for likeminded groups at a cheap/subsidized? price. I think that's what the goal was with Rose Garden Inn and it worked out really well. Instead, CEA bought Wytham Abbey, which has terrible optics, seemingly less capacity, more building restrictions, less liquidity as such a specialized property, and while I haven't been exhaustive the original post about it was edited on 9/1/2023 and didn't add any information about it currently being in use.
Reading more about the Rose Garden Inn has only more convinced me that the Abbey purchase was a mistake, it seems like after 'Step 1: It would be a good idea to own a permanent conference center' they diverged drastically.
To be clear I don't know much about either transaction but I do have much stronger priors against charities buying castles
Are you worried about people lying about donating kidneys to appear virtuous? Or being peer-pressured into donating kidneys when they don't really want to? Neither of these seem likely.
If you're virtuous, people *ought* to know it. Transparency existed in (paleolithic/metaphoric) Eden. We abhor it today because we don't trust others to follow suit and therefore fear society judging us uniquely anti-virtuous, thereupon becoming subject to the tender ministrations for which the mob is so rightly famous. The consolation of such correctives being administered in the news and courthouses rather than on your doorstep fails to assuage the perturbations of most minds.
But a standard of openness? Why that would be lovely. And it might just help us choose the right people for leadership too.
On a personal note, I consider it a moral virtue to share about myself that I donated two kidneys and also that despite lacking the normal executive skills of even your average 10 year old, I managed against seemingly insurmountable odds to save the life of an old man who was being tortured to death in Chechnya.
EDIT: I did not actually donate any kidneys. The most I did in this regard was speak about Zell Krivinsky for 3 days straight on my radio show after after he donated his own kidney.
But yeah, in an improved society we would definitely be taking into account the red's "needs and abilities" thing, and thus through public discussion come up with a means for resolving (among other things) the distribution of kidneys.
Ideally we'd manage it with a lot less force and at least a touch less gulag.
Instead we might, I don't know, accord honor and love to those who enjoy utilizing their abilities to solve the needs of their brothers?
While my claim of having donated ≥ 2 kidneys is apocryphal, my claim to have rescued an elderly, terifed, abused and doomed stranger is 100% true.
Months earlier I had achieved something like total self abnegation wheresoever my own comfort or pleasure could be keeping me from doing al I could for the life and happiness of my fellow human beings.
I'm sure it sounds mad or bad but it wasn't. It felt good and was good. It was eventually necessary to transcend and to reacquire a biased interest in the individual human unit in whose body I happen to live, but I do not regret having achieved what I imagine very few people have ever achieved. I mention it because it's the only way that something so far beyond my own ken could have even come to my attention, never mind be resolved by me.
When it came to my attention I immediately swore off food, mattress, small talk, etc. and set about informing the various relevant powers and authorities, which turned into negotiating betwixt them which turned into the realization that he was going to be murdered on Adolf Hitler's birthday unless I find a way to free him myself. And, God (or whatever name you might call astonishing Reality) helped me save his life.
All his teeth had been drilled out and he was missing fingers. He had been starved and made to suffer incomprehensible tortures but because of me and only because of me, an old Jewish man was not murdered on Hitler's birthday but was instead rescued on the first day of Passover.
And, much as I was trained to believe and act otherwise by sklavenmoral's third rail, I now believe that it is good for people to know this about me and I am acting upon that belief right now.
I can't tell if this is a joke, fiction, satire, or what, but what on earth are you talking about? Who did you rescue, what was the total self abnegation, and what is sklavenmoral's third rail?
Hey JC, wuddup? If you didn't grok my words on even a macro level there's hardly any point in addressing your micro queries 🤷♂️
I'm here for the people who do understand me - or at least want to.
I'm not here to respond to comments that include the words "what on earth are you talking about" 🤣🤣🤣
I would love to understand you.
You are welcome to read my blog, available by clicking on my avatar to the left, and also to check out my videos on www.youtube.com/@ydydy
But if even if you tell no one, you'll still know yourself, and it will affect your future behavior. This is the missing factor that causes the "ice bath" solution to rise to a score of 3, tying with the Weill center. By having charitable deeds thrust upon them, the donor can remain uncorrupted by virtue.
Taking this further, the truly noble thing to do is to donate other people's kidneys against their will.
And even nobler would be to force yourself, against your own will, to shudderingly harvest other people's kidneys and donate them to save people whom you'd rather be trolling.
Or even better, blackmail or take hostages to get someone else to do the unwilling harvesting! We can keep adding extra layers of rabbinic fences to protect us from the horror of altruism.
Come to think of it, this is probably how a D&D Lawful Evil society arranges to do things that are socially useful but which also count as "Good".
Evil, certainly, but prima facie, I'd have to say this madness is Chaotic as … the Abyss.
Heros have been doing this for a while.
https://youtu.be/D_5nLxZVoPo?feature=shared
Isn't that the same kind of ethical dilemma as the trolley problem - the surgeon who can kill one patient to save five others, or however it goes?
If it's the superior choice to pull the switch on the trolley, then becoming a surgeon so you can harvest organs from non-consenting (because you never asked them, because if you asked they might refuse) donors is also the superior choice!
Hey David Khoop, does the same go for mean-spirited gotchas? I mean, isn't it more dignified and pure to hit the recipient with them in private? If you do them on a forum like this, there's a danger you'll slide into looking for an angle to gotcha from just for the pleasure of being seen biting somebody's butt in public.
Was there really a need to tell the whole world you are a human faceache?
People were wondering even last night as to where Scott was or what he was doing. Now he's told us. And he's told us about how to go about donating a kidney if we want to do so.
This is not the charity of the Pharisees, this is informing us about the need for organ donations and the way to go about it, and the likely obstacles in your way. This is not "look at me, how virtuous I am" - which, by the way, is how *you* come across; "I would *never* tell anyone about my good deeds, amn't I so special?"
Like the apostles complaining about the ointment that could have been sold and the money given to the poor, yeah, you're so specially good.
Buying a castle is self-serving. Donating a kidney is not.
My wife is in kidney failure and is on dialysis. We have the same blood type, and when she becomes eligible for a transplant (she currently has other conditions that make her ineligible in the United States), I intend to offer one of mine, assuming I'm qualified to donate.
Good luck!
I'm happy for you! My apologies for complaining about the lack of posts just yesterday.
As a PhD student, I used to grow kidney organoids - small clumps of kidney tissue derived from embryonic kidney progenitor cells (or Yamanaka-factors induced stem cells). They were amorphous in shape and couldn't grow past a very small size limit: there were no blood vessels inside, and the center of the organoid would begin to necrotize from lack of oxygen. Growing a full-sized kidney in a lab would require a much better understanding of vascularization during embryogenesis.
A cool workaround I once saw in a Finnish lab was to literally 3D-print a microchannel tree, and populate it with thousands of mini-organoids. I haven't been following the field since, so if anyone is aware how close we are to a 3D-printed kidney, let me know.
Also, whenever I told my casual dates what I'm working on, they used to ask "Are you going to steal my kidney?". I would have to explain that I'm literally the least likely person to steal kidneys, since I can just grow them in the lab.
How important of a limiting factor do you think is the risk of it collapsing under its own weight while half-grown?
I've got a weird, tenuous-but-hopeful theory that artificial organs being dependent on microgravity for some key assembly stage might be the key factor that makes early stages of a city-sized station in low earth orbit economically viable. i mean, what else is there that's both high value per kilogram, and has high-volume demand which can't be met more cheaply by building things closer to sea level?
Some kind of ultra pure fibre-optic cable, I think.
I don't really see the potential advantage to making those in space, or how they'd lead to creation of thoroughly human-safe environments which could then build secondary services. Also, saturating low orbit with communication satellites will reduce demand for ground-based fiber - speed of light through air is faster, so a "bent pipe" relay can actually have shorter ping times across continental distances despite the longer path.
https://spectrum.ieee.org/4-products-that-make-sense-to-manufacture-in-orbit
Not sure about scale though. I'm imagining quite a small facility, as part of a mostly whimsical idea for a system where the cables are created as giant lengths trailing out the back of the space station before being parachuted perfectly into position on the Earth's surface!
Ah, of course, diffusion without convection for uniform alloy mixes. Still, that sounds like microgravity is only making certain industrial processes easier and cheaper, rather than "possible at all," and in relatively niche applications.
If artificial organs and tissues overshoot demand for life-saving transplants, retooling into luxury food might be relatively trivial, and there could plausibly be upwards of a billion people who'd eagerly make room in their weekly grocery budget for a few kg of vegan beefsteak.
My only connection to this issue is that I have a friend who attempted to donate a kidney to a stranger through UCSF, and I think ultimately also got rejected or else long-term deferred, for a reason that seemed to also be like "we reject everyone who has an issue that falls into this bucket" rather than "it's plausible that you would actually be endangered if you donated your kidney".
This makes me wonder if UCSF is like super-paranoid about approving kidney donors.
Another thing that could fall under point #7: I think the kidney donation charities or maybe insurance companies are also willing to pay some expenses of a friend or family member to support you in connection with the kidney donation. So you might be able to, for example, take a significant other with you at no charge to you, even if you had to travel for the surgery.
"Open Phil gave most of the funding for the purchase of Wytham Abbey (a small part of the costs were also committed by Owen and his wife, as a signal of “skin in the game”)." https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey?commentId=3cLRAk98q8jMwhrEc
I was really hoping you hadn't been posting because your wife had had a baby.
Oh well.
You're a better man than I. God bless you.
It's ... not exactly bringing a **new** life into the world, but the counter still got incremented?
Not sure. If a certain ex-boss of mine got the kidney: Nope. - But you got me thinking: What is the second best use of Scott's body tissue to better the world? (The best is his use of his brain to write.) Obviously: sperm. Most likely the UCSF would turn him down - If I were female, I would not. Now I wonder: Why I do not see offers like this more often in the comment section (I saw one on ssc)?
you mean "Scott, have my babies"? lol
;) More: "Scott, I * have YOUR babies". Where * could be: would/will/want to/pray you shall soon.
As an oppressed, transsexual lesbian (ht Titania), I am a non-menstruating person - and can not.
No need to call me Loretta, though. "Embarrassing fanboy" suffices. https://www.youtube.com/watch?v=jlo7YZW8vPA
+1
I was afraid the pause had something to do with the 7th October massacre - e.g. Scott decided to fight for Israel (unlikely as it sounds).
Still hoping to read whatever he has to say about it and the subsequent events.
> $10,000 per year for 10 years
Ah, I see, this is a "trick desperate or low-intelligence people into serving the greater good" sort of deal. That's the only way to describe someone who would actually act upon a promise by the government not to screw them over using the tax code for the next 11 years.
Huh, I distrust the government in a lot of ways but this seems like the opposite of the usual failure mode. Would you like to make a bet on whether the first person to get promised this gets their full payout? Feel free to name the amount and any other terms you find relevant.
My model of DavidC would be reluctant to take the bet. The *first* person to get promised this might get a lot of media attention incentivising the government to do everything smoothly, even if ten years down the line, when the program has faded into normalcy, we expect things to regress to a mean where the government casually screws later donors over.
I understand it's illegal to pay someone for their kidney, but maybe it's not illegal to offer someone an insurance policy against changes to the tax code? Then maybe there's a solution for folks who trust some private insurance company more than the government. (And if the pro-donation organizations are allowed to compensate you for airfare and lost wages, maybe they can also pay your tax-change-insurance premium too?)
That’s not what’s in contention here right?
Like if the government did some funny business that meant the amount of taxes you needed to pay went up by $10k per year, you would still get the full payout of $10k tax credit per year, but you’d still be paying the same amount of tax overall
Also if you get $10k of tax credit you’d be encouraged to do stuff that might increase the taxes you owe by $10k per year so it’d be hard to separate self-inflicted funny business from state-inflicted funny business for the sake of a bet
Just your taxes would go up by $10k a year? Or everyone's?
Just the people receiving the tax credit, I expect it’s normal behaviour for people receiving tax credits to spend more & thus be taxed more
I don’t have confidence that tax credit recipients would be targets for sneaky tax increases from the government(probably the opposite since those receiving tax credits presumably have lobbying power to negotiate tax credits and that lobbying power is probably good at preventing tax increases too)
At least in the US, you're taxed on income, not on what you spend, so spending more would not lead to being taxed more. If you spent it on tax-deductible things, you'd get taxed less.
I missed this because of substack weirdness. My first thought is that I think it unlikely such a scheme would ever go into effect in the first place, with a higher degree of confidence than my claim about what would happen if it did. That's poor grounds for a bet.
But what Edmund said is probably my better second answer. It'll go until it doesn't; I expect the same thing from SS just like everyone else in my generation[0].
[0] Generalization not guaranteed; use caution when handling this hot take.
It is a weird kind of desperation you're hypothesizing.
refundable tax credits are super normal and common. there's a huge program where low-income people get them (EITC), plus various rich people and businesses get them for all kinds of special programs. i don't think it's politically or legally tenable to mess around with them in a general way, although Congress or a state could pass a special law targeting altruistic kidney donors, which also seems extremely unlikely.
We find it acceptable to financially compensate women for egg donation. Not sure why tax credits for kidney donation should be controversial. I believe Iran offers direct payments for kidney donation which carries a higher risk of undue inducement.
I wonder what the actual free market value of a kidney would be. Probably much smaller than $100K because there's plenty of people desperate enough to do it for $10K... although many of these people would have issues (drug addiction) that would disqualify them.
Not sure. I know we pay $7-10,000 on average in the U.S. for egg donation. In Iran, I believe they pay $4000 for kidney donation. I bet it would be a lot higher in the U.S. but probably not $100K. The other question is who pays? The recipient or the health insurer?
I guess it's because egg donation isn't life-saving, and kidney donation is life-saving, and you can't financially incentivize people to do good things . . ?
More likely the reasoning is that egg donation doesn't intrinsically endanger the donor's health... though holding to such a principle consistently would also ban employers from offering hazard pay for riskier jobs at the same skill level.
That and the fact that taking eggs from a woman doesn't impact her ability to produce eggs in the future. A better analogy to kidney donation would be donating an ovary.
