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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7 Responses to Would you give a kidney to a stranger?

  1. bluemoose says:

    I’ve read an article about what was called, I think, social scaling. I don’t remember the specifics and don’t have a link, but basically it says that our brains order people in a target-like pattern — from those near and dear to us in the center, all the way to the faceless masses “out there” who do not have any direct relationship to us.

    To me, this makes sense and explains why I would be willing to consider donating a kidney to someone in my inner circles of relationships, but it would never cross my mind to do it for a complete stranger. There are a few people I will risk bodily harm for, and most of the rest of the world I won’t. The world at large can’t and won’t mean a thing to me if that “me” isn’t intact to ponder it.

  2. I haven’t yet read the article, though it’s on my to-read list (i.e., in the New Yorker that’s in the bathroom this week!). I too believe that I would donate a kidney to a friend or family member. I have family members who have very serious medical problems right now, and I’ve had to think a lot about what I would or would not sacrifice to help them. For instance, I don’t think I could move to another state to become the primary caregiver for a family member, because it would involve not just sacrificing my time, but my career goals, my home, and my sense of autonomy. But if I could give them something physical–whether it’s money or an organ–I see that as a reasonable and loving way to care for them.

    Peter Singer, incidentally, sounds good in that quote but significantly less good in others. He is infamously eliminationist with regard to people with disabilities; his pragmatism leads him to conclude that they are less worthy of ethical consideration and, in fact, life, than great apes. So his callousness with regard to proximity doesn’t surprise me.

  3. JP says:

    My husband gave his sister a kidney. I would say OF COURSE that is different from giving a kidney to a stranger. There is a prior relationship; all sorts of things are bound up in that, not the least of which is that her ill health or death would also be a loss to him.
    It’s nice, and true to say anyone’s death is a loss to us all, but it’s not really the same.
    All that said…it is not a simple or easy procedure. The survival rate for donors is high, this is true, but it’s not the whole story. My husband nearly died in the hospital, not from the surgery, but from botched medications. (This is just a general warning for anyone receiving hospital care)
    As far as the transplant experience. He was constantly treated as a set of available parts by the transplant team, and sometimes by the rest of the family. It was extremely difficult and painful to deal with.
    We came to understand these issues are common with family donations, similar to the vein Robin mentioned above. In some ways, I think a donation to stranger would be easier.
    Also, it is important to note, the recovery is long, and the pain is substantial. A donor will be out of work for some time. My husband’s company health insurance is a very large one; so this will apply to many many people. He did not receive any paid short term disability, because the insurer only paid disability if they had also paid for the related treatment. In organ donation, the recipient’s insurance or foundation and public funds bear the medical costs. (Poorly…we’ll be getting collection notices for years)
    My point is, there is a great need for organ donation, and any donor deserves a parade for being an outstanding human being. And, it is harder in a million ways than all the research will tell you.

  4. Bonnie says:

    In theory I’d have no problem donating a kidney to a an acquaintance, or even a stranger. But then I think, what if my sister, or another family member, ends up needing a kidney at some point? I’m not sure if I could live with myself if that happened and I didn’t have one to give because I’d already given it away to a stranger.

  5. Jenny1144 says:

    I find myself agreeing with Bonnie: I keep moving in the direction of willingness to donate a kidney to a stranger, but I keep being stopped on a very visceral level by the objection, “But what if someone I love needs a kidney someday?” I think part of it comes from the same source as so much of my money-related greed: I want to save money rather than giving it away, not because I want to spend it, but because I want the security of knowing I’ll have to spend it in the future. I don’t care about my kidney, and the operation sounds like a trivial price to pay for saving someone’s life, but I want the security of knowing I’ll have it to give to someone I love in the future.

    Is that wrong? I haven’t decided yet. I think it depends on how highly you rate proximity in your ethical calculations. It may be selfish to care more about my family and friends’ survival because I want them around me and would grieve if they died, but I do believe we have a greater duty towards people who are already in our lives than for people we don’t know because we’ve entered into a sort of social contract with them. We owe more to the people who’ve been our friends for years. Maybe we also owe something to people in general, but they aren’t part of our specific sphere of responsibility. It’s a bit like we’re each custodians of a certain building: we’re hired to keep that one building ship-shape, and even if we hear about some other building down the street that’s being neglected, we can’t go clean that one up until we’ve done our duty towards the one that’s ours. A silly analogy, maybe, but I do think we each have a small selection of people that it’s our duty to take care of. We can exceed (or expand) that sphere of duty, certainly, but we can’t neglect it.

    Now, whether a purely hypothetical and not too likely future need of a family member exceeds the present need of thousands of strangers–that one, I’m not too sure about. My gut may be steering me wrong there.

  6. magicbean says:

    Singer is so linear it hurts me. So much suffering and relief is unpredictable…maybe you donate a kidney to a stranger who then suffers in some other tragic way and he lives through it because of your kidney. Or you choose not to give a kidney to a friend and it causes some emotional transformation that allows a peaceful death. There’s not some balance sheet of emotional accounting that says “Kidney donation worth 3000 points of happy therefore do it.” Isn’t Singer the animal liberation guy? Or am I thinking of someone else.

    That said, I can easily imagine myself in any multitude of situations where it might be the right thing to donate a kidney to a stranger…or a friend…or not. But I have a really good imagination.

  7. Tom says:

    I follow Singer’s ethics very closely; he has been so persuasive to me that I am pursuing a career as a barrister in order to earn-to-give, have adopted vegetarianism, and am considering donating a kidney. (still have not decided)

    With that partiality declared, I think he would respond to your objection in the following way:

    1. Persons, insofar as they possess morally relevant attributes ( a capacity for pain, consciousness etc.), are entitled to an equal degree of consideration as any other person who possesses comparable attributes- What makes it true that someone is entitled to moral consideration is that they have these attributes in the required quantity.

    2. There is no necessary difference in these morally relevant attributes between those you know and strangers. In this sense, partiality based on how well you know or like someone is ethically arbitrary in the same way as racism, classism, sexism etc. (and Singer would want to add speciesism to that list.)

    3. Morality is objective, which is to say what one ought do doesn’t vary with personal opinions or attitudes.

    C: In the absence of any objective difference (like facts about their capacity to suffer) between the morally relevant attributes between two persons, it is appropriate to weight their interests as being objectively equally demanding of satisfaction.

    I would point out here that the facts of the case would sometimes render partiality towards relatives and friends ethically acceptable. For example, it may be the case that the net consequence of caring for people you have relationships with ends up outweighing acting in a strictly impartial fashion.

    So, I think it is actually possible to accommodate your concern within Singer’s ethics.

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