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GIVING SEASON 2024
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by Bob Jacobs 🔸
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Adjusted life yearBioethicsDonation choiceKidney donation
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I've been talking with my hospital about donating my kidney and it's been going rather well. However, one piece of unfortunate news they told me is that I can't donate both my kidney and a piece of my liver (and that I can't do this in another hospital either). So people that want to donate are faced with a dilemma of which one to choose. I asked the doctors whether they had literature on this, but unfortunately they didn't know of any that compared the two.

I've looked at some papers, and the side effects for both kidney donation and liver donation seem to be negligible for the donor (way less than 1 QALY).

That leaves us with the question of what has the bigger impact for the recipient.
I've looked for papers that compared them directly, but couldn't really find anything.

It seems like for kidneys:

The average donation buys the recipient about 5 - 7 extra years of life (beyond the counterfactual of dialysis). It also improves quality of life from about 70% of the healthy average to about 90%. Non-directed kidney donations can also help the organ bank solve allocation problems around matching donors and recipients of different blood types. Most sources say that an average donated kidney creates a “chain” of about five other donations, but most of these other donations would have happened anyway; the value over counterfactual is about 0.5 to 1 extra transplant completed before the intended recipient dies from waiting too long. So in total, a donation produces about 10 - 20 extra quality-adjusted life years.

Liver donation seems to generate less QALYs, though the estimates vary a lot.

So I'm currently leaning towards donating my kidney. Does anyone have any more insights into this? Does anyone know of an analysis that compares the two? (If someone is/wants to write one, I'd be glad to help) Please share your thoughts.

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Vasco Grilo🔸

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Thanks for your willingness to contribute to a better world, Bob!

Have you considered not donating either of those, and instead support the best animal welfare interventions?

  • If donating a kidney averts 15 DALY (= (10 + 20)/2), and costs you 1 k$[1], the cost-effectiveness would be 0.015 DALY/$, which is similar to the cost-effective of GiveWell's top charities of around 0.01 DALY/$ (50 DALY per 5 k$).
  • However, I think corporate campaigns for chicken welfare, like the ones supported by The Humane League (THL), have a cost-effectiveness of 15.0 DALY/$ (= 8.20*2.10*0.870). I got this assuming:
    • Campaigns affect 8.20 chicken-years per $ (= 41*1/5), multiplying:
      • Saulius Šimčikas’ estimate of 41 chicken-years per $.
      • An adjustment factor of 1/5, since OP thinks “the marginal FAW [farmed animal welfare] funding opportunity is ~1/5th as cost-effective as the average from Saulius’ analysis [which is linked just above]”.
    • An improvement in chicken welfare per time of 2.10 times the intensity of the mean human experience, as I estimated for moving broilers from a conventional to a reformed scenario based on Rethink Priorities' median welfare range for chickens of 0.332.
    • A ratio between humans’ healthy and total life expectancy at birth in 2016 of 87.0 % (= 63.1/72.5).
  • So it looks like:
    • Donating to the THL is 1.00 k (= 15.0/0.015) times as cost-effective as donating a kidney.
    • One could achieve the benefits of donating a kidney by donating to THL just 1.00 $ (= 15/15.0).
  • In addition, I guess you would be donating to someone in a high income country, where the consumption of animals with bad lives is high, so I would personally worry about the meat eater problem.
    • I estimate the scale of the suffering per time of all farmed animals is 4.64 times that of the happiness per time of all humans, which suggest saving a random human life leads to more suffering than happinness nearterm.
  1. ^

    I think the cost will tend to be higher. From Sekercioglu 2020, "the average donation-related costs range from $900 to $19 900 over the period of predonation evaluation to the end of the first postoperative year".

Bob Jacobs 🔸26
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Hi Vasco,

I already do work for an animal welfare organization. I looked at the study and it's not about Belgian hospitals, so it doesn't really apply to me. Some of the listed costs aren't present (I don't have a wage so no wage loss), those that are present are mostly paid for by the state (travel, accommodation, medical...) and those that aren't are paid for by my parents (housework). The only one that applies is "Small cash payments for grocery items (eg, tissue paper)" which is negligible, so the expected DALY per dollar is extremely high.

In Belgium you can leave a message to the person you're donating to, so I had planned to leave a message about veganism and effective altruism. I think this will be a very powerful reason to change behavior, seeing as it comes from their altruistic donor.

Also, donating will help with persuading people to be more altruistic in general. In psychology you have this concept of a costly signal, which causes people to take your (related) ideas much more seriously.