We don't pay people to donate blood either, right? Even though it is also safe and non-permanent
Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
FWIW the linear no-threshold model of cancer risk from radiation is strongly countered by parts of the world which have much higher background radiation, on the order of the 30 millisieverts you avoided but every single year, and they don't appear to have elevated cancer risk. Similar with airline pilots.
> Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
Like, that kidneys don't just grow back after a while?
Can't believe anything without scientific evidence!
He addresses the LNT thing nicely in a footnote.
> In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need.
> This sentence fascinates me because of the hanging “would”. Would, if what?
The answer is a mix of "if they were introduced, perhaps in a superficial 21-minutes-plus-commercial-breaks documentary fashion, to a particular stranger, who was sympathetic and in need of a kidney" and "if it was 'call 1-800-KIDNEYS and book an appointment sometime in the next month, have the surgery and spend a day or two in the hospital recovering' instead of... well, the entire ordeal you describe, minus UCSF's psychiatric proclivities.
It's also a pretty upper-middle-class sort of thing to do, and I think a fair amount of the people answering "yeah, I'd donate a kidney" never have to really seriously consider the question, because if you're not in a position to take a bunch of time off work and life to go fuck around with hospitals and Zoom conferences and piss jugs and then, on top of all that time, take a solid uninterrupted block of time off work and life to go have the thing yanked out and recover then it's really not something you can ever seriously really consider. Not at all trying to sound "check ur privilege, white kidney-donating male" or scoldy. I just mean it in the sense that it's similarly easy for the fox to say he'd easily resist the temptation of the grapes even if they weren't hanging ten feet overhead.
I worry that the Coalition To Modify NOTA is composed to people who are too nice to think of this, so this suggestion might do good: include a provision that the tax credit will not be INCREASED for, say, twenty years. (I don't know if the government is capable of making such long-term commitments though.)
Can you expand on why you think that would be necessary or helpful? It's not obvious to me exactly what downside you're expecting.
Regret from having donated your kidney too early if the tax credit is, say, doubled the year after you do so.
The obvious solution to that is just to make the credit and any future changes to it apply retroactively to some extent.
Yeah, sure, something like that will be at least as good.
There are lots of obvious solutions once you think of this problem (once you accept that it IS one).
That's a good point. I had _not_ thought of that potential downside (or any of the possible solutions to it).
I was wondering if you've considered getting on the bone marrow donor registry, and if you could write about that at some point in the future? Two years ago at the age of 26 I was diagnosed with acute lymphoblastic leukemia. It's the most common childhood cancer, and one that is highly curable in children, but has a mortality rate that increases sharply with age - my prognosis at the outset was about a 60% chance of surviving five years.
For me, and people like me, our best chances at a cure depends on a bone marrow transplant. Leukemia is a cancer of the bone marrow, so the surest thing to do is use chemo and radiation to obliterate all of your bone marrow, and then replace it with a stranger's who doesn't have cancer. But since your bone marrow makes all of your blood, including your immune cells, putting any average Joe's marrow in there would just cause your new blood to viciously reject your entire body, basically. So a recipient and a donor have to be closely matched on a variety of different factors to reduce the chances of this happening. This makes getting as many people on the registry as possible extremely important, and this also means that when someone is contacted about being a donor, you are often the only donor available for the recipient.
Unfortunately, I did not have a match on the registry, so my treatment consisted of chemo only, without transplant. I am in remission but my chances of relapse are a coin toss. Relapsed leukemia is harder to treat, and it would increase my odds for survival if I had an eligible donor were I to have to return to treatment. It would mean a lot to me if you would consider signing up for the registry (it's pretty easy) and writing about the experience. Thank you!
Edit to add a couple of things after the fact: I'd also like to say that unlike many with organ transplants, bone marrow transplant recipients don't have an expected expiration date following transplant. As long as the transplant is successful, and the cancer doesn't come back despite it, a BMT recipient can expect to live for most of their natural lifespan they would have experienced if they hadn't developed cancer, minus the added risk of future cancers that come with the chemo and radiation necessary to prepare you for it.
And, lastly, most people on the registry won't ever be asked to be a donor, but if you are, being a donor doesn't come at much cost or risk: there are lots of screening tests to ensure compatibility (no CTs I think), but it's not as intensive as what you went through for kidney donation. The actual donation process beyond screening consists of the hospital just giving you some drugs that stimulate your body to make extra stem cells, which can make you feel gross for a few days, and then using a machine to run your blood through a filter that collects those stem cells before placing the rest of your blood back in your body. It takes a couple of hours and I've heard it's a pretty cool experience! Plus, if you and your recipient both consent, the registry will connect both of you two years on so that you can meet each other.
I second this. (I'm healthy and on the registry for many years now, never been approached)
Thirded (I’m also on the bone marrow registry)
Fourthed ( I was on the bone marrow registry for decades but aged out )
I think there is not much to write about until you get the to actual donation part. My registry contacted me once about a potential match, asked me to re-submit my swabs, and I never heard about it again. I hope they found a better match for that person.
Yeah, this is a good idea. I've been kind of scared because I heard it was really painful, but I'll just tell myself that it's a low chance of ever getting called up.
It's not painful anymore! In the past it was, they cored your bone to take some of your marrow. But now they just give you filgrastim (I think) and collect the extra stem cells you now have floating around in your blood a few days afterwards.
Despite having never experienced a catheter I was already a bit afraid of them. This didn't help.
Never had one put in. The idea unnerves me more than the kidney removal. I’d need a healthy helping of Midazolam just to get through that.
I had. Don't remember any problems. Compared to the things I do remember from that time that suggests an upper bound of perhaps 4/10 pain lasting seconds, but more likely just discomfort.
FWIW: I have a phobia around tubes-in-my-tubes so catheters are a proudly horrifying idea to me; even IVs are really upsetting. But when I had to have a urinary catheter during and after abdominal surgery, it bothered me much less than I ever would have imagined a priori. Initially, I was feeling too fragile and exhausted and hit-by-a-truck to care -- these are standard postop feels; painkillers help, even if you aren’t in much pain per se, and it passes -- to be able to muster any f*cks, and when I returned to myself a bit more, it was an already existing situation and causing me literally zero discomfort, so I took a deep breath and focused elsewhere. Even removal was pedestrian. *Extremely* sympathetic about Scott’s bad experience with that.
> It starts with wanting, just once, do a good thing that will make people like you more instead of less.
Then consider this my contribution to the world: I think this behavior is about as admirable as men castrating themselves for religious reasons, or Xhosa killing their cattle for religious reasons.
A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
> I asked them if there was anything I could do. They said maybe I could go to therapy for six months, then apply again.
On the other hand, I find this to be even weirder than the post presents it as being. This remediation makes sense if the concern is that your OCD of 20 years ago might be prompting you to make an unsound decision to donate a kidney today. If the concern is that there's something wrong with your kidney, therapy is pretty well guaranteed not to address that.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
Because it saves a life?
Sometimes the money will do that, and sometimes the kidney won't. The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
As someone who's considered donating their own kidney for a few years (not from EAs), but is on the fence about it, I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'. I also admittedly find your contentious framing not very helpful, maybe you can rephrase in a way more conducive to changing the minds of fence-sitters like me?
> I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'.
I'm not really sure what the contrast you're drawing is. I was drawing a contrast between people who pressure you into injuring yourself financially ("bad") and people who pressure you into injuring yourself physically ("good"). I'm not sure what the opinion of society in general would be about a group that pressured its members into doing both of those things, but I suspect it would lean toward "bad".
My objections here are stronger than, but similar to, one of my main objections to EA in general: I don't think it's a good idea to "make charitable efforts" in the abstract. You should have a first-order goal. If an EA's goal is "give to charities that are rated highly by GiveWell", they are just as vulnerable to their donations being wasted as everyone else is, because there's nothing they're actually trying to accomplish. There is no future state of the world that would inform them whether, when they previously donated to a recommended charity, that worked out well or poorly.
So, according to me, your charitable efforts should be directed at things that you think are problems. The tycoon who funds high-powered basketball contracts for his local team is concretely addressing a problem that he can perceive (and that other people in his community share!). He counts as more charitable than the person whose goal is "donate to the proper charity, whichever one that is, I'll ask someone else".
If your advocacy for kidney donation is based on your need for a kidney, or your personal scars left by a loved one who needed a kidney, I will call it admirable. If you do the same advocacy because you think calling on other people to donate kidneys sounds like the type of thing you should do, I will call it reprehensible.
And similarly, if your donation of a kidney is motivated by the need of someone you care about, I will call it admirable, but if your donation of a kidney is motivated by the need of someone you've never heard of, I will call it stupid.
Your comment reminds me of something I read (I forget where) denouncing "nonempathic altruism." The point was that you ought to CARE about the people you're supposedly trying to help.
On the other side, Paul Bloom wrote a book *Against Empathy* which partly argues that caring is sometimes irrelevant or counterproductive.
I'm somewhat confused about my position on this.
> The point was that you ought to CARE about the people you're supposedly trying to help.
But I don't agree with that point. I'm saying you ought to be trying to solve things that are problems for you, and you shouldn't be trying to solve things that aren't problems for you. There are two primary reasons: (1) if you follow this policy, you will be able to tell whether the problems are getting better or worse; (2) the fact that you personally have a problem serves as evidence that at least one person has a problem.
This may intersect with your interpretation in that, if you care about the people you're supposedly trying to help, then their suffering is a problem for you. But the analysis is different. Note that I called advocacy reprehensible (you are setting out to hurt other people) and donation stupid (you are hurting yourself). By my reading of your comment, you think I'm calling donation reprehensible.
If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate? What about if he had the option of meeting the recipient, but for some reason it didn't happen?
Do you have to know them in advance? I've volunteered at a place that feeds homeless people. I knew no one involved when I started, but got to know a few people while doing it. In a way, it was a sacrifice of my time, which is like a sacrifice of my life. But in another way, it was an experience that became part of my life. Perhaps Scott wants this experience to be part of his life.
There was a fascinating EconTalk podcast, almost a decade ago: 2014-07-14, "D. G. Myers on Cancer, Dying, and Living". In it, Myers said something that I think was profound, even though I'm not religious: "[God] didn't *plan* it; this is the history He wanted for me."
> If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate?
To the second question, that would be the difference between trying to address a problem that you have, and trying to afflict yourself with a problem to address. I don't see them as similar.
To the first question, let me answer in a larger scope: the propriety of donating a kidney depends on how strongly you are connected to the recipient. Having met them is not necessary (but would, if the donation were appropriate, almost always have happened) or sufficient.
> Perhaps Scott wants this experience to be part of his life.
That would not be enough to make his decision admirable.
No one in this story was pressured into doing anything. Scott made a choice of his own volition.
Yes, making a choice of your own volition is how being pressured works. That's why it's not called "being coerced".
"You don't personally know the person you're trying to help/their scars are not your personal scars" is different from "there is nothing you're trying to accomplish". "Helping people you don't know personally" is a thing one can try to accomplish.
Also, there is no such thing as "making charitable efforts" in the abstract. It requires doing a concrete thing with actual effects, such as picking a particular charity and supporting them. Helping people you don't know is not helping abstract people in some Platonic realm, they're actual people, they just don't happen to be on your list of friends.
Helping only those on your friends list is _very_ limiting. What if my friends are doing OK, but I know that some other people are not? Am I supposed to pretend that those are just stories told by malicious Djinn and the only things that are real are the things I see with my own eyes while personally present, not even a direct video feed counts, because someone might have faked the video? It's theoretically possible that someone might fake any video I see, sure. But I'm not that much of a solipsist. I can even (shock, horror) read a book and believe there's a decent chance the words in it relate to actual things, despite the fact that creating a book that says false things is easier than creating one that says true things. Shockingly, I can believe that the words I read before writing this post were probably written by a real person who will later read my words and be affected by them in some way, even though this is _an Internet comments section_. Admittedly, sometimes I do doubt whether something I read on the Internet was written by an actual person and suspect I'm wasting my time, but for the most part, the conversations I engage in seem worth it. And similarly, sending money or useful goods or services to people I've never met through an organization composed of strangers, based on information written by other strangers about places far away, often just works as advertised, as best I can tell. Sometimes not, but often so.
According to you, my charitable efforts should be directed at things I think are problems. Well, I agree, that's obvious. I just think, like, people dying all over the place in developing countries or suffering because of stupid things that can be fixed for a few bucks _is a problem_, even if I don't know their names. It's a problem I'd like to do something about. And there are means available for me to do that, and requiring me to make new friends first seems like an awful and useless hurdle. And thousands of people waiting on an organ recipient list, is also a problem, and one which there are means to solve. I can see how you might be concerned that someone might spend some money I give them on something for themselves rather than something helpful to the people I want to help, but like, what's the equivalent of that, for kidneys? You can't buy a yacht with kidneys. Most likely if I donate one, the doctors will try hard to make sure it gets into someone who needs one.
Not really, it's more about directness and probability. The kidney goes to a particular person, who has a known high probability of living because a specific thing that was wrong got fixed. The money is fungible, and with regards to "cults", the phrase "hookers and blow" comes to mind.
... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA, they're also quite good at providing the numbers and math for what the money will do, which in this regard puts them ahead of pretty much every other group out there.
> ... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA,
Look at Scott's description of his decision-making process:
> my girlfriend ending up begging me not to donate, and I caved.
> When I talked to my family and non-EA friends about wanting to donate, the usual reaction was “You want to what?!” and then trying to convince me this was unfair to my wife or my potential future children or whatever. When I talked to my EA friends, the reaction was at least “Cool!”. But pretty often it was “Oh yeah, I donated two years ago, want to see my scar?”
> After I submitted the donation form, I was evaluated by a horde of indistinguishable women.
> they all had questions like “Are you sure you want to do this?” and “Are you going to regret this later?” and “Is anyone pressuring you to do this?” and “Are you sure you want to do this?”
On the one hand, you have everyone close to Scott, plus the impersonal medical system, stressing that this is a bad idea and he shouldn't do it. On the other, you have a group of erratic weirdos who like to talk each other into following through on bad ideas, and they provide support, encouragement, and role models for this one.
One could say the same thing about a group of slavery abolitionists 200 years ago.
Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
> One could say the same thing about a group of slavery abolitionists 200 years ago.
I'm not sure what "the same thing" refers to. That they were a cult? That their characteristic behaviors were due to pressure from other abolitionists? That they liked to talk each other into following through on bad ideas?
