Would you give a kidney to a stranger?

Larissa MacFarquhar wrote a piece in the New Yorker that’s been getting some buzz lately, about people who donate kidneys to strangers. I read it last night, and oh my. It is remarkable–not only for the examination of the psychology of these donors and the complexities of the relationship between organ donors and recipients*, but also of the history and evolving attitudes about organ donation, and the medical realities of kidney disease and donation. (Did you know, for example, that if you get a replacement kidney, they don’t take the old ones out, so it’s possible to have quite a few sloshing around in there?)

There is no single profile of the psychology of a stranger-donor, and the piece ends with a remarkably matter-of-fact Methodist minister for whom donating a kidney appeared to have no more emotional freight attached to it than tithing to her church. Someone needs a kidney, she’s got two, the operation is remarkably safe, what’s the problem? Why aren’t more people doing it?

What is the problem?

Would you donate a kidney to a stranger? To a family member? To a friend?

And–another question Ms. MacFarquhar examines that I find just as interesting–would you accept a kidney from someone you know? Would you actively solicit a kidney from friends and family, if you needed one?

I would not donate a kidney to a stranger, nor do I feel any sense of a moral call to do so merely on the grounds that I could. My body and its functions are not some form of wealth that I am hoarding like Scrooge McDuck: they are constitutive of my identity. They are ME. And no one has an a priori right to my blood, my organs, my womb. I may choose to share, but that is my choice. Having two kidneys when others have none is not the same has having two loaves of bread when others have none. The body is different. I do not owe anyone access to my body.

That said, I believe I would give a kidney up quite willingly for a family member or friend. (“I believe” because I’ve never been in that position.) Often, apparently, organ donation can cause some difficulties in personal relationships: the burden of gratitude on the part of the recipient may be too much to be borne gracefully. That, to me, seems a risk worth taking. Have you never lost a friend because of a thoughtless thing you did or said, or simply because you drifted apart? This hurts, but we survive it, and that is a friendship lost for stupid reasons. If I saved a friend’s life, or their quality of life (dialysis is far worse than I knew), and lost the friendship as a result, I could cope with that. I would live without you, if you could live.

I also believe that I would have no problem hitting “Send” on a mass “Okay, guys, I need a kidney, who’s up for it?” e-mail to my own nearest and dearest. And–perhaps this will strike you as selfish–if that relationship could somehow not withstand the hugeness of what had passed within it, I could live with that, too. I would do everything I could not to allow a vortex of guilt and martyrdom and obligation and unease from taking over, but if it did … at least I’d still be alive to experience the awkwardness. I can live without you, if I can live.

Why not to a stranger? In his book The Life You Can Save (which is about global poverty, not organ donation) philosopher Peter Singer lays out the following principles:

First premise: Suffering and death from lack of food, shelter and medical care are bad.

Second premise: If it is in your power to prevent something bad from happening, without sacrificing anything nearly as important, it is wrong not to do so.

He goes on to make an argument about giving to international aid, but clearly the same reasoning would apply to giving a kidney. And I agree with both premises.

I find Mr. Singer’s logic hard to argue with, but his belief that proximity and relationship do not matter when assessing ethical choices seems fundamentally wrong to me. Perhaps not wrong according to cold Vulcan logic, but any ethical system that doesn’t allow for how people will actually behave and feel is not a workable one, and a philosophy that is not workable is nothing but a thought experiment. I would spend money to save the life of Mr. Improbable that might save the lives of 20 poverty-stricken Africans I have never met and feel no guilt, in part because I bet every one of those 20 would do the same in my position. If we do not owe more to our family and friends than to strangers, what, exactly, does “relationship” even mean?

What do you think? Do go read the article, if you can. I would be deeply interested in hearing your thoughts! (I’m going to have to have delayed gratification on that, however. I’m traveling and internetless this weekend. If you’ve posted here before, your comment will go through automatically; if not, you’ll have to wait until I return on Monday to moderate. Thanks for your patience!) If you’re not a subscriber, you can apparently buy online access to a single issue through the link above–or go to your library or borrow a friend’s copy. There’s a new issue out on the stands, so you probably can’t get it in a bookstore.

*Can we please stop calling them “donees”? And what is with this trend of referring to a person being mentored as a “mentee,” which makes them sound like a demented candy? The beneficiary of a donor is a recipient. The person being mentored is a protege. It’s not that hard.

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