Considering Directed Kidney Donation Within the EA Community
Hi everyone,
I’ve been thinking deeply about donating one of my kidneys to a stranger, and I’d like to explore the possibility of donating it to someone within the EA community—someone who shares core values with me.
So first and foremost; is there an EA’er that is waiting for a kidney for themselves/a loved one ?
Perhaps there is not, which could end the discussion, but from a hypothetical standpoint, the following still interests me:
The idea of helping a fellow EA’er in such a profound way is compelling, both from a potential impact standpoint as well as in terms of personal fulfillment, but it also raises a number of ethical and practical concerns that I have been considering. Any thoughts on any of the following topics would greatly be appreciated!
Equity and Fairness: By prioritizing someone within our community, am I inadvertently encouraging a moral system where only those with specific connections/affiliations/ ideologies have access to potentially life-saving resources? AKA am I making a critical thinking error by seeking to apply a filter to a medical procedure?
How would I even go about ensuring that a potential recipient truly shares the values of effective altruism? Is it even feasible or fair to attempt such a verification?
If I donate to someone within the EA community, is it fair to expect or assume that they will continue to uphold EA principles or contribute to the community in specific ways? I have read other posts about donors writing a letter to their recipient post-surgery, aiming to convince them of EA principles.
Legal and Ethical Complexities: Are there legal or ethical challenges associated with directed donation based on shared values, particularly when it involves a specific community like EA? I can imagine a doctor might assume pressure is being applied/ financial incentives are at play if a directed donation is attempted outside friends/family circles.
Given these concerns, I could understand why, from an ethical perspective, it would be better to proceed with an undirected donation through a standard registry, where the recipient is chosen based on medical need alone. Very undefined thought process however, hence all the questions :).
I’d really appreciate any insights or advice from this community as I navigate this complex decision.
Thanks in advance for your thoughts!
Your kidney is yours: you can donate it to whoever you like. I don’t think there’s anything worse about directing it to a particular community than to a particular family member or friend; indeed, some of the highest rates of non-directed donation are among Orthodox Jews in the NYC area, which feels somewhat analogous to what you’re considering.
In terms of the moral impact of your donation, one of the most important variables is the length of your donation chain. You may have already read up on this but if not: many people in need of a kidney have family members who want to donate but are incompatible due to various antibodies. So those family members commit to donate on the condition that their loved one gets a kidney from somewhere else. These chains are hard to set up only among directed donors, because every kidney donor needs a kidney back. Non-directed donors can help get a chain going, and they can get very long. Mine was 4 kidneys; one particularly huge chain was 30 long. Participating in a chain can mean you’re contributing (at least somewhat, counterfactually) to multiple donations, not just one.
Setting up chains is hard and time-consuming. The nurses who operate the logistics here are among the most clever people I’ve met. It’s really tough, complex work. There’s tradeoffs involved: it might take months to set up a chain of real size, which could make life less convenient for the non-directed donor (I’ve been there!). Insisting on directing your donation will definitely make setting up a chain a good deal harder. That could overwhelm the motivation to give to an EA, depending on how much you value intra-community donation versus trying to get as many people kidneys as possible.
Speaking just for myself, one of the most important EA values to me is the idea that all sentient beings should be in my scope of moral concern. Everyone matters. For me, that pushed toward non-directed donation rather than giving within a particular family or community.
If you want a simple, one-sentence piece of advice: I’d give non-directed, wait for a reasonably long chain, and hope for the best. But I’m not you, and it’s your body, and whatever you do, I’m grateful you’re considering donation and thinking about it this carefully.