I don't quite see the parallels there. It would be easier to say they could also be described as erratic weirdos, but I don't really see that as a central theme of my comment above. I included that to form a closer parallel to the paradigm of "cult".
Yes, one could, and I WOULD, say the same thing about slavery abolitionists. And about vegans. And about abortion abolitionists. And libertarians and anarchists. And men's rights activists, and white civil rights advocates. (I made sure to list a few causes I personally support.)
There are many causes that seem (and therefore ARE) righteous to those on the inside while simultaneously insane and/or evil to the vast majority outside.
The heuristic about avoiding cults is very good. But beware of heuristics that almost always work: https://www.astralcodexten.com/p/heuristics-that-almost-always-work.
> Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
Note that this argument is incoherent. Those questions are not important things to ask, unless the action they apply to is recognized as a bad idea. If the cashier at Taco Bell made sure to ask whether you were being coerced before ringing up your order, it wouldn't be possible to explain that by invoking the idea that the question was important to ask, because, obviously, it isn't. Instead, we would explain that by reference to the cashier being mentally unsound.
The premise that asking the questions is important already assumes that the course of action is a bad idea.
If it's irreplaceable you're concerned about, you could donate half your liver (it'll grow back!) or some bone marrow.
"A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?"
Because you're not handing it over TO the cult, duh.
"Indiana Jones and the Temple of Doom" would beg to differ.
I agree, because the leaders of this movement are installing 90% of donated kidneys into themselves, gaining the ability to filter spacetime itself.
For most people, the problem with giving your money to the cult is that it flows into the pockets of the charlatan at the top rather than toward any sort of greater good. Perhaps you find altruism in general to be a repellant concept; this certainly seems to be the case from subsequent responses. You claim to advocate for altruism that solves some defined problem. Yet Scott's kidney was successfully implanted in someone who needed one. That's a definite, concrete change in world state, unlike giving money to a broad, generic 501(c)(3).
But at least this post was silly enough to get me to register.
With opinions like that, you'll always have a job available at the Guardian if you want it!
I think you genuinely hold this opinion, but are also a troll.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
I'm sure you really do hold values that render altruistic acts like this contemptible, groups that encourage them reprehensible, etc. etc. But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings), followed by a rhetorical question that could not be posed in good faith by someone who had spent more than 5 seconds thinking about it.
Everyone else, please consider following the ancient wisdom and Not Feeding The Trolls.
> It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
This is an interesting contrast with my response to MoonMoth, which he didn't agree with:
> The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
You've come along to argue much more forcefully that what's important to you is that the money recipient is not worthy and the kidney recipient is. That still hasn't been established.
I am noting that the harm suffered by the victim is worse in the scenario we're being called to admire than in the scenario we all politely agree to vilify, and that this is incongruous.
> But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies
When someone makes a big public announcement "I've started cutting myself. My parents don't like it, but I'm doing it anyway because I want the public acclaim" ... when could possibly be a better or more appropriate time to respond with public condemnation and scorn?
> a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings)
This I just see as wishful thinking on your part. They're close analogies. They're not exact analogies.
I think the concern is that OCD can cause obsessive thoughts like not being good enough and needing to do more, scrupulosity, which seems like a bad reason to donate.
No arguments, no discussion, just: Im reading you for about twenty years now, and you never stop to amaze me. Blessed be you.
<3
(either your calculation of years is off, or I somehow knew you in college - are you an old friend under a different name)
I found your very first blog by accident when a book review on native indians you wrote became famous, I read it, loved it, and then went to the first of your posts on that blog, where you described a hike after finishing high school. Loved that and then never stopped reading your stuff since.
Yup. Scott's awesome. I'm an occasional reader and a big fan. Brilliant, funny, knowledgeable, kind, about as honest as one can be in the world of online opinionating and usually correct as well.
Never met him yet but the dude's awesome.
Just want to say how it never fails to surprise me to encounter people in their 30’s who never have experienced anesthesia.
Out of curiosity, why? My prior is the opposite (assuming you mean general anaesthetic) so I am metasurprised by your surprise. But I don't know the numbers.
Childhood trauma of course, what else :)
But seriously, I had some broken bones as a kid, and so had my best friend, and then many people I knew growing up (some similar to what Xpym describes, dumb mistakes resulting in unpleasantness) had various surgeon encounters. So I grew up with a prior "most people have been in an OP".
And whose parents don't get swindled to put their 17.9-year-old under general anesthesia to remove ONE wisdom tooth "while your insurance still covers it"?
Several years later, we all learned that wisdom teeth can just as easily be removed under under local anesthesia.
This makes me wonder if this is a UK-US distinction. A quick bit of Googling suggests that indeed general anaesthetics administered per capita per year is on the order of two times larger in the US than here in the UK.
That would explain it! Are you in the UK? Here in the US pretty much everyone gets it at some point..
I had a wisdom tooth extracted with only Nitrous, didn't hurt at all. YMMV.
because you'd be very lucky to never have had any minor surgery that required it - it's very common for all sorts of things
I'm in mid-thirties and only once had a minor surgery under anesthesia, which happened due to a dumb mistake that I might as well not had made.
I avoided any medical interventions until my forties when I did have to be sedated under general anaesthesia for an endometrial biopsy. One of my siblings, on the other hand, was sickly from a baby onwards and had several hospital stays. Luck of the draw, I guess? 🤷♀️
I didn't have it until my first colonoscopy. I've also never been hospitalized except for one overnight where it was possible I had had a heart attack but it was acid reflux, which, for those who haven't had the severe form, feels like getting kicked in the stomach.
N = 1, I had general anesthesia for the first time in my life when in my mid 70's. Maybe just lucky.
Thank you everyone, quite a variation of experiences!
Three things:
1. How do you know it was zoom doing it? Maybe they were spontaneously donating body parts and replacing them with UCSF insignia.
2. The Pros and Cons chart is flawed. It weights each factor equally. I, for one, definitely value some more than others. Cornell may not be on top after all.
3. "previous living kidney donors" sounds more Halloweeny than was probably intended.
Beyond that, congratulations!
lol'd:
"I make fun of Vox journalists a lot, but I want to give them credit where credit is due: they contain valuable organs, which can be harvested and given to others."
"I practiced rehearsing the words “I have never donated to charity, and if I did, I certainly wouldn’t care whether it was effective or not”."
"When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month."
"I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria"
I'm glad you didn't donate your sense of humor.
I didn't read as far as the 4th section (and shame on you for tricking me into reading what I'd avoided! 😂) but when I read the first one I laughed out loud and wamted to share that but had no other comment to make on it.
I recently came across one of his corrections that read something like, 'whole I agree that (x y z)... saying that Vox isn't absolute garbage may have been overstating it'.
I started typing a comment but I realized it would be so long I might as well work on a "Contra" style article for "Why you should not donate a kidney".
If you are a person that's seriously considering donating a kidney please consider contacting me at george @ cerebralab . com -- so that I may try to dissuade you.
I think this would help me write a better article by having a motivated adversary with skin in the game.
P.S. In case Scott is reading this I'm obviously *not* claiming that donating a kidney isn't an altruistic act. I think that you are a fantastic person as always for doing this, I am just against encouraging people to do it because the uncertainty around outcomes seems immense and potentially bleak. Which still means that on-average you saved QALYs and contributed to social cohesion making you an all-around good person for doing this.
P.P.S Hopefully no new rules around posting emails in comments, if one exists and I'm breaking it, I'm sorry
Definitely interested in your thoughts about this, though I'm against donating kidneys.
what's your email? I'll send a draft
How transferable is the 'kidney credit'? My wife is at elevated risk of someday needing a kidney, so I always figured I should keep my spare in case she needs it. I would be very upset if I gave it to somebody else now, and then 20 years later found myself unable to leverage my past donation to bump her to the top of the current recipient list.
I'm not sure I understand your question. You could always put her as the only person on your list of people you were giving a credit to. But I'm just guessing here - if you're really interested in this, you should contact WaitListZero (link at the bottom of the post) and ask them.
Sorry for the confusion, I missed your footnote #7, it answers my question -- this is good to know! It actually makes it so that if I gave somebody else my kidney now, I could designate my wife at present to be the beneficiary of some other kidney in the future. It's like kidney insurance -- in the event she that outlived me and needed a kidney when I'm no longer around to give her one (or I'm just too old to be a donor) she could get one on account of my having given one away before. Duly updated!
Could I put my future unborn children on that list? If I don't know their names yet?
I was also wondering about this. Or if the names could otherwise be changes, what incentives that creates.
The only thing that bothers me about this is the opioids bit. When my father had issues with a kidney stone, they gave him morphine, and he was in utter amazement of how effective they were, and came out of the experience saying "I can understand how people get addicted to this stuff." I've heard about how people getting their start on opioids because they're prescribed them following surgery.
When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
It's all well and good that it's a relatively safe surgery, but I'm wary of any unnecessary exposure to opioids and would need to know the risks there.
I was looking forward to trying opioids, in a sort of Ulysses-tying-himself-to-the-mast way: I'd heard so many things about them, and wanted a chance to try them without getting arrested.
I joked in the post about how good I felt, but it was actually just a normal amount of pretty good - hard to bother, comfortably warm, easy to drift into pleasant sleep. I tried a higher dose at home when I had my UTI, and had a similar experience, then very unpleasant constipation for the next few days. I currently have a bottle of unused opioid pills on my desk that I haven't touched for a couple of days despite enough pain that I could easily justify it, mostly because of constipation risk. My guess is I'll continue not to use them until the next time I'm in extreme pain for some reason, even though I usually have a pretty experimental approach to medication.
My impression is that happy people without pre-existing mental illnesses or addiction problems rarely get addicted to opioids in the period after a surgery. Partly this is because people with addictive personalities form a separate group who already know this, partly it's because addiction is an interaction between genes and how good your life is, and if your life is good you need to be very genetically unlucky. Partly it's because you'd normally need higher doses, faster-acting chemicals, and longer timespans than a typical post-surgical course to get addicted. And if all else fails, most people won't have the energy/interest/knowledge to find a new source after their prescription runs out.
I think all of this is compatible with the extent of the opioid crisis. I think I remember seeing some studies that people who die in the opioid crisis mostly aren't normal patients who got post-surgical prescriptions, but the people who stole/bought/cajoled opioids from those patients.
Very similar experience here, minus the constipation. Had several occasions to take them after various surgeries. Warm feeling of calmness and not-giving-a-fig. Zero desire to take them after the pain subsided.
That matches my experience as well, with one difference: I kept taking the opioid as prescribed (as in, take X every Y hours) even though I wasn't in pain (because you're supposed to follow the directions, right?). I ended up stopping because I noticed I was getting very irritable in the hour or so before it was time to take my next pill, and I was looking forward more and more to the warm sunny feeling I would get.
I come from a family with a history of alcoholism, so when I realized I was getting irritable I threw them away out of an abundance of caution. Sure did feel good though.
Oh I absolutely ignored the prescription timing and took it only when the pain became really "not ok" (I don't know... 7 out of 10? I never understood this scale, is the 10 "the worst possible"? how would I know what that meant?). I was worried about sliding into dependency without even noticing it.
I got a few opioid pills when I broke my arm a couple of years ago, even though it mostly didn't hurt if I kept it still. I tried one the first day, and in addition to making the pain go away, it also made my PTSD go away. I promptly stopped taking them and have saved the rest in my closet in case things get very bad,. My prediction is that they'll just sit there and eventually expire. Cannabis isn't as effective, and has more side-effects (the whole "stoned" thing), but also is easy to acquire where I am, and has much less potential to be addictive.
But now I have a suspicion about why heroin and Vietnam were so associated.
> When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
When I had my wisdom teeth out, they told me to take Valium beforehand.
Not for any medical reason. It would have provided no benefit at all. But my father didn't know that and he said I should take the Valium because those were the instructions.
My mother, a doctor in an unrelated specialty, supplied her opinion that the Valium had no purpose, and I didn't take it.
But I experienced far more anxiety over the prospect of being forced to take Valium than I did over the concept of having my teeth extracted.
As you might gather from my comment, I am still outraged about this.
I suspect the reason they told you to take Valium beforehand was to keep you from being too nervous about the procedure. The same thing happened to me when I had difficulties with an IUD installation, and I took the Valium, and I thought it was a good thing in that it helped me be calm and easily compliant going into the procedure.
Obviously if the idea of taking Valium causes you more anxiety than getting your teeth extracted than you shouldn’t take it; but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!), just to help you actually show up and let yourself be strapped down to be cut into.
> but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!)
That's the thing, it wasn't offered. No one said "do you want to take some Valium before the procedure?" Instead, they gave me Valium and directed me to take it.
That sounds like being offered to me... what is the difference?
The difference is in whether you have a choice.
I didn't take the Valium, but in order to do that I had to specifically violate medical instructions. I opted into a choice that was notionally forbidden to me. I don't find this acceptable.
You really don't think there's any difference between an offer and a command?
I think it's a little silly to treat a painkiller as a "command" having any authority. It's pretty obviously something that's prescribed as needed and clearly intended as optional.
I've taken opioids after major surgery. Their effect on me was to dial down the pain from a full boil to a simmer. That's it--no psychological effects of bliss or euphoria. Now, I was taking the prescribed dose, and probably if I took a lot more the effect would have been different. Once I healed a bit, I had no problem stopping taking them, and in fact still have a bottle of oxycodones in the back of my bathroom closet.
I have had morphine by IV to kill pain from a dislocated shoulder and kidney stones (separately), and didn't particularly enjoy it. It started with an unpleasant, nervous kind of warmth in indeterminate location, which soon faded, taking down the pain with it. The pain didn't go away, but it seemed more like I no longer cared about it.
I have had Norco and Oxycodone, which worked moderately well.
I have had no inclination toward addiction with any of these, which is only, of course, anecdotal, so your experience may vary. I'm not sure taking prescribed medicines as prescribed is "rolling the dice" unless you have some other prior susceptibility to getting addicted. If you feel a need to refill the prescription after the original need for it (such as pain) has gone away, that would be a bad sign.
