I think this is a cool choice and a good post—thanks for both! I agree with your bottom line that kidney donation can be a good choice for EAs and just wanted to flag a few additional resources and considerations:
I think theseother EA forum posts about the costs and benefits of donation are worth checking out. In my mind the most important update relative to when I donated is that the best long-run studies now suggest a roughly 1 percentage point increase in later-life risk of kidney failure because of donating. I think that translates less than 1:1 to mortality for a variety of reasons (ability to get a transplant, maybe xenotransplantation or other things will be easy in 20-50 years) but I think that factor probably swamps the near-term (roughly 1⁄3,000) risk of death in surgery when thinking about the EV calculation.
I think I took ~3 weeks off work to recover from donation (it was also around the holidays for me), and I think for folks who work in altruistic jobs that may dominate the cost calculation. 52 hours seems like a very low estimate of the expected time cost to me all in though.
I think people sometimes assume that the original donor gets full counterfactual “credit” for all the steps in a chain. My read of this evidence is that even though average chain length is ~4, the marginal social value of an altruistic donor starting a chain is “only” ~.8-1.7 transplants (depending on blood type) because the relevant counterfactual can be other chains being longer.
I think things like this post are themselves a pretty important channel for impact. I think the impact of my personal donation was dominated by the small influence I had on getting Dylan Matthews to donate, which then had a big knock-on impact because his writing led a number of other people to donate.
Overall, I think these kinds of persuasion considerations can play a weirdly big role in how you evaluate kidney donation, and I don’t have a clear bottom line on which way they cut.
Made update about risk of kidney failure going up 1 percentage point
I felt pretty much good to work the day I left the hospital 🤷♀️ maybe my job was uniquely unstrenuous and undemanding. What would you estimate as the time allocated to donation?
My donation was nondirected but paired, so I will take all the credit for the counterfactual of making other people’s chains longer lol
Totally agree that an important part of impact is movement building. We will hopefully have a kidney donor meetup at EAG DC where non-donors can come ask questions
I don’t have a particularly good estimate on total time, but my impression is that most doctors recommend people plan to take a couple weeks off from office work, which would maybe 2-3x your 52 hr estimate?
Agree about 2ish weeks off work as the standard, though Alexander and I donated ~ten years ago, and I have some (purely anecdotal) sense that the surgery experience (and recovery) for people like Nicole who’ve donated since then at a big center might be better.
Since I was able to be productive right away on personal projects and errands, I didn’t count this time in my estimate.
I used my time off to learn JavaScript well enough to eventually switch careers from Data Scientist to Frontend Developer, so it was a pretty fruitful period for me.
I would estimate the time I spent for my living kidney donation to be much bigger than 52 hours as well. A lot of that is because I spent significant time ensuring that I was as protected as possible. Also because my donation was interrupted by COVID.
First I would count my time in research to determine which hospital I wanted to go through as well as all my travel time to visit that hospital because it was out of state (my state has zero NKR affiliated hospitals and only did 6 living donor transplants last year—am I going to trust them to do mine? NO!)
Next, I went through the process, was approved, then COVID hit. Enough time went by that I had to do the entire evaluation process over again. Each evaluation process easily took AT LEAST 52 hours for me because each time involved a two-day testing process plus travel plus additional local tests.
Then time was wasted when my coordinator got COVID and couldn’t put my case up for approval. Last minute extra tests—partially BECAUSE OF COVID—added to the time I spent doing this.
Lastly, I spent extra time nearby the hospital after surgery in order to obey their recommendations that I stay local in case complications arise but also I did this to kickstart my recovery by eliminating my normal life responsibilities. It worked beautifully and I am recovering very well. But I know that if I hadn’t taken that time off it likely would have impeded my recovery.
Hi Nicole,
I think this is a cool choice and a good post—thanks for both! I agree with your bottom line that kidney donation can be a good choice for EAs and just wanted to flag a few additional resources and considerations:
I think these other EA forum posts about the costs and benefits of donation are worth checking out. In my mind the most important update relative to when I donated is that the best long-run studies now suggest a roughly 1 percentage point increase in later-life risk of kidney failure because of donating. I think that translates less than 1:1 to mortality for a variety of reasons (ability to get a transplant, maybe xenotransplantation or other things will be easy in 20-50 years) but I think that factor probably swamps the near-term (roughly 1⁄3,000) risk of death in surgery when thinking about the EV calculation.
I think I took ~3 weeks off work to recover from donation (it was also around the holidays for me), and I think for folks who work in altruistic jobs that may dominate the cost calculation. 52 hours seems like a very low estimate of the expected time cost to me all in though.
I think people sometimes assume that the original donor gets full counterfactual “credit” for all the steps in a chain. My read of this evidence is that even though average chain length is ~4, the marginal social value of an altruistic donor starting a chain is “only” ~.8-1.7 transplants (depending on blood type) because the relevant counterfactual can be other chains being longer.
I think things like this post are themselves a pretty important channel for impact. I think the impact of my personal donation was dominated by the small influence I had on getting Dylan Matthews to donate, which then had a big knock-on impact because his writing led a number of other people to donate.
Overall, I think these kinds of persuasion considerations can play a weirdly big role in how you evaluate kidney donation, and I don’t have a clear bottom line on which way they cut.
Thank you for your comment, Alexander!
Made update about risk of kidney failure going up 1 percentage point
I felt pretty much good to work the day I left the hospital 🤷♀️ maybe my job was uniquely unstrenuous and undemanding. What would you estimate as the time allocated to donation?
My donation was nondirected but paired, so I will take all the credit for the counterfactual of making other people’s chains longer lol
Totally agree that an important part of impact is movement building. We will hopefully have a kidney donor meetup at EAG DC where non-donors can come ask questions
I don’t have a particularly good estimate on total time, but my impression is that most doctors recommend people plan to take a couple weeks off from office work, which would maybe 2-3x your 52 hr estimate?
Thanks for writing this Nicole!
Agree about 2ish weeks off work as the standard, though Alexander and I donated ~ten years ago, and I have some (purely anecdotal) sense that the surgery experience (and recovery) for people like Nicole who’ve donated since then at a big center might be better.
Also, I think this Annals of Internal Medicine meta-analysis on the risks of kidney donation is a good resource for people who feel comfortable reading academic papers.
Since I was able to be productive right away on personal projects and errands, I didn’t count this time in my estimate.
I used my time off to learn JavaScript well enough to eventually switch careers from Data Scientist to Frontend Developer, so it was a pretty fruitful period for me.
I would estimate the time I spent for my living kidney donation to be much bigger than 52 hours as well. A lot of that is because I spent significant time ensuring that I was as protected as possible. Also because my donation was interrupted by COVID.
First I would count my time in research to determine which hospital I wanted to go through as well as all my travel time to visit that hospital because it was out of state (my state has zero NKR affiliated hospitals and only did 6 living donor transplants last year—am I going to trust them to do mine? NO!)
Next, I went through the process, was approved, then COVID hit. Enough time went by that I had to do the entire evaluation process over again. Each evaluation process easily took AT LEAST 52 hours for me because each time involved a two-day testing process plus travel plus additional local tests.
Then time was wasted when my coordinator got COVID and couldn’t put my case up for approval. Last minute extra tests—partially BECAUSE OF COVID—added to the time I spent doing this.
Lastly, I spent extra time nearby the hospital after surgery in order to obey their recommendations that I stay local in case complications arise but also I did this to kickstart my recovery by eliminating my normal life responsibilities. It worked beautifully and I am recovering very well. But I know that if I hadn’t taken that time off it likely would have impeded my recovery.