Thank you for writing this! I think most people considering kidney donation should read something like this. That being said, I would hesitate to recommend this piece to a prospective donor, at least in its current form. I can’t respond in-depth, but maybe the most succinct way to explain why is that I think it has some elements of a soldier mindset. I’ll use the skin in the game sub-section as an example:
Many of the people in the “Harvard” school of Nutrition indeed eat vegetarian diets and limit protein intake, or at least avoid large amounts of saturated fat and fatty meat.
Why is Harvard in scare quotes? That’s just the name of the school. I noticed this throughout the piece, including in the title of section 1c. I don’t think this adds to your argument, and I worry it’s just a rhetorical attack against all medical and professional establishment.
Have most of the researchers looking at kidney donation donated a kidney? Have most nephrology researchers donated a kidney? Most surgeons doing kidney transplants? … Maybe they are all evil people? They will not take even a marginal risk to save a life. Maybe they are all insane and are unable to translate what they learn from data into reality. But then you at least have to accept that you’d be making your decision based on research done by evil and/or insane people.
Is believing that the entire medical establishment is “evil or insane” actually the most parsimonious explanation for one of many stated-revealed preference gaps in the world? I think I should exercise for 60 minutes a day, but I often fail to do that. Does that make me insane? Of course, I think your actual goal is to hint at medical professionals not even endorsing donation in theory:
… Or maybe, their understanding is nuanced enough that they don’t think the risk is marginal.
Nephrologists spill a lot of ink discussing the risks of kidney donation (which I take it you’ve read much of). Why can’t we just trust the things they say about what they think the risk is?
I might have some motivated reasoning here since I donated a kidney. But, for what it’s worth, my experience of the kidney donor evaluation process was basically a bunch of professionals trying to convince me that risks are real and non-negligible, that there are limits to what we can infer about them from the existing literature, that if I have any doubts I shouldn’t donate, etc.
But it wasn’t a screed against it by any means. It seems like the overall take that the vast majority of nephrologists and experts in the field have landed on is something like: “kidney donation is sufficiently safe for the healthy donor, and it provides such significant benefits for the average recipient, that we can, in good faith, devote much of our careers to facilitating it.” [1] And hospitals, notorious for taking overly conservative approaches to care as to avoid legal liability, at least in the US, have agreed with that assessment.
I still think it’s worth critically scrutinizing the purported risks, but I don’t think it’s necessary to postulate that medical professionals secretly think the operation isn’t worth it, nor that they are all “evil and/or insane.”
Thank you for writing this! I think most people considering kidney donation should read something like this. That being said, I would hesitate to recommend this piece to a prospective donor, at least in its current form. I can’t respond in-depth, but maybe the most succinct way to explain why is that I think it has some elements of a soldier mindset. I’ll use the skin in the game sub-section as an example:
Why is Harvard in scare quotes? That’s just the name of the school. I noticed this throughout the piece, including in the title of section 1c. I don’t think this adds to your argument, and I worry it’s just a rhetorical attack against all medical and professional establishment.
Is believing that the entire medical establishment is “evil or insane” actually the most parsimonious explanation for one of many stated-revealed preference gaps in the world? I think I should exercise for 60 minutes a day, but I often fail to do that. Does that make me insane? Of course, I think your actual goal is to hint at medical professionals not even endorsing donation in theory:
Nephrologists spill a lot of ink discussing the risks of kidney donation (which I take it you’ve read much of). Why can’t we just trust the things they say about what they think the risk is?
I might have some motivated reasoning here since I donated a kidney. But, for what it’s worth, my experience of the kidney donor evaluation process was basically a bunch of professionals trying to convince me that risks are real and non-negligible, that there are limits to what we can infer about them from the existing literature, that if I have any doubts I shouldn’t donate, etc.
But it wasn’t a screed against it by any means. It seems like the overall take that the vast majority of nephrologists and experts in the field have landed on is something like: “kidney donation is sufficiently safe for the healthy donor, and it provides such significant benefits for the average recipient, that we can, in good faith, devote much of our careers to facilitating it.” [1] And hospitals, notorious for taking overly conservative approaches to care as to avoid legal liability, at least in the US, have agreed with that assessment.
I still think it’s worth critically scrutinizing the purported risks, but I don’t think it’s necessary to postulate that medical professionals secretly think the operation isn’t worth it, nor that they are all “evil and/or insane.”
They also seem to think it’s a terrific thing for someone to choose to do, and they tend to hold donors in very high regard.