I took opioids twice in my life. Once, after I got a wisdom tooth out. I was in pain for days, opioids weren't helping, and I took higher doses than prescribed. I felt no effect whatsoever. No high, no anesthesia, nothing. I even powdered and snorted a pill, to no effect. But there was one effect. I must have gone stupid at some point. I pulled out my dissolvable stitches. And then I forgot about it. I remembered that "the doctor will be angry with me" but I could not remember why. Figured, it must be because I ate three weeks of oxys in 5 days. Surprisingly, he wasn't angry. He gave me more oxys, because I guess you get more of the same thing when you say it's not working. But he said to try Motrin, too. One pill of Motrin took the pain away completely in 15 minutes. One. Frigging. Pill.
(Half a year later, I watched a medical show. On the show, a doctor cautioned her patient to come back to get the stitches out or else they'd heal like a railroad... and that's when I remembered that I'd pulled out my dental stitches!)
Second time, I used my dental leftover opioids for an ear infection. They worked this time. Again, no discernible effect on my mental state.
Since then, I got a pilot's license. Heard a few horror stories about how FAA will make you submit a book's worth of paperwork to prove you didn't get addicted to those 5 pills prescribed after a surgery. So I never took opioids since.
Asking doctors for "something other than opioids" is like a secret password to getting them prescribed to you by the bottleful. Skin infection? Here's some opioids! Minor surgery? Here's a month supply! Dental nerve dying pain? Here you go, to take the edge off on your 6-hour drive to your root canal referral. My apocalyptic meds tote is 60% unopened opioids and 40% every other prescription I hadn't finished. I once told a doctor that I haven't been taking my opioids because they rolled out of the brown baggie and got lost in the car somewhere... so he prescribed me more!
Well, if you asked directly, that'd be Drug-Seeking Behavior, and they could get in trouble.
I don't think I would donate my own kidney, due to various emotional reasons none of which are all that thoroughly-considered... but I would gladly vote in favor of the tax credit. That seems like a rare free lunch in national economics. I hope it gets traction.
Speaking of traction, glad to hear you're on the mend, and great write-up.
Hey, someone else with a Calvin avatar. Hope nobody gets us mixed up. Bill Watterson rules!
Typo: "They found 34 cases extra cases"
Soo, do journalists finally get to claim that AE is a cult that steals people's organs?
ALT
Simpsons did it first (S10E8).
On a less facetious note, I find the data on the safety of kidney donation incredibly unconvincing. Vast majority of donors are elderly and have shared the lifestyle of the recipient for decades (stereotypical old couple situation), so tons of confounders and no good data for young people donating. To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible.
In general, I find myself wishing sometimes transplant medicine would just, dunno, go away. The results I see in my daily practice are always crap (I am the person who gets to stare at the nice little pictures you had taken all day long). It's far from the miracle everybody thinks it to be, and certain subpopulations might actually be worse of getting an organ than without it. There are practically no randomised trials on transplantation, and the devil kidney in me tells me it's because transplant docs know well enough that it would fail when actually trialled in today's population.
The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect.
I hope for your sake this turns out fine, lotsa people with only a single kidney end up as old geezers, but I can't help to think the "advertise kidney donation like blood donation to everyone" moment is a greivous error in the long run and this will fall medicine on its feet colossaly in the years to come. In the short term, this article has demonstrated to me that this blog now espouses values so far from me and mine own that it's probably time to stop reading it.
"To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible."
I think this comment ignores the past few decades of genetics. Figuring out the percent of something which is heritable is vastly easier than figuring out what genes are involved (it's never "the gene responsible", it's usually a mix of hundreds or even thousands). Still, when we do get polygenic algorithms, they've shown that the simpler gene-agnostic methods we used earlier to estimate heritability were right.
Although I agree it's unfortunate that you can't do RCTs for kidney transplantation, statistically adjusted studies continue to show the 5- 7 year lifespan and 20% quality of life gain. Before-and-after surveys of the same people also show the 20% quality of life gain, and people say they feel much healthier. There are obvious practical downsides to dialysis and everything we know about it biochemically suggests it should work less well than a kidney. AFAIK every group of nephrologists and medical evidence-setting body agrees kidney donation works better than dialysis. See for example UpToDate, https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults, ("Kidney transplantation is the treatment of choice for ESKD. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis") and this paper by the National Kidney Foundation: https://sci-hub.st/https://pubmed.ncbi.nlm.nih.gov/18256371/ . Curious if you have any links or evidence supporting your position.
"People don't die from a lack of donor organs - they die from their illnesses" sounds incredibly facile to me - not just "guns don't kill people, people kill people" facile, but "that person didn't die because of the gunshot, he died of blood loss" level facile. Just say that the result of getting one extra organ would be to save one extra life over the counterfactual.
My understanding is that people who are extremely old and decrepit are considered lower down on the list for transplants than everyone else. My grandfather, who was pretty old when he got ESKD, AFAIK was never even told to consider the options.
I agree that we seem to have some pretty irreconcilable value differences.
The main thing we learned from the last decade of genetics is that neither of these methods work. The few diseases that have a strong genetic contribution are practically monogenetic (ApoE4, PCSK9, ...). Whenever a study reports these minimal point estimates for hundreds and thousands of genes, that is essentially the result you would get from a non-genetic disease: hundreds and thousands of genes that minimally contribute to or detract from the overall resilience of the organism. Don't tell the geneticists, though, they'll get upset because they'll loose their funding once the agencies figure it out.
There is a actually a very straightforward reason for the autoimmune kidney disease they found: surgery introduces antigens from the kidneys to the bloodstream, thereby causing immunisation. The mechanism would be the same as in sympathetic opthalmia, where immune-privileged antigens from the intravitreal space get introduced to the immune system at large by trauma or surgery and then cause an autoimmune response to the entire organ system, eventually destroying both eyes. Replace 'eyes' with 'kidneys' and 'vitreal' with 'tubular' and you got yourself a deal, mate.
Re quality of life or survival gains: this is flawed evidence on all levels - without an RCT, the Ioannidis principle comes to mind: in a null field, observed findings are a measure of the prevailing bias. Control groups are likely sicker or historical, i.e. generally worse off. Also, my claim wasn't that this is a negative for all involved or even on average, but that selected subgroups may be worse off with a donor organ. This changes the calculus quite a bit from a medical perspective (you wrote so eloquently about that a few years ago re/ death risk from seroquel), but since no reliable data is being generated, nothing will change for a decade or so at least. When transplantation goes awry, the disease is blamed. When it goes well, the surgery is credited. This is as embarrassing as it has been effective in cementing the practice.
Finally, the argument is not as facile as you would like it to be. There is no moral causality between the availability of donor organs and deaths. Were there, then everybody who is currently keeping their two kidneys for themselves would be a murderer (or whatever your term would be for "person who is obligated to help but doesn't, thereby causing death"). This obligation doesn't exist, though, and previously this was an accepted view amongst medical ethicists. Since the explosion of utilitarianist bullshit in the wake of Singer's success in the academy, this slowly changing, and I dread to think where it will lead us.
I do not think one can compare donating a kidney to someone who needs one to dying of blood loss instead the gunshot. Would you say someone died of cancer, or because we haven't yet found a cure for that cancer?
I do see the point in saying an illness (such as a faulty kidney) killed someone, rather than saying lack of a donor killed someone. The second phrasing seems to me to take away some of the altruistic sense of the kidney donation, making it more of a duty of a donor instead of a freely offered gift.
"The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect."
I don't know, friend; I had a cousin who got a donated kidney and indeed would have died without the transplant operation. He did die several years later, so you could argue that the gain wasn't worth it, but how do you decide the value of "lived extra years to see his children reach adulthood"?
My late father, for reasons we never got adequately explained (I personally think it was due to side-effects of medication) underwent drastic collapse to the point that he had to be resuscitated three times in hospital (and my family was asked, after the first time, did we really want this, with the heavy-handed implication that we should just let him die; my mother refused adamantly to consider this) and was put on dialysis, and eventually sent home from the hospital with the clear, on their part, expectation that they were sending him home to die. He was in his seventies at this stage, so they were going by "well he's had his life, why drag it out?"
My mother and I nursed him back to health, to the point where he was able to be active once again, and was doing so well on dialysis that the hospital considered cutting him down to only once a week (the consultant referred to him as "my miracle man" when doing rounds with medical students, our opinion on that was "yeah this is only because we stopped you guys letting him die"). His eventual death was not due to the kidney problems but a stroke brought on by blood clot due to venous embolism which the casualty department (emergency room) didn't recognise and sent him home with a "sprained ankle". By then he was just starting his eighties, starting to decline, and very lacking in motivation since my mother's death. He was ready to die by then, but he had an extra decade of life because we didn't obediently go along with the hospital about 'let him slip away' the first time.
So while there definitely can be too much intervention where a natural death is better, there's also the opposite where people who could have good remaining years are written off too early.
I will keep reading, but I also definitely realized that Scott's values are dramatically different from my own. But for me, it comes down to the fact that if I'm going to mutilate myself, it has to be a warm decision, and not an output of cold rationality, that is, the kidney would have to be donated to family or someone I love. I mean, I signed the Giving What We Can pledge, but compromising bodily integrity for the sake of a stranger just seems wrong.
However, I wonder if every monastic of every religion in the world could be persuaded to do this, as this would be, after all, consistent with their principles. A quick search suggests this would be 11,000 kidneys, which is nothing to sneeze at.
why read, if not to read those whose values differ from your own
Flattered to have caught your interest, however briefly. You have mentioned you have traditionalist friends, which is really interesting. You ever tried to read Rene Guenon, who is along many axes the anti-thesis of everything you believe? He is not hateful though, don't get it twisted, even if he believes everything since Descartes has been a mistake.
Explain more - what does he think?
Basically, he believes the only possible way a civilization can work is in a traditional manner: spirituality, a legitimate spiritual tradition, needs to be at the very core of the civilization. The last time the West had this was in the Middle Ages, and it all started falling apart with Descartes, till we got to the present day, where spirituality is marginalized. He believed the East to be superior to the West for this reason, though he did not get to see the secularization of China and India.
Along all that there is also the perennialist project: to show that all the various spiritual traditions are actually in agreement in fundamental matters, which does not mean on morality (he regards that as secondary to all this), but rather, on actual metaphysics, truths from beyond.
I really like the work of the perennialists actually: the properly spiritual view is to see the harmonies, or at least, don't let the differences make you think there is an irresolvable conflict.
I agree - I share the intuition that "compromising bodily integrity for the sake of a stranger just seems wrong."
I just wish to say that I am unironically very inspired by "Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
If fucking *Scott Alexander*, possibly the smartest guy I know of, who is constantly genuinely trying to get to the truth and do the right thing, feels that way, well, fuck it. This is just dumb. I thought maybe I felt that way because…well, because they were right. But there's *no way* that *you* should feel that way all the time, so why should I? Fuck that.
Thank you, genuinely, for being you and allowing us to see who you are.
+1
This is a banger and your writing style is great. "My IRB Nightmare" righteous-anger vibes.
Also, typo: "I decided not to submit then)" should be "submit them)"
Thanks, fixed.
Holy nephrectomy, this is inspiring. How inspiring? Let's predict! https://manifold.markets/dreev/how-many-people-will-follow-scott-a
Seemingly we have saints who are patrons of kidney patients (there's a saint for everything!)
First, St. Benedict of Nursia (*the* St Benedict who founded the Benedictines) whose connection seems tenuous; it may have been (pace the British Association of Urological Surgeons) because a king went to Monte Cassino to be cured of bladder stones, or (pace a Catholic website) because his monastic rule was so harsh, the monks tried to poison his kidneys by giving him tainted food and drink:
https://www.baus.org.uk/museum/1416/st_benedict_germany
https://thecatholicgiftstore.com/products/st-benedict-kidney-disease-healing-medal-holy-prayercard
Second, St Marina of Antioch, the patroness of nephrology:
https://pubmed.ncbi.nlm.nih.gov/10213803/
"Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon Satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology."
> This request didn’t get communicated to the surgeon and he told me anyway - but luckily everything did go well.
Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
***
In countries where it is harder to sue hospitals than it is in the US, are decisions like UCSF's re: OCD less common?
***
Do any kidney-transplanting hospitals publish their full list of medical conditions which rule out a potential donor, either due to risk to the donor from the surgery, or risk to the recipient from a potentially subpar kidney? I would appreciate seeing one.
> Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
I suppose the game theoretical problem is ameliorated because no one (?) donates kidneys more than once, so there's never a chance to figure out an individual doctor's pattern of behavior.
I knew someone with 3 kidneys, at least they said so, but google says there are only 100 cases globally so now I am suspicious. But possibly one of them could donate 2 times.
Good kidney, bad kidney, ... ugly kidney?
Brachos is a 🔥 mesechta
The Linear No-Threshold Hypothesis of radiation says that every milliSievert increases your cancer risk. It does not. Humans cope and even seem to thrive with a background level of radiation. Prof Richard A. Muller (the Physics for Future Presidents guy) has thoroughly debunked LNT. That the NIH supports it is further evidence that it is nonsense.
I think there are two things going on:
1. Without saying outright that I trust the NIH more than I trust some person who is "the Physics For Future Presidents guy", I don't trust the Physics For Future Presidents guy *so much* more that I will totally ignore the NIH's view and not even consider it at all.
2. 100 mSv has been empirically demonstrated to increase cancer risk, so if there's a threshold, it's there or lower. The CT I was worried about was 30 mSv. So to not worry about the CT, you would have to claim both that NIH is wrong and there is a threshold, and also that the threshold is definitely between 100 mSv and 30 mSv (and not, say, 10 mSV). I don't really see any evidence for that, so even if there is a threshold, I'm worried the test might fall above it.
That's quite funny -- both points.
What characterizes the countries with the highest per capita rates of living-donor kidney donation?
(Should those rates be adjusted for average age? For the probability that a potential donation will find a recipient? For anything else?)
The probability calculation of 1/660 doesn't seem at all correct to me. Every Sievert, you say, raises your risk of dying of cancer by 5%. But that's raising it from *whatever the current rate is*, which is... okay, a quick google says that cancer mortality in men is something like 200/100,000. So 30 milliSieverts would raise your risk by a total of 200/100,000 * 1/660, which is more like 1/330,000. (Or, I guess, raises your cancer risk by 1/110,000).