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defun 🔸
Are you confident about this? Donating an organ might seem quite extreme, possibly making the average person view you as 'very weird,' which could have the opposite effect.
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Vasco Grilo🔸
Thanks for following up! Cool! Even if there is no direct nearterm financial cost, you could plausibly use the time saved by not donating a kidney to generate at least 1 $? For example, I guess the cost to your parents would be higher than this, so they might be happy to donate a few dollars to THL for you not to donate a kidney. Even if not now, the time you save may also increase your income by more than 1 $ in the next few years. For an hourly rate of 20 $/h, it would only need to increase your wages expressed as working time by 3 min (= 1/20*60). This sounds inspiring. At the same time, would you feel comfortable donating a kidney if it being good depended on the beneficiary having a sufficiently high chance of becoming vegan or effective altruist? Note the beneficiary would probably rather read a message which does not convey that you are expecting something in return... If you chose to make a (possibly indirect) request in your message, you may want to consider asking for a donation instead of raising veganism: * If you trust my numbers on the scale of the suffering of farmed animals, the annual suffering caused by a random human to farmed animals is equivalent to 4.04 DALY (= 4.64*0.870). * So, for a life expectancy of the kidney recipient of 30 years, the potential gain due to becoming vegan would be 121 DALY (= 30*4.04). * The above could be averted donating 8.07 $ (= 121/15.0) to THL. * The kidney recipient would probably prefer to donate a few dozens of dollars to THL over becoming vegan. As for raising effective altruism in your message: * I guess the kidney recipient would tend to have an older age than that at which people usually become engaged with effective altruism, so there would be less room to change to a more impactful career, and I assume most of the benefit would come from additional effective donations. * Giving What We Can estimated each GWWC Pledge leads to 22 k$ of effective donations. If I recall correctly, these effective d
Bob Jacobs 🔸16
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  • I don't think we can just equate 15 QALY's to 15 DALY's, these are different metrics. I tried to find a converter online but it looks like there is no consensus on how to do that.
  • Additional benefits of making someone an EA include: doing part-time/volunteer work (e.g. currently everyone at effectief geven is a volunteer), and them making other people EAs (spreading the generated expected QALY's further).
  • Same things could be said for veganism, which is less likely with a one time donation since people don't make that part of their identity. But the cost-effectiveness is a good point. Maybe many small donations over time could achieve those same things while being more cost-effective? But then again the funding landscape might change. I'll think a bit more about this.
  • I think the recipient is much more likely than that to sign the pledge, since the average person who has heard of EA associates it with SBF-types while this person is a direct life-changing beneficiary.
  • I also noticed you didn't add the 'costly signal factor' to your analysis. I think we EAs tend to fall for the McNamara trap of basing our decisions only on quantitative observations and ignoring the rest. A lot of the fac
... (read more)
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Vasco Grilo🔸3
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I think downvoting comments like the above is harmful:

  • It disincentivises people to make honest efforts to express dissenting views, thus contributing towards creating echo chambers.
  • It increases polarisation.
    • I assume people who believe they are unfairly downvoted will tend to unfairly downvote others more.
    • I had initially not upvoted/downvoted the original post, but then felt like I should downvote the post given my perception that the comment above was unfairly downvoted. I do not endorse my initial retaliatory reaction, and have now upvoted the post as a way of trying to counter my bad intuitions.
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keller_scholl11
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For what it's worth, I upvoted and disagree-voted, because I think I think you're wrong and because you clearly put thought and effort into your writing, and produced the sort of content I think we should generally have more of, even though I'm annoyed locally that "don't do either" is a much easier comment to write than "here's the analysis you asked for", leading to the only serious comments on the post being people stating your view.

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Vasco Grilo🔸
Thanks, Keller! That makes sense to me.

DC

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I would personally recommend waiting to sell your kidney when there is a feasible jurisdiction you can travel to that allows kidney markets (e.g. Argentina under Milei).

nemeryxu4
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Doesn't seem worth it at that point since markets will start to clear, as in Iran, lowering counterfactual impact. At that point it largely becomes a question of earning to give.

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ag4000
I think DC's point is that the donation one can makes from the proceeds of selling the kidney outweighs the counterfactual direct impact of donating the kidney.
Leo1
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The expected impact of waiting to sell will diminish as time goes on, because you are liable to change your values or, more probably, your views about what and how best to prioritize. This is especially true if you have a track record of changing your mind about things (like most of us). While the expected impact of waiting is, say, the value of two kidneys, conditional on not changing your mind, this same impact will be equal to the value of one kidney, or less, if you have a 50% chance or more of changing your mind. So I guess your comment is valid only if you are very confident that you will not change your mind about donating a kidney between now and the estimated time when you can sell it.

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Molly Hickman

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@Bob Fischer, my understanding is the recovery from liver donation is quite a bit worse than recovery from kidney, which makes intuitive sense to me... The liver has to grow back (painfully, iiuc) versus the remaining kidney just gradually works a little harder. I don't know how different the incisions are. FWIW, I was able to stop taking my prescribed opioid less than a week post-op, and didn't even need acetaminophen shortly thereafter. I'm happy to tell you more about my kidney donation if that would be helpful!

