Just noting that there’s a huge literature on this exact question, eg
Phil Trammell, “Philanthropy timing and the hinge of history,” Feb 2020
Will MacAskill,”When should an effective altruist donate?,” Sept 2019
Holden Karnofsky, “Good Ventures and Giving Now vs. Later,” Dec 2016
Julia Wise, “Giving now vs. later: a summary,” Jul 2013
Josh is like the Velvet Underground: not a household name, his message reached relatively few of us, but almost all of us wound up donating.
(Lovely piece Molly; I also had some wild catheter experiences but thankfully nothing this bad.)
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.
Loved this piece, and I think this articulates something important that even big histories of the war I’ve read (and contemporary commentaries I remembered) missed
There was a lot of incredulity about responding to 9/11 by going after Iraq given that almost no one claimed Iraq was behind the attack; at best you had sort of desperate allusions to loose linkages between Hussein and al-Qaeda affiliates, which turned out to all be false. But skeptics were probably responding overly literally and in terms of the actual chain of logic instead of “which factions in government are empowered by this development,” the answer to which was the PNAC crowd that wanted an Iraq invasion.
Seems useful in thinking about moments like MechaHitler or the DeepSeek shock. In the latter, for instance, a lot of people made good arguments that DeepSeek being able to train an excellent model with less compute implies that compute is more valuable than we thought, and that export controls might be more important, but despite that, it probably on the margin empowered Jensen Huang and the laissez-faire faction by making Biden’s policies look feckless.