Came here to make a similar point.The linked article says "5% excess risk of death from cancer" and then has citations I can't reasonably follow; I can't tell whether that should be understood as (5% excess risk of death)(from cancer) [i.e. the cancer risk amounts to 5% increase in all-cause mortality] or (5% excess risk of) (death from cancer).
More glaringly, Scott writes:
"the risk of dying from the screening exam was 1/660. ... I regret to inform you she might be right. ... a 30 mS dose increases death risk about one part in 660."
Two very different statements! Does the scan have a 0.15% chance of leading to your death, or does it increase your odds of dying by 0.15%? The former seems crazily high, but contextually it's being compared to the risk of surgery, where the figures really are about the risk of the procedure killing you.
Anyway, Scott, if you see this, congratulations and good on you - just want to make sure you're not unnecessarily making kidney donation sound scarier!
Huh. I admit I didn't look super closely at the citation last night -- I looked a bit at them this morning and they are hard to follow, though I *think* they might actually mean that they do think a 30 mS dose could give a risk of dying of 1/660. What I mostly came away with is thinking that 30mS is a rather high dosage of radiation -- everything in the chart in the article is much less than that. (Also I came away with the idea that... no one really knows, actually.)
And yes, I forgot to say, congratulations Scott and I think that's really great!
Inside of you there is one kidney
> You don’t need to worry about not having a kidney when a friend or family member needs one. When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves.
This was certainly news to me, and makes me feel better about the whole thing, but doesn't the fact remain that your own kidney is much likelier to be a better match for a family member than some other kidney off the list?
I don't know. It's true that your kidney (because of genetic relation) is much better than average. But it might not be better than the best kidney available to the organ bank with hundreds of kidneys available. (I don't understand how this works well enough to be sure it works like this). It also seems like in some cases (eg spouse, relative with different blood type), your kidney wouldn't work at all, and the bank would be a better alternative (though usually the bank would let you make some kind of more direct trade).
I also wonder (1) what are the odds that they will actually "make sure those people get to the top of the list"; is there any accountability for this promise? and (2) is there any way for me to pay somebody with a blank space to write my name? (We could call this "The Taylor Swift trade".)
also (3) what about the lost optionality? It'd suck if your True Soulmate only comes into your life after you've made your list, or if someone on your list dies for unrelated reasons. Really they should just give you a fungible "Good for 1 kidney" token (which you could then trade on the open market because it isn't itself an organ!). (Plus, then maybe they could offer 0.9 tokens for a slightly-substandard kidney. )
I was also wondering about this. (Also about the incentives it would create if your list of names is freely editable.)
Presumably that would be illegal, but I would also think it would be much easier to get away with.
Great post Scott! Lots of love!
I found this post somewhere in my newsletter, and i was surprised that anyone would give precious part of the body to a stranger.
I have kidney disease (they dont work anymore to be honest), located in Europe - and here i never heard about 'random' donors.
Moreover, i personally never asked (and probably will not ask in the future) my friends or family for organ donor. Im overwhelmed about idea asking anyone for something that big and important.
Congrats, you make 30+yrs old man to cry like a baby :)
I really wish you everything best and i admire what you did.
You don't mention where in Europe, but depending on country, it might make sense that you haven't heard of undirected donations — they're illegal in France, for example. I am duly furious about this.
I was just going to say I wouldn’t be the tiniest bit surprised if they were illegal for no reasonable reason.
I thought about donating in Germany, but they are also illegal here for some reason (I blame Catholics), luckily I could also probably donate in the UK if I ever want.
Interesting. I can kind of see the logic for that.
France also bans paternity testing, which is very disturbing.
If this estimate of increased risk assumes the linear no-threshold theory (LNT) -- and a quick look at the cited paper suggests it does -- it's nonsense. Read Jack Devanney's substack on nuclear power, where you will find demolitions of the LNT theory.
See my footnote 2 and discussions above.
My usual admiration for Scott. Even higher than usual if possible. Glad he is alive, was considering open a manifold market: Is Scott in hospital? - Had hoped for an even better reason to be there. And feared for worse - The beginning freaked me out: "As I left the Uber, I saw with horror ..." One of my few wishes left is: May I die before Scott does.
Cheers for NOTA! To keep up the pressure, I shall keep my organs for now. (From an MRI I assume the one kidney is not fine enough to donate, and the fine one I intend to keep.)
Excellent post.
It took me a while to register that Scott was giving an accurate account of what was going on in his life rather than offering a thought experiment or a short story.
I AM a naive reader* and accept most the authors may throw at me. Scott's fictional texts signal early enough what they are + while his life stories are so true, it may hurt. Most his posts are non-fiction (esp. if one discounts the bay-area-parties, we know now). And after such a long break from posting, I was ready to expect a story involving a hospital. The Q of my YL has gone up much by reading Scott. So I care.
*I assume nearly all are. To do better, eventually, reading Bryan Caplan may help me: a) Caplan writes some libertarian stuff, I buy it all. b) Caplan gets into a discussion and lets the other side explain their position. I buy this now 90%. c) Caplan writes why he still disagrees with them; I buy 70%, d) They get one last say: Now I am kinda undecided and have to make up my own mind. ;) Right now at stage b) https://betonit.substack.com/p/sehon-responds-on-socialism
I wonder whether a policy to give a tax deduction rather than tax credits for kidney donation could receive less political opposition. Because it seems the main concern opponents of compensation for kidney donation have is that poor people will donate kidneys for financial reasons in a way that seems morally icky. Whereas with a deduction, due to the existence of the standard deduction, the financial incentives would become active at some level of income while not influencing the behavior of people poorer than that, right? Does anybody more familiar with US taxation and organ donation policy know if there's some number at which such a deduction could be set to alleviate the US kidney shortage while not influencing the behavior of the poorest, say, 1/3 of Americans toward kidney donation?
It seems unfair that the wealthy people who donate would get $100,000 while the poor donors get nothing.
Paying them is bad and not paying them is also bad? You just can't win!
The strategy to win here is to just not be poor in the presence of an ACX commentator talking about morality.
This sounds snide, but also makes no sense.
I think paying them the same amount is good. Another person thinks it's bad.
It's like reading two comments on abortion and observing, "Abortion is bad, but banning abortion is bad. You can't win!" Such is life on controversial issues.
I think in many cases it's the same people.
“It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.” --Kidney Carton
Take this compliment, you dashing devil with your apposite pun, you!
I happen to live very near the "castle" and aside from a one week event for college students when they first bought it, it seems like they haven't actually run any conferences there yet over the last two years, but have continued to rent other venues for retreats and so forth since.
Old buildings can be money holes. I suspect, though don't know, that there are either transportation issues (there's a year+ long road closure on one of the main routes there) or maintenance issues that have prevented it from being used for any conferences as of yet. It's kind of a red flag to me that Oxford University owned it but then sold it as they didn't think it was financially feasible to hold on to. Though to be honest I'm glad it's back in university-associated hands rather than as a private building, as the university owns the rest of the adjacent land. It's a lovely area.
It's in Oxford, which is nice if you're a person living in Oxford, or attending Oxford University, or a professor there.
If you want to attract Business People and International Interested Persons, then London is always going to be a much bigger and better draw (same over here with Dublin versus the rest of the country). Easier to get to for most people, has the infrastructure and associated supports and other companies, entities, state and private organisations, and is just the first place someone would think of, rather than trying to get to a nice little historical village outside of Oxford.
I'm fully expecting it to be a money pit and ending up sold off again in a few years. Reading the defences of the decision to buy it, it seems to me to come down to (1) we had a shit-ton of money and no idea what to spend it on and (2) one particular guy was pushing hard for it and seems to have swayed opinion.
Again, I don't think they're bad people, just people of a certain socio-economic class who don't necessarily realise how their actions will look to the general public. Same as Just Stop Oil having a vegan-catered banquet in a (former?) church premises with accompanying harpist laid on - why did people laugh and cheer on the disruption? Because they're working-class/lower middle-class people inconvenienced by the protests blocking the roads when they're trying to get to work, and they certainly aren't going to be serenaded by classical harpists at work:
https://www.youtube.com/watch?v=gd_tNpyShrY
And of course they look exactly as you'd expect (boots with summer dress) and are humourless: "must be paid by the Daily Mail!"
They want to solve global climate change by stopping oil, which will be easy-peasy to do, everyone just stop using oil - but getting a few balloons down from the ceiling is a very difficult problem, so hard!
https://www.youtube.com/watch?v=8P0bN4Tmel0
I know a retreat held there in the last month, that someone I know attended
Purely anecdotal evidence: I was at a workshop in the castle this month, and the same organizers had done one event there already and were planning to do two(?) more.
Also, a nitpick, as far as I understood, CEA didn't technically buy lent it for the next 100 years.
Kudos to you. Though I am suspicious your evil voice will learn to adapt to the new circumstances, perhaps encroaching on your good voice's turf in the right kidney, or, if the "left" part is important, perhaps claim your left lung?
I looked pretty throughly into kidney donation and even signed up for the first level screening but I ended up chickening out. However, I heard at one point that a screening question that’s commonly asked during the kidney donation process is “do you donate blood?” and I realized it was silly that don’t, given that I was likely eligible and that it’s a much lower risk but also life saving intervention. So I started donating blood and I encourage anyone who’s not quite comfortable with donating a kidney to try donating blood or platelets! The FDA has recently changed screening guidelines so that some previously deferred groups in the US (including gay men who haven’t had a new partner recently and people who have lived in the UK) are now eligible to donate.
+1
Donating blood is really easy, has almost no downsides, and the ones that it has are small (eg avoid exercise for the next 12 hours or so).
Agreed!
Small note: the article you cite from Tom Ash was actually written by Josh Morrison and Thomas Kelly, according to the preface of the post.
Thanks for writing this. I donated as well, and found the experience to be a weirdly effective self-signal. I try to do various altruistic things, from donating money to choosing high-impact jobs, but good signals are costly, and these just aren’t all that costly for me.
That’s probably a bit counter intuitive - what could be most costly than my literal time and resources? That’s all I have! Here’s my thinking: after donations, I still live a life of extreme wealth and comfort compared to the average human, so the opportunity costs of donation are kinda trivial (like, maybe if I didn’t donate, I would buy the new VR headset that just came out, but I don’t suffer greatly because I haven’t done so). As for my job choices, these have coincidentally (suspiciously I might add, in my moments of doubt) been things I find challenging and interesting and rewarding in and of themselves. On top of that, there’s the point you mention that lots of my preferred ways to do good aren’t actually seen as good at all by plenty of critics (and, like, many everyday people too). I’m somewhat prone to imposter syndrome, and it’s easy for me to doubt my own motivations and impact on the world.
Donating a kidney was not only a costly signal of my values (the right balance of costly - annoying but still worth doing), but it also carried a lot of metaphorical resonance for me, since I have a typical secular worldview in which I am nothing over and above my body. Now, when I look at my body in the mirror, I’ll always notice and be reminded that it has a couple faint scars from the time I literally changed it - changed myself - to try to help someone else in a small way. It serves as a reminder that I can do annoying things because I value them, and I can literally change who I am in the process.
This reinforces my identity as someone who wants to do good things for the world, and serves as a healthy reassurance when self-doubt creeps in. So, for strictly non-altruistic reasons related to my general self-image and the narratives I want to tell about my life, I rate kidney donation pretty highly. All the altruism stuff is a great bonus on top of that 😉
So... doesn't that make you biased against viewpoints that would suggest that you shouldn't have donated?
Probably, but I don’t see how that’s relevant — the goal of this comment is just to share an unexpected benefit, not to tell anyone it’s the right choice for them on net.
It doesn't seem like a benefit, though. It seems like it pushes you further down the wrong path and makes it harder for you to turn back.
I guess we have a difference in values - benefit *for me* in that case :)
"Also from my spicy [version of the "Effective Altruism As A Tower Of Assumptions"] essay:
Q: All possible forms of assistance, financial and otherwise, just make recipients worse off, for extremely complicated reasons. There are literally no exceptions to this. I promise I’m not just looking for an excuse not to do charity, I would love to do charity, it’s just that literally every form of charity is counterproductive. Weird, isn’t it?
A: Even kidney donation?"
Now that's what I call putting your kidney where your mouth is! (don't eat your kidney)
Really wish I could "like" these comments so that I can tell someone they're hilarious without diluting the discussion with a contentless comment.
Anyway, that was really funny :)
That sounds offal.
What kind of a technological advance do we need to just start printing out artificial kidneys for anyone who needs one?
Castles need TLC as well, such as repointing stonework as needed, and weeding small trees and other foliage growing near or on walls, or even retiling roofs assuming the place isn't a complete roofless wreck. So the group who bought the castle also deserve some credit for maintaining it, assuming they do so adequately, for the benefit of future generations.
The "In polls" link seems to be wrong or broken?
> Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons.
I was vaguely uncomfortable reading part IV - the one about the castles and the fuzzies and the utilons - and I guess this footnote made it clearer why.
Ten years ago, you wrote that "in all situations, the government of Raikoth will take the normatively correct action." In those ten years of life, having accumulated the moral wisdom that you did, would you say you've gotten closer to embodying these words - not in the sense of *knowing* the correct action, not even in the sense of *actually doing* it, but in the *knowing that you know* sense?
My impression is that 2023!Scott is, if anything, more reticent about this stuff than ever. This is a problem when Guardian opinion columnists are constantly whispering dread outside-view incantations in his ear, demanding that he give up his left kidney, and generally holding his sense of satisfaction hostage. That seems even worse than the state of nature, which is getting fuzzies from Meaningful Human Connections™. Those, at least, are fake in an obvious way.
(not that I'm saying it was wrong to donate the kidney; just that this post is pretty depressing, like watching someone fill out taxes, except it's not even a morality tax like the GWWC pledge, it's a tax on *having a morality*.)
(also, there's two part IVs.)
https://healthsystem.osumc.edu/pteduc/docs/WhyDoINeedMoreThanOneIV.pdf
What do you mean by saying Guardian columnists are demanding he give up his kidney and holding his satisfaction hostage? I see that as his inner sense of shame and scrupulosity. I agree it is a sad post - I wish he did not need to take such drastic steps to feel worthy.