Per Scott Alexander:

I donated my kidney, but I’m probably not going to donate a lobe of my liver (even though this is also mostly safe and also helps people in need). This isn’t because there’s a real distinction about which parts of my body are vs. aren’t sacred, it’s just that I guess I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful. If anyone gives you grief about admitting this, ask them how much of the axiological law they’re following.

Mendy

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That's what they say but it's no longer true. I know multiple people that have done both.
Happy to share much more if you DM me.

1mkl32j201091

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Such an altruistic sacrifice is quite admirable, but why not just commit to donating more money to effective charities (global dev/animal welfare)?  That is much more efficient and effective, unless you place a low value on undergoing a kidney removal? An analysis for cost-effectiveness seems somewhat strange in this context.

Bob Jacobs 🔸30
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I already give everything, except what's required for the bare living necessities, away. The analysis is warranted seeing as the cost-effectiveness is so high (see other comment) and analyzing which intervention is higher impact is just a general ethical/EA practice, even when we aren't talking about ~15 QALYs

EDIT: This is not as impressive as it seems at first glance. I'm a student so I only buy cheap things anyways (which means I get a modest-proposal-esque thought every time e.g. This 30 dollar jacket costs as much as curing one person of blindness). We'll see how I behave if I ever get some large amount of money.

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1mkl32j20109114
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I see. Well, that changes my perspective. Originally, I assumed that you did not give away everything except for what is necessary to live. With the context that you are giving maximally, then donating your liver or kidney can go beyond that so it makes more sense why you are asking the question. I don't think analyzing QALYs is strange generally. 

You are quite the EA! Congrats

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Ulrik Horn
I want to gently push back on this being more EA than not undergoing surgery and removing important parts of one's body. I think you might be influenced a lot by your feelings (I know I am despite trying to be rational - I am rational about how irrational I am!). Therefore, I could imagine myself in your situation feeling a strong pull to be an organ donor because you feel like you are not giving enough otherwise. I therefore strongly advice to wait a few years after you have graduated and you have a comfortable, stable income. This way you will have compassion for your future self which is likely to most of the time have a stable and comfortable income - the student years pass quickly! Take care of yourself whatever you do, this is a marathon, not a sprint (unless we are unlucky with AGI timelines and alignment).
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Bob Jacobs 🔸
I mean it's not an important body part, you can live perfectly well with only one kidney, which is why I'm giving it away. If by some cruel twist of fate I do end up needing another kidney, I'll be on the top of the recipient list thanks to my donation. Of course I am, empathy is a feeling after all. I don't see why this is a reason to not do it. I will not do the procedure during the school year, and will take as long as I need to recover afterwards. I'd prefer to do it sooner rather than later, since earlier interventions are almost always better than later interventions due to the higher amount of knock on effects (e.g. if I convince someone to be vegan now it's better than years in the future, since I'm saving the animals in the intervening years). Also I study ethics, so a "comfortable stable income" is probably not happening anyways :)
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PabloAMC 🔸
While admirable consider whether this is healthy or sustainable. I think donating less is ok, that’s why Giving what we can suggests 10% as a calibrated point. You can of course donate more, but I would recommend against the implied current situation.

Ben Stevenson

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Moral trade opportunity: Alice donates a kidney, Bob donates part of their liver?

[This comment is no longer endorsed by its author]
Ben Millwood🔸2
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I think this isn't a good example of moral trade (afaik the issue here is an empirical one and not affected by differing moral values), but even if it was I don't think it would answer the OP's question unless you were clearer on whether the OP is Alice or Bob, and how they'd find Bob / Alice.

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Ben Stevenson
This was meant as a joke (I think OP got this) but on reflection it probably wasn't funny / a good opportunity to try to be funny. I actually agree with your empirical/normative point, and I'll retract the comment so others aren't confused.
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Jesse Gainsburg19
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While your primary question is whether you should donate your kidney or liver lobe, I actually reject your premise that you have to choose.

While hospitals don't let you donate both at the same time for good reason, it's now fairly common (insofar as living organ donation is common) for hospitals to allow folks to donate both assuming full recovery from the first operation.

I believe I was told when donating my kidney that I wouldn't be eligible to donate part of my liver, though my memory is fuzzy because it was some years ago. 

However, I looked into it after a few years, and sure enough, was cleared to donate part of my liver. Perhaps the medical community is slowly coming around to this, but the transplant clinic you are working with isn't quite there yet. 

I ended up going under the knife for the second time in July 2023. I was cleared to donate at two top-flight hospitals in the US despite my prior kidney donation, as a point of reference.

If you are truly interested in doing both, I'd suggest donating the kidney first. The recovery is not as strenuous, so it's a good "trial run" to see if you would be interested in doing the liver donation, too. One point that might move you marginally more towards liver donation is that there is a group (NOTA) trying to legalize compensation for kidney donors which might increase the supply of donated kidneys, thus marginally making donated livers more valuable. 

Today marks the 6-year anniversary of my kidney donation. Aside from the raw QALY's of it all, I found it to be a rather rewarding experience. 

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