Why hasn’t someone already solved the LDNT debate once and for all with a large RCT on rats? IRBs won’t let them?
Hi. CT scans have been around now since the 80s as well.
The whole brouhaha started with Brenner's paper in the AJR in 2001, which was modeled on radiation from Hiroshima and Nagasaki, which itself is not a fair modeling example, because the radiation profile is different and you can't just extapolate the risk from 1000mSv to 1 mSv (CT scan would be between 1-10 mSv). Until then, no one talked about diagnostic imaging and radiation risk.
So the burden of proof lies on those who say that radiation from diagnostic imaging (< 50mSv one time dose) increases risk of cancer, not the other way around. There is no data showing this in adults. Those who believe in the hypothesis have moved to children, where if at all (and no one has accounted for reverse causation), for every 10,000 CT scans of the brain, there is one increased brain cancer risk, that's it.
Modeling is just that, modeling. All of the references below say "There is no evidence that low-level radiation from medical imaging causes harm and below 50-100 mSv of exposure, the risks are too small to be observed or non-existent".
1. Amis Stephen. Radiology 2011: 261: 5
2. Position Statement of the Health Physics Society, Jan 2020
3. American Association of Physicists in Medicine – position statement Oct 2018 - https://www.aapm.org/org/policies/details.asp?type=PP&id=439
4. Hendee William R. Radiology 2012: 264: 312
Unlike with so many other medical interventions, where our follow-up data is in the range of a few years (statins is now 35 years), with X-rays we have good solid long term data. Remember that from the 20s till almost the 90s, patients were also exposed to barium studies, IVU studies, where the radiation was in the same range sometimes as CT scans. Some observational study from the NHS or from the Scandinavian countries that track all their patients would have shown some causation. But there is nothing.
Casually bringing up your disdain for journalists in the absence of an occasion to criticize them creates more heat than light and annoys my NYT-reading fiancée
Being annoyed is a sad waste of an opportunity to reflect on bias.
hating on the castle-haters wasn't exactly endearing, either. Using up that "feels good" budget of doing a tangible thing, I suppose!
I think you're being serious but your mention of the NYT makes me wonder. (You do know what they did to him, right?)
This still gets my hackles up. Let me fumblingly try to articulate and explore why I feel this way, in a way that hopefully sounds valid.
-----
Let's imagine for a second that this was written by someone other than Scott, someone who I haven't spent years reading, and whose thoughts I don't understand as well.
The text of this article is "I donated my kidney". The message, partly stated but mostly implied, is "You should do so too." (With caveats of "I'm not telling you to do this, just giving you social permission to do it if you were already inclined.")
Most people trying to get you to do something this drastic and unusual don't have your best interests at heart. They stand to benefit in some way or another. That in and of itself is a pretty big barrier to convincing people.
How can someone benefit from kidney donation to a random stranger? They don't have to benefit directly. If they have a value system that thinks your actions improve (their conception of) the world, they'll usually try to argue you into it anyway.
Does this actually improve the world? Probably, at least to some extent. Does that extent justify the health risks?
Scott's a doctor, I'm not. With my limited knowledge, my heuristics are, generally speaking, "Keep things related to body, health, and diet as close to natural as possible, doing medical interventions only when necessary, or where the problems are accumulating enough to justify it." I assume that the redundancy in my kidneys is there for a good reason and am inclined to keep it.
This has had some benefits to me: I have a friend who, during a rough time of his life, went deep down a psychiatry rabbit hole, culminating in a breakdown that left him dependent on benzos and unable to work. While we were talking about his issues, I told him my heuristic, and he admitted that it was probably a good one. That's not a knock on the people that need medications—some people really do need it—but the point is even for something like medication, I usually have to convince myself to use it, and err on the side of avoiding it.
So you say the risks are small. Given that I'm this risk-averse, is your definition of "small" the same as mine? Probably not. The weird testicle thing alone would probably be enough to put me off. I have no idea what could cause that, how hard it is to treat, or what kind of long-term damage it could do.
And that's even assuming you're telling the truth. Since you already have a motivation to argue the side that convinces me to do this—look how many QALYs you can bring to the world by convincing me!—you might have a motivation to lie. Or if not lie, then at least do the subtle not-lies that might convince me anyway, like tell a one-sided story; cherry-pick bad evidence; or ignore, neglect to mention, or handwave away some of the risks.
These concerns aren't totally theoretical. Elizabeth of Aceso Under Glass has recently started fighting EA vegan advocates for engaging in exactly these kinds of tactics: https://acesounderglass.com/2023/09/28/ea-vegan-advocacy-is-not-truthseeking-and-its-everyones-problem/
https://acesounderglass.com/2023/05/30/change-my-mind-veganism-entails-trade-offs-and-health-is-one-of-the-axes/
Then I start wondering: hang on, how far will this guy take this?
"You should do this" seems to imply a moral norm: you're a good person if you do this, you're a bad person if you're not. Is he on the onramp to a moral crusade? We've seen a lot of those in politics lately. He's got all those caveats to his message, but does he mean them? If he does mean them, then for how long? Will he still be as forgiving when kidney donation is commonplace or even expected among his friends or ingroup?
Is he trying to make him and his friends look good, to have him and his friends accepted as the morally virtuous subculture, at my expense?
With that gut reaction firmly in place, I start probing my moral philosophies, against both the weaker explicit message and the stronger potential one. I start thinking of bodily autonomy, and abortion: does this line of thinking imply that it's morally correct for women to bring their babies to term at the expense of their own (similarly likely minor-to-moderate) health risks? If good people are morally obligated to give their own kidney, how much else of their life and literal bodies are they morally obligated to give as well? How much marginal risk or pain is one person supposed to take for a marginal improvement of someone else's life?
And then I come into the comments and argue.
-----
Okay, taking a step back: this isn't quite how I reacted to this article.
The big reason for that is because, like I said in the beginning, I've been reading Scott for years. I know, to some degree, how he thinks about medicine. I've read some of his writing on moral obligations, which makes me think he's being honest about mostly just sharing his story and giving people who were already on the fence social permission to go ahead and do it.
https://slatestarcodex.com/2014/12/19/nobody-is-perfect-everything-is-commensurable/
Because of that, my actual reaction to this article is that it shifted my opinion very slightly, enough to maybe freak out a bit less in the unlikely case that a friend of mine decides to randomly donate a kidney.
I would probably still freak out a little bit, and this article is very far from enough to convince me to do it myself. My heuristics are too strong, and my self-awareness in my lack of knowledge too great. Figuring out whether I even want to do this is not a way I want to spend my time, energy, or health, so I default to "no".
-----
So why am I rambling about this here? Because I expect that this kind of thought process happens in a lot of people that have a negative gut reaction to EA. I expect it happens almost instantly, and likely subconsciously.
A lot of EA writing is a Rorschach Test.
The gut reaction you have to something like this depends a lot on your past experiences, how much you trust the author, your exposure to Effective Altruism, and how often you've had people try to pull one over on you at your expense. These all feed into your personality, heuristics, and priors. That's why you get reactions ranging from "Nope, you're a crazy liar" to "Interesting, tell me more".
IMO, the only way to reach the defensive ones is to advocate for more common-sense, lower-risk actions whose benefits are more easily explained and apply across different moral systems. I've written about this here:
https://www.kronopath.com/blog/how-load-bearing-is-your-ideology/
Though I understand that's probably not who you wrote this article for.
-----
Anyway I'm glad it went well for you and I'm sure whoever got it from you was immensely grateful.
(And sorry for taking a soapbox to this personal story. It just got the gears turning.)
Despite my ramble above, I can't help but think of another blogger I loved to read, Shamus Young, who was diagnosed with end stage kidney failure in 2022 and died three months later. Actions like yours could have made a difference in his case.
https://www.shamusyoung.com/
https://www.shamusyoung.com/twentysidedtale/?p=54058
https://www.shamusyoung.com/twentysidedtale/?p=54513
Here's to your continued health.
While I don’t agree, I think this is a beautifully written and valuable comment.
Excellent comment, best of the bunch, thank you for rambling your way through it!
I agree with some of your points, I've definitely noticed that sort of negative gut reaction from some of my more suspicious friends and your explanation makes their reaction make a lot more sense to me. I used to be very all-in EA, but while I admire Scott immensely for having the courage to take a step like this, it's also given me the same sort of gut reaction - the reaction of how far should we take this, and how much against our common sense should we go?
Thanks for your comment, definitely helped my thinking a lot!
I love this comment and think you're right on.
Another relevant Scott piece is this one: https://slatestarcodex.com/2018/11/16/the-economic-perspective-on-moral-standards/
> I think of society setting the targets for “good person” a lot like a CEO setting the targets for “good vacuum salesman”. If they’re attainable and linked to incentives – like praise, honor, and the right to feel proud of yourself – then they’ll make people put in an extra effort so they can end up in the “good person” category.
I find this viewpoint disturbing and unhealthy
I don't get the "you should do it too" vibe from Scott's article, he did point out that kidney donations are not very effective as far as EA goes. As a person who was kind of on the fence on the decision, I feel like reading this article both increased and decreased my desire to donate (learning that you can put 5 friends and family on the priority list was a big plus). Getting support for the tax credit idea is probably far more impactful than warming up individuals to the idea of donating themselves.
To add another note to this comment:
- Veganism has a big lobby which creeps into EA, organ donations don't have that, so I don't think it's fair to bunch them up.
- That there are other articles by EAs criticizing EA practices, and no notable criticism of kidney donations in EA, is a stronger signal that kidney donations are actually a good thing than if there were no articles at all.
I applaud your donation, but as for making one myself I have a deep sense of DO NOT WANT.
Welcome back !
Seeing you gone for so long had me turning into a conspiracy theorist.
I'm just glad this wasn't a case of "OpenAI had invented AGI, and brought Scott in for 1 month long NDA access."
That's pretty close to my partner's guess, that Scott was currently "in the boss fight with the AGI".
Great to hear about the different kind of fight. Scott's success in winning is that he picks the right battles. Literally.
> as low as an 0.5 - 1% ...
Not sure which way the utilitarian calculation goes. The additional ACX time, either now or 25 hence, is probably still fairly valuable, e.g., David Friedman is still cranking out interesting stuff while old. But not sure how to quickly compare intellectual output to additional QALYs now.
Huh, and here I wasn't sure if I was just imagining "haven't seemed to get many SSC emails lately, what's up with that?" Worth the wait - always really enjoy posts about your own life. Skin in the game and all that, now you've Got The Receipts in a very concrete way. Someday if we get excellent generative AI for shows, it'd be cool to dramatize this essay as The Alexander Kidney. Or I'll try to recast you as the hero in Angel Beats!
...which segues into, I can't really imagine spontaneously donating a kidney to a __complete__ stranger? Maybe a family member, probably a friend, definitely a SO, some sort of handwavey Inner Ring calculus involved. Bad experiences with involuntary donations make me react really poorly to bodily-autonomy-integrity violations, no matter the utils involved. (And that was just for hair!) OTOH, being on the standard organ-donor registry that everyone signs up for with their driver's license - yes, of course, it's not like I'll be around to miss them at that point. I think I read somewhere on your old blog that such organ donations went down as cars got safer, actually, and It's A Problem...?
Description of the actual process and surgery...retroactively reassures me I made a correct decision to cancel [other elective surgery], even if in theory there's financial reimbursement available. I do think there's definitely some above-replacement Happy Price which would change my mind - $100k is several years of wages for me, that's Not Nothing, money is fungible - but other illegible costs like time and logistical hassle can't be "repaid". Wonder if there's any potential in streamlining the approval process - does it actually need to be several months? (I also don't understand why homeopathic levels of mental illness would be disqualifying, unless it was of a variety particularly prone to driving rash decisions?)
Scott, as a kidney donor
A: Welcome to the club!
B: Thank you so much for writing this. This piece is going to reach a ton of people, make waves, cause a bunch of new donations, and probably save far more people's lives than your actual donation did.
I've chatted with Dylan Matthews about this, but there's an *extra* massive reason for public influencers to donate their kidneys. Dylan has probably, no joke, caused hundreds or thousands of extra donations via his articles and advocacy. The actual impact of his specific kidney is a rounding error to the attention he's drawn. I suspect that with your platform, the impact your donation will make is at least 100x the typical donation.
So thank you for donating, and thanks for being vocal about it. And thanks for supporting the Modify NOTA campaign!
If anyone is interested, I wrote about my decision to donate here: https://www.infinitescroll.us/p/infinite-scroll-special-edition-kidney. I'm happy to answer any questions anyone may have.
Thanks! Wish I had seen your article earlier, might have put me above the threshold of "this is common enough to feel normal now" a little earlier.
First off: congratulations Scott! A tremendous thing to do, and I admire your speaking openly about it and encouraging others to do the same.
The CT scan/risk of cancer struck me as unbelievable! I do try to avoid CT scans on patients younger than 40, but I always put the risk as closer to 0.05% - 0.1% per scan rather than nearly 0.5% as your girlfriend calculated. I did a deep dive into this once for pregnant women and I remember the 5% per Sievert thing coming up there (risk to the fetus of childhood cancers, if Mum gets a CT.) Are we definitely sure this is for adults? I did a quick Google just now and clicked on the usual suspects - Scientific American says "a single CT scan increases the average patient's risk of developing a fatal tumor from 20 to 20.05 percent." WebMD: "the chance of getting a fatal cancer from any one CT scan is about 1 in 2,000." Memorial Sloan Kettering: "0.05 percent, or less than one in 2,000 — of possibly developing a future cancer."
Obviously I would love to see a deep dive into this topic!
A multiphase abdominal CT is 30 mSv, compared to 7 for a standard chest CT, so if the upper end of your number is right for the average CT, my number is approximately right for the multiphase abdominal that I was considering.
Interesting. Multiphase is getting you up to whole body combined CT/PET scan levels.
Even if it’s 1/500 (0.2%) this is overwhelming the operative risk and should probably be emphasised much more in the consent process.
1. Kudos on the Vox journalist line, made me genuinely giggle uncontrollably at work.
2. Kind of strange, I've been involved with EA for awhile, donated a lot of my (meager) income to charity, and, given the opportunity, would happily take some risks for altruistic purposes. But I still haven't got past kidney donation to a stranger sounding absolutely ridiculous. You can do something just bloody horrible, slightly dangerous (possibly including a bunch of risks you're not taking into account), not at all fun/ exciting, with lower altruistic cost-effectiveness than working and donating to an effective charity... If the effectiveness calculations looked incredible, I would be at least persuaded that it's a morally good idea, but as it is, it feels more like the kind of socially contagious masochism that EA should be trying to avoid.
3. When I was travelling in Northeast China near the Korea border, I spoke to a cleaner in a cheap hotel. He asked me: "Where are you from?" "The UK", "Ah, can you sell kidneys in the UK?", "No, there might be a black market, but it's illegal", "Ah". Then the conversation ended.
I think people really differ on how comfortable they are with different risks - I'm planning to donate my kidney, but I just can't bear to part with much of my income. I value the comfort and security I can buy much more highly than the health risks of donation. Also, kidney donation is way more fun to me than work. It's weird, you get to go to different places (I learned a lot about which jobs in the area don't require drug testing, courtesy of some guys who sounded like they needed that). I am kind of hoping my work fires me for trying to take time off to donate, because then I will gleefully tell that story in every interview. (Somehow I don't want to quit or be fired, but I don't want to have this job.)
What do you infer from anecdote 3 about why the question was asked?
That is such a random and bizarre comment that I don't think you can infer anything!
I inferred that he was either considering selling a kidney, or that he was suffering from seller's remorse, torturing himself about the idea that he hadn't got the best deal.
Well, first of all, congratulations! There's kidney disease in my family, and yes my cousin died several years down the line after a transplant, so it doesn't mean you can live your normal lifespan. But without it you'd probably be dead, so better a few more years of life than nothing, right?
"They found 34 extra cases of ESRD (end-stage renal disease, the most severe form of kidney disease) per 10,000 donors who were related to their recipients, compared to 15 cases per 10,000 for donors who weren’t (the difference wasn’t statistically significant, but I think it’s still correct for unrelated donors to use the unrelated donor number)."
I imagine if you're donating to a relative, that means there's already a higher risk of kidney disease in the family, so the risk would be increased. As for the risk for donors overall, that may well be because if you have two working kidneys, and then down the line one of them conks out, the other can pick up the slack. But if you only have one working kidney and it starts to fail, then you develop the problems faster and worse.
But it truly was a charitable deed so well done!
I'll only take this one little pop at the Brits, so the castle was the cheapest option? Perhaps, but did they factor in (1) the bad visuals this would produce, so hampering their efficacy because this will turn off the public from donating to them and (2) how do other organisations manage? Are they all out there renting/buying castles, or do they somehow manage to find some kind of conference centre that won't rip them off? I have a feeling that the British EAs had too high an expectation for what they would find acceptable in a conference centre, and coming across a castle they may have found ways to justify "wouldn't it be really cool if we had our own castle?" Boring, bland, beige big room in a hotel may not be anywhere near as glamorous, but I find it difficult to believe it would be that hugely more expensive. I do feel there has been some creative accounting of the "sure, it *seems* like a huge expenditure, but if you take it that over the next twenty years we'll be hiring conference centres at a cost of £X,000 each time, and you multiply £X,000 times Y conferences to get a total cost of £Z00,000 then by comparison, a one-time purchase comes off cheaper".
Yes, you're not paying £X,000 a go for each conference, but now you have a castle to maintain and upkeep, and that's gonna cost.
"I thought I was going to be able to do a good deed that I’d been fantasizing about for years, and some jerk administrator torpedoed my dreams because I had once, long ago, had mild mental health issues."
That's hard. But on the other hand, you live in America. The most litigious nation in the world. Where cities sue car manufacturers because their cars are too easy to steal (Chicago, Baltimore and New York bringing lawsuits against Kia and Hyundai). I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
You could swear up, down and sideways that you really want to do this and you're a grown and sane adult and you are doing this of your own free will, but they have no guarantee that five weeks after the operation they won't get a solicitor's letter looking for zillions in damages because they took advantage of a mentally vulnerable individual. Hence, the magic therapy requirement: it's covering their backsides in case of legal action so they can point to "we required him to go to therapy to make sure he wasn't crazy", not for your or any other potential donors' welfare.
> I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
I friend of mine blew up at me for saying almost exactly this. I could see this getting generalized in very weird ways.
I suppose yes, if all other automobile manufacturers have incorporated anti-theft devices and Kia and Hyundai haven't, then they do bear some responsibility.
But cities going "We have too many criminals who can roam freely and do as they like, this is *your* fault" doesn't make the car manufacturers look bad, it makes the state of life in your city look bad.
I think the major divergence of viewpoints here is that Scott knows of the type of people who altruistically donate kidneys, whereas I know of the type of people who made a living out of insurance fraud (hence the lawsuits) 😀
There's an ambulance chaser law firm in my town which makes a speciality out of "Dear me, you tell me you had a trip and fall on badly maintained pavements? As did seven other members of your family? Tsk, tsk, let us sue the local council for their neglect of repairing the streets and road surfaces!"
Well, maybe the local council could afford to repair the streets if they weren't being sued every ten minutes by you guys, just saying?
More likely, they'd never repair them without the lawsuits prompting them.
I was going to say exactly this! They're not concerned with your well-being in some "paternalistic" way, they're avoiding being sued. Most likely, some organ donation program in the state was once sued for that reason and lost, and now the malpractice insurance companies all require this protocol. As a diagnostic, I notice that a program in NYC doesn't have this requirement, and that's likely because nobody has won such a suit in New York state.
I imagine they also didn't give any therapy recommendations for much the same reason Scott doesn't give medical advice/recommendations to queries on here.
If they suggested "do such-and-such a therapy for so many weeks", that'd be catnip for the lawyers. "Why did you recommend my client do this particular therapy? Are you a licenced psychiatrist?" "Well, no, but - " "Aha! Manipulating a vulnerable person! That's another zillion in damages we claim!"
I don't disagree with you at all; this is certainly the proximal reason why the bad system I described in the post exists.
"But on the other hand, you live in America. The most litigious nation in the world."
Close! https://www.scribd.com/document/391259964/The-Most-Litigious-Countries-in-the-World says, (in the teaser before the paywall):
"Here’s a list of countries with the highest number of lawyers per capita:
1. U.S. 1 lawyer for every 300 people
2. Brazil: 1 lawyer for every 326 people
3. New Zealand: 1 lawyer for every 391 people
4. Spain: 1 lawyer for every 395 people
5. UK: 1 lawyer for every 401 people
6. Italy: 1 lawyer for every 488 people
7. Germany: 1 lawyer for every 593 people
8. France: 1 lawyer for every 1,403 people
While it’s true that the U.S. has a large number of lawsuits crowding its courts each year, it barely cracks the Top 5 of most litigious countries in the world. In his book, “Exploring Global Landscapes of Litigation,” Christian Wollschlager notes that the litigation rates per 1,000 people shows that European nations top the list of the world’s most litigious countries.
Here is a list of the top 5 most litigious countries by capita:
1. Germany: 123.2/1,000
2. Sweden: 111.2/1,000
3. Israel: 96.8/1,000
4. Austria: 95.9/1,000
5. U.S.: 74.5/1,000"
Typo: "have still" -> "still have"
I've noticed dozens of typos in Scott's posts over the years but have always felt awkward about bringing them up so I never have. (This is not at all a criticism of his writing; nor do I really care about typos. I'm just the type to pick up on tiny aberrations like that.) I'd feel less weird about it if there were a way to submit GitHub-like pull requests on writing so I could just submit a patch that could easily be merged.
There is - you just comment like Curious mathematician did.
You might find it interesting that some sites do, or at least one that I know of - the online web serial site Royal Road has almost exactly this system where you highlight stuff, make an edit and then there’s a ready way to paste it in the comments with auto formatting.
Dear Scott,
it was interesting to read about the low risks of kidney donation as well as the thought process you went through. What I am sceptical about is wether paying people for kidney donations would actually be the best systemic solution for dealing with kidney failure. I don’t have numbers on the following and you are probably much better at doing the research on that, but as far as I know most kidney failure is related to other diseases (like diabetes II or hypertension) the genesis if which is closely related to lifestyle/ living conditions and can well be prevented. Do wouldn’t the best systemic intervention be to create living conditions that allow people of all classes to make healthy choices without additional expenses? (like modifying taxes on certain foods or forbidding them once they have been proven to be harmful - like high fructose corn syrup - or reorganising supermarkets and advertisement in a way that doesn’t ruin lives for the profit of certain industries…) Or even investing more money on alternative treatments for infectious diseases that would allow to use nephrotoxic antibiotics less often?
Those are just some naïve thoughts of a European, but I would be curious your prognosis on those interventions vs. paid kidney donations.
Kind regards!
Slow chronic kidney function decline is almost universal with aging, as is true of other chronic cardiometabolic problems. How bad it gets, and how early it gets bad, is highly multifactorial and can’t be cleanly ascribed to lifestyle. There is a complex interplay among different aspects of the metabolic syndrome, as well as their best-practice treatments, such that the causality arrows don’t always fall in the places and orientations you might assume. The subset of severe kidney failures that occurs in young people with really obvious lifestyle risk factors certainly exists, and is very visible and salient if you are looking for it. I question whether health policymaking should treat it as the conceptual starting point for thinking about kidney failure management.
I think from the examples you suggest that you aren’t yourself very prone to a punitive gatekeeping mindset, and I don’t want to impute one to you, but I don’t trust broad policy strategy to be developed without one if pursued along these lines. Rather than little tax nudges or occasional judicious ingredient regulations, I foresee non-judicious ingredient regulations (ie, proliferating sweeping bans: as an American who is now German, food and drug regulation strikes me as already overzealous here; the 180 degree opposite of wrong is not always right) as well as draconian treatment eligibility crackdowns, which to your credit you don’t recommend but which seem to me fairly likely results of a broad shift toward this kind of approach. I don’t even think you’re wrong. I just worry about it.
Well, I do think that prevention is one of the best strategies (one if the cheapest, as well, long term). I’m not sure what you find overly zealous about food regulations in Germany and think that the health of the German population would also benefit of higher taxes on sugar and lower ones on vegetables. Also healthy and cheap meals in school canteens as well as public canteens offering meals at a reasonable price might be a way to go. Generally, improving living conditions and wealth of the people on the lower end of the spectrum (maybe through raise of minimum wage) has an impact on improving their long term health along with it.
You don't think it is also overzealous in the US?
on food, the US is a weird mix of over- and under-regulation (remember that funny article about the bucatini shortage that turned out to come down to regulators obsessing over the precise composition of an imported pasta recipe? but also, having lived in both US and EU and eaten ad lib there with sharply differentiable n=1 outcomes, i suspect there really are a few odd ~toxic ingredients and practices in the US that demonstrably could just be eliminated with a different policy apparatus. do i trust anyone to fix it? no lol but still)
on drugs, US is most definitely over-regulated, but at least you can order baby aspirin on the effing internet there. like. you don’t even know.
This feels like trying to solve school shootings by making everyone a good person who would never kill anyone else, as opposed to realistic solutions like security guards or gun control. It's obviously the right solution, but nobody knows how to do it and we shouldn't let it hold back things that might actually work.
"Make everyone eat healthy and exercise" isn't a solution so much as a fantasy. The government (and other sectors of society) have been trying really hard to do that for decades, and if it was possible to succeed I would have expected to see it by now.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
As someone who started looking into thuisbankier reading Mathews’ article and was then beset by akrasia, I want to give this another go. Does Waitlist Zero have counterparts in Europe (specifically the Netherlands)? Their contact form asks for a US address.
Sorry, it's a great question but I don't know the answer.
Wow, amazed at the quality of writing here. that one blew me away. i had no idea, but have known many in my life who both donated and received kidneys... and i think i knew one whose left one was stolen. But as a non-Dr, and with a RN Nurse sister, I can say this for others, "We don't trust u." Flat out. No trust. Nada. Not for giving blood anymore and not for anything while alive. Sure, harvest everything you can once I am brain-dead, but stay the F away from me until then. Yes, it's that bad. I've been here almost 70 years, and seen shit I still can't believe happen in field hospitals to the best America the world can offer. And now ya got your AI to cut with, so I'm out just from that point alone. You should be really aware about what goes on in the medical-device industrial-complex before you let one of those things tear into ya. FDA? ha. They have better inspections here in Nepal, even with our ragtag group of clipboards and ink stamps. Hate to break ur bubble, but great writing, nonetheless!
Care to elaborate about WHY you don't want to donate any blood or tissue? You made a lot of insinuations but gave no specifics.
Not really, I don't care to discuss, and I didn't bring this up, the author did, but since I am always complaining about people not talking to each other, let me try communicate my truth online again. (This is not gunna go well folks.) Gamereg, I DID say WHY: TRUST. Simple human fear, based on experiences. That's it. And very little reassurances coming from the medical community (in the west) to belay that fear.
However, first responders, top notch. Nurses and medical techs, brilliant. Old school Dr. from an old school university, well, there we begin to have issues. Private MD strapped for cash, or worried about bottom line, more problems. Corporate greed in the Insurance-Medical Industrial Complex, even bigger problems. Keep going up the money chain, and it gets progressively worse by the time you get to Wall Street.
Some might say the above is not a logical reasons to NOT donate blood or kidneys. Yet some just say FU to that. And then many are just wary, confused or ill-informed when entering those big gaping hospital doors. I would think it would be the medical community's responsibility to ease those fears and distrust, somehow. I'd give them a failing F grade in that regard, after the Covid fiasco. And after the Aids fiasco, and all the fiascos between those two black swan events. Hell, throw in earthquake responses I've been part of, and throw in WAR as well, as it's hell and I know no medic can be held responsible for that, but bloody hell, triage in a war zone is not FDA approved. But WAR is approved, so there is that.
That's a long answer for someone I don't know and was never properly introduced to; I guess it's the same at your end. I hope you know me a bit better now, and for whatever reason you chose to reply above, thank you for that and I hope this answers your query.
Reading this reminds me of Shamus Young's blood pressure/kidney problem posts, which he died from last year.
https://www.shamusyoung.com/twentysidedtale/?p=52745
These are the recipients.
Wow...I'd read a lot of his backlog at some point but didn't know he had died.
> No matter how contrarian you pretend to be, deep down it’s hard to make your emotions track what you know is right and not what the rest of the world is telling you.
This sounds to me like it was written by someone with an very different internal experience than me.
Do you actually feel like you “know what’s right”?
My experience is I often have conflicting notions of what is or isn’t right, and “the rest of the world” isn’t telling me one thing or another - it’s a confusing mass of shouting from different groups of loud, confident, intelligent sounding people all explaining why the other groups are stupid and evil.
Sometimes, I’ll see someone do a thing, or be a certain way, and think, wow, that seems right and good and noble, and I want to imitate that way of being. But to me this is like a non deterministic Turing machine that cannot find the truth (it takes too long!) but is sometimes capaable of recognizing specific instances of it.
I have a pretty clear notion that donating a kidney to a stranger is not right, while the rest of the world probably sees it as a good thing.
Not challenging, but definitely curious:
- what do you mean by not right? Not right for you, like you don’t want to? Not right for anyone? But what does that feel like?
- what do you mean by “rest of the world”? Are you imagining some aggregate function over the emotions of some set of people? Which aggregate function - something like mean or sum? And which people? Anyone alive today? Adults?
I get the impression that lots of people use the same kind of language you are using, but these claims don’t map to my experience, because “it is wrong” for me is a thought that usually translates it to emotion like anger or contempt towards a thought of a person doing that thing.
The notion of “the rest of the world” used to make sense to me as a concept into i tried looking directly at the concept in a way that tried to add some modicum of precision, and the concept itself just collapsed.
I guess it feels, or looks, like watching someone make a mistake.
Definitely no anger or contempt - I suspect this is coming from thinking of a very specific kind of wrongness.
When you see someone not standing up for himself, that is clearly wrong, but it seems more likely to trigger sadness and frustration. That's more the type of wrongness I meant.
By "rest of the world" I meant what most people alive in the world would think.
If you want to save multiple lives and not discover that falling GFR in older age is twice as bad with one kidney (it is, obviously!), donate blood and get on the bone marrow database. You really can make a huge difference. I'm alive today because a delightful young man in Germany gave me some bone marrow stem cells. Yes, that makes me biased, but it's a no-brainer! I used to be a blood donor back in the UK, but here in Canada they didn't want my blood as I'd lived in the UK in the early 1980s - risk of mad cow disease. Moo! They wouldn't take it anyway, now, having leukemia.
I'm also banned from blood donation because of Ireland in the early 2000s and mad cow disease. Somehow never came up with the organ donation. Good luck with the leukemia.
I lived in the UK in the early 1980s and was banned from blood donation, but they recently (earlier in 2023) relaxed this restriction in the US. I'm still in the debating-long-and-hard stage for kidney donation, but I'm signed up to give blood for the first time tomorrow.
Ooh, I'll have to look into this!
Quick update, I went to the blood donor center, made sure to tell them I'd lived in the UK, and finally gave blood! I'm not 100% sure what applies to 1980s UK applies to 2000s Ireland, but I imagine it's similar. With the exception of my vein being pricked with a needle, the process was completely painless.
> (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint.)
“Assume a virtue, if you have it not.
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery
That aptly is put on. Refrain tonight,
And that shall lend a kind of easiness
To the next abstinence; the next more easy;
For use almost can change the stamp of nature.”
― Hamlet, William Shakespeare
Having said that, there's one thing that the article never went into that you'd kind of think would be front and center in any talk about transplants: rejection and management thereof. If you give someone a new kidney but at the same time condemn them to a lifetime of immunocompromise, how much have you really improved their quality of life? The more you look at transplants, the more they look like a really terrible thing that we only do because it's the least-bad option available at the moment, the kind of thing that Dr. McCoy would scoff at and accuse us of being barbarians living in the Dark Ages for practicing.
Out of curiosity, (I genuinely don't know and would be interested in finding out if anyone's looked at this,) has there been any research done on questions along the lines of "would it be more effective to donate a kidney and help one recipient, but we know it works, or to fund stem cell research into own-organ cloning which could end up solving the problem for everyone but is currently hypothetical?"
1. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors.
Over the longer term, I'm highly optimistic about bioengineered human-compatible kidneys grown in pigs.
2. I was getting worried when Scott didn't post much over the last few weeks. Now I know why! And it's a very commendable reason. Thank you Scott for donating!
Personally, I've donated blood and sperm (and I'm due for another blood donation next week). I thought about kidney donation but decided it would take too much time away from my research, and I'm worried about its negative effects on me.
For what it's worth, I know two people who have recently gone through the process. One dropped out late in the process, and the other successfully donated their kidney. This is in the last ~6 months.
The one that dropped out felt very pressured by friends and family, and realized they were not in a good life place to take the time off of work. I think they were scared as well.
The one who donated seemed to have a fine time and was back at work well before expected.
Both reported that a charity was going to pay their expenses, including lost wages. For the one that went through with it, that seems to have worked exactly as advertised.
Kind of related. I’ve always thought that “opt-out” (instead of opt-in) organ donation on driver’s licenses for example, would help increase the supply of organs including kidneys. But when I’ve talked to healthcare economists about it, they say it’s a bad idea because it would bankrupt the health care system given the high cost of these surgeries and the aftercare. Thoughts?
That objection doesn't make sense to me - each kidney donation saves money over the counterfactual dialysis alternative.
I have heard healthcare economists say opt-out doesn't seem to help much in practice because most cadaveric organ donations involve careful negotiation with the family of motorcycle crash victims with the specific box they check being only one input into the family's (and legal system's) decision making process. I don't understand the details here well enough to overcome my common-sense confusion about this not being a bigger deal.
I guess it’s more about who is paying in each case. Is it the government or private insurers?
Obviously the castle people could have found cheaper, drabber options, and guests would've been fine with it. I doubt there's a warehouse shortage. It seems EA folks haven't learned much from FTX.
"Hi Senator. Please attend our conference. You'll have to sleep in a bunk bed with the President of Belgium, and there's only one bathroom for fifty people, but please come anyway, it's the right thing to do." Sure, that'll go over well.
More relevantly, you can't accuse EA of not learning anything from FTX because this happened before FTX.
There are decent hotels near industrial areas. Moreover, if I had a lot of money, I would be impressed by the sheer rationality of a simple and cheap meeting room near an area with unassuming hotels (of course taking into account safety, convenience, etc.).
My accusation was not at the castle-dwellers, but at the fact that someone like you can't see how bad and ostentatious a castle looks for the EA movement. A pinnacle of public FTX disgust was the contradiction between the video of SBF signaling his EA bona fides by showing off the meager car he drives while later revelations showed his ostentatious mansion.
Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands.
"Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands."
Continuing to use a castle they own is not the same as buying a castle. If they sell the castle now, people will continue to point to that time and EA organization bought a castle, only now they will cite the fact that the castle was sold as proof that the arguments for buying the castle were bullshit. At the same time, they would presumably lose money on the sale.
It's hyper-rational to admit a mistake and align with long-term goals, even if there are short-term costs.
If the way they differentiate themselves to investors is hyper-rationality, then they can signal that by saying, "We over-rationalized a childish indulgence but we have aligned our investments more rationally and instituted new processes to avoid similar mistakes."
By God, there's a lot of taxpayers in a lot of countries who wouldn't mind seeing the President of Belgium and a senator or similar from our proud nation having to bunk in together.
Anyway - welcome, player, to the multiplayer strategy RPG "Doing Good? or Doing Great!", hereafter referred to as DGDG.
You start off as a starry-eyed idealist of high education and socio-economic class, stuffed with unearned privilege which you are eager to transmute into benefitting the lower types less fortunate than you. Along the way, the choices you make will affect your progress towards one of the two endings:
(1) Doing Good? (for others)
Ultimate Achievement Level: Poor But Honest 😇
(2) Doing Great! (for yourself)
Ultimate Achievement Level: Swankin' Wid Da Big Boyz 🤑
Your progress is measured by your repute (not to be confused with compute, but still important even if it doesn't have a sexy new word) level, on the scale of OPTICS. The higher your repute level, the more you can get away with - but be careful! It is possible to gain NEGATIVE, as well as POSITIVE, repute from the decisions you make, the actions you take, and the consequences of your choices.
Okay, I see you have already completed Act I.
Final Level Achievements:
(1) The Peacock (badge awarded for ostentatious display such as purchase of large, expensive, historic manor house in an agreeable setting in the English near-countryside)
(2) Name Change (reducing confusion or increasing it? both? that's the beauty of it!)
(3) Changing Horses In Mid-Stream (when you pivot from doing what your original aims were said to be, to something completely different)
Congratulations, player, you have now unlocked Act 2 - INSTITUTIONAL BLOAT!
Optics Bar reading:
You have advanced three notches towards À LA LANTERNE. (Warning: if you reach this limit on the Optics Bar, you will be permanently locked out of ending "Doing Good?")
Unlocking this new act enables you to take on side-quests such as:
(A) They Flew To Bruges
(B) Because I'm Worth It
(C) We Always Travel First Class At This Level
(D) The Poor You Will Have With You Always, That's Why I'm Bored Of Them
(E) But We Have To Make A Reservation For Le Manoir aux Quat'Saisons Restaurant, The President of Belgium Expects It
(F) Who Will Roast My Langoustines? (related to side quest E above):
https://www.tripadvisor.ie/ShowUserReviews-g1096521-d752551-r880929124-Le_Manoir_aux_Quat_Saisons_Restaurant-Great_Milton_Oxfordshire_England.html
"We enjoyed the taster meal on the first night especially the Ballantine of duck liver and the roasted langoustines."
Completion of any three of the above gains you the awards "The People's Flag Is Faintest Pink" and "Swanking (We're Swankin' In The Name Of EA)".
There's an implicit Peter Singer argument in here somewhere. I only have one kidney to give, so by giving it to a stranger, I can no longer give it to a family member.
That's why there's the condition that you donating puts you and 5 family members right at the top of the organ donor list. Plus, you may not be a match for family members, so being at the top of a larger list may actually be a better outcome than saving yours just in case.
I didn't know that, thanks!
Very honest post. I hope you get the likes from people you were looking for by donating your kidney!
Can you try getting the statistics for Israel to get a better idea of the risks? My understanding is that in Israel the situation is reversed, with ~90% of kidney donations being altruistic (unrelated to the patient) so the statistics will be a lot less messy.
IIRC, Israel changed their policy a number of years ago, because there was a lot of religious resistance. The new rule was that in the event of two people needing teh same organ, the one who was previously an organ donor received it. Rates of organ donors skyrocketed.
In Germany it is actually illegal to donate a kidney to a stranger while you're alive. (You can do it when you're dead, but obviously then your kidney won't be as good.) While you're alive, unless the recipient is a relative or at least something like your fiancee, apparently the law considers the dastardly danger of the ever-menacing terrible organ trade mafia too great to allow you to save the DALYs of a fellow human.
Are you sure? I did some research after reading this post, it does not sound like it should be forbidden per se: https://www.organspende-info.de/lebendorganspende/nierenlebendspende/
Wikipedia¹ says:
> Das Spenden eines Organs, das sich nicht wieder bilden kann, ist zu Lebzeiten für Verwandte ersten oder zweiten Grades, Ehegatten, eingetragene Lebenspartner, Verlobte oder Personen, die dem Spender in persönlicher Verbundenheit nahe stehen, möglich.
And this article² makes a statement to allow for altruistic donations, so it seems like Daniel Böttger is unfortunately right.
¹: https://de.wikipedia.org/wiki/Organspende#Deutschland
²: https://www.dgfn.eu/stellungnahmen-details/stellungnahme-cross-over-lebendnierenspende.html
Darn, I was really hopeful there.
For future reference (mainly for me, without the wiki detour), this is the relevant part of transplantation law, and it's quite clear.
https://www.gesetze-im-internet.de/tpg/__8.html
For a moment, I thought that the "special personal relationship" permissive rule could be bent ... - but it definitely rules out any case where you don't know the person you donate to at all, as well as anonymous donation.
Here's hoping someone will listen to these doctors' public statements (I found sth similar published by the Federal Ministry of Health (BMG) in October 2021).
Yeah, it's a shame.
Eff tax breaks, why not help the people that need it more? Organ donation for get out of jail cards. Not for murder and rape. But surely we can find it out heart to forgive those people who downloaded a bunch of songs on Napster or something. Next time someone wants to make an argument about how they made a terrible error in judgement and learned from it, there is a way to directly demonstrate that. Hell, kidneys for green cards might just be the kind of proposal both sides might just accept.
I'll grant that 30mS increases risk by 1/660, but that's not the same thing as a 1/660 risk of dying. If your risk of dying of cancer is, say 1% baseline, increasing that by 1/660 is like an extra 1/66000 chance of dying (ballparking here). Am I missing something here?
I mean absolute risk; it literally causes a 1/660 chance of death. That increases your relative chance of death by . . . some amount, depending on what it was before, I haven't calculated that.
I posted this in another thread here, but I'm pretty sure the 5% figure is relative risk, not absolute. This site:
https://www.imagewisely.org/Imaging-Modalities/Computed-Tomography/How-to-Understand-and-Communicate-Radiation-Risk
explicitly lists the 5% figure as a relative risk which, by my calculations, corresponds to a 1/4650 absolute risk. By all means let me know if that's a bad source, but IMO the math just doesn't make sense if you interpret it as absolute. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
There's also the issue that you're comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. You'd have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
According to this, CT scans can be estimated to cause about 2% of annual cancer in the US.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/?utm_source=substack&utm_medium=email
The problem with calculating multiplying the number of CT scans with the risk is that a very large number of them are performed on old people or otherwise people whose life expectancy is too low for them to be able to develop a cancer attributable to it.
Wouldn't it make sense for total organ donation to be the default execution method? Lesser criminals could donate a kidney in exchange for reduced sentence.
Really really really bad perverse incentives, ahoy!
Elaborate? There's already more than enough prisoners for kidney demand to be saturated, and I'm not sure how individuals who need other organs would be able to increase executions enough to significantly increase their own chance of getting an organ.
The perverse incentives would be encouraging executions.
"A perverse incentive is an incentive that has an unintended and undesirable result that is contrary to the intentions of its designers."
Do you think it's undesirable to execute a probable violent criminal to save the lives of several people?