16 ms·

My Left Kidney

• allturtles 3y ago
  I dunno, I feel like this whole article just makes it clear how fundamentally flawed the idea of calculating your way to good (in both the moral and the practical sense) decisions is. It's clear from the article that even the first-order effects of a kidney donation decision are incalculable: no one really knows the exact risk accrued from the CT scan, or the surgery, or the upside to the recipient. It doesn't seem OP included the direct costs of the transplant itself at all (all those tests and scans and screening interviews, the travel and lost time from work, and then the cost of the two surgeries). Then one could go on and on with calculating higher-order effects forever. ("I'm married to someone who gives $500K a year of their income to EA causes, but if I die in surgery there's a 5% chance they will commit suicide out of grief, denying XYZ dollars in future income to the cause...") Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less."
  • Vecr 3y ago
    Maybe they've worked out some sort of precommitment to prevent that, or he put poison pills into his will or something.
  • jodrellblank 3y ago
    Or the risks of hospital-acquired infection (maybe his girlfriend considered that). What about effects like if it aches for years afterwards but won't kill him; at what level of ache would that turn from "reminder that I did a good thing" to "damnit"? Hand transplants are a thing - would he give up his non-dominant hand to someone who lost both of theirs in an accident? Eye transplants aren't a thing, but if they were, would he give up one to a blind person? If it was really easy to see the damage (hand) and lose an obvious piece of functionality (eye) it would be much harder to argue with numbers "studies show that most people who lose a hand survive more than 7 years". Would he lose an eye, a hand, a kidney, a lung, a lower leg, a foot of intestine, a chunk of liver, a section of skin, a few litres of blood, if it did more good to someone else than to him? > "Indeed, OP tries to present a bunch of arithmetic to justify their decision, but admits that it ultimately rested on an emotional gut feeling: "It starts with wanting, just once, do a good thing that will make people like you more instead of less."" The Last Psychiatrist wrote that you shouldn't need validation from other people, shouldn't want it, and if you do want it - fix that. Doing it hoping you gain some indelible "society values me" token to carry around with you forever so you can use it as a trump card and people will like you more, feeling like you've never done anything good and that you need to to be likeable, doesn't sound much like "altruism: Unselfish concern for the welfare of others; selflessness.", does it?
• CommieBobDole 3y ago
  I've always enjoyed this author's work, but there's something almost pathological about the way he assumes that the risks of this act are well-quantified enough to make a rational mathematical decision about it, or that those risks are even well-quantifiable at all; there are ten thousand paths to medical complication here that aren't captured in "this is the percentage of healthy kidney donors who died during the operation or died of kidney disease later". Honestly, I would have respected "I wanted to do it, I became obsessed with doing it, I knew it was likely dangerous and I can't quantify how dangerous, but it did it anyway because I thought it was important" more than this many-page attempt to mathematize the un-mathematizable. Which I guess raises a larger point about how the rationalist and EA and other similar communities have a tendency to try to reduce fiendishly complex multivariable human issues to equations and statistics without realizing that some problems are not math problems and will defy any attempt to be quantified, statistitized, or calculated.
  • Aurornis 3y ago
    > Which I guess raises a larger point about how the rationalist and EA and other similar communities have a tendency to try to reduce fiendishly complex multivariable human issues to equations and statistics without realizing that some problems are not math problems and will defy any attempt to be quantified, statistitized, or calculated. Some of my old coworkers were really into EA, LessWrong, and the rationalist community. At first it was fun to read some of the articles they shared, but over time I observed the same pattern you described: Much of the rationalist writing felt like it started with a conclusion and then worked backwards to find some numbers or logic that supported the conclusion. They had already made up their minds, after which the rationalist blogging was all about publicly rationalizing it. The other trend I noticed was how much they liked to discard other people's research when it didn't agree with something they wanted to write. They were very good at finding some obscure source that had a different number or conclusion that supported their claims, which was then held up as an unquestioned source with no further scrutiny. Someone once described it to me as "second option bias": Rationalist writings have a theme of taking a commonly held belief and then proposing a slightly contrarian take that the closest alternative explanation is actually the correct one. Once you start seeing it, the pattern shows up everywhere in rationalist writings. In this article for example: 1. Argument that kidney donation is actually much safer than people think because the author picks 1 or 2 specific failure modes and cites those as if they captured all possible downsides. 2. Argument that CT scans are actually much more deadly than people think because there are many possible downsides that we can't account for. Author admits to surveying a contentious field and selecting the most conservative risk estimate he found. 3. Argument that the Center for EA buying their own expensive castle to host their own meetings is good, actually. Anyone who questions the Center for EA spending millions on a remote castle so they could meet there must be wrong and misinformed and outsiders, with little more than "just trust them that the math is right" as the argument. This author is a very good writer so he's masterful at breezing past the details, but it's hard to miss the pattern once you start seeing it. The pattern is more obvious in a lot of the less popular rationalist writings where it's clear the authors discarded any sources that were inconvenient to their conclusion but elevated any sources that told them what they wanted to hear. Another common pattern in rationalist writing is to make strong claims based on weak evidence, then to hedge in the footnotes as a way to preemptively defuse counterarguments. Sure enough, this article has some footnotes that acknowledge that the radiation risk numbers he used in the main article are actually highly disputed and he chose the most conservative ones. This point is conveniently separated from the main article to avoid detracting from the point he wanted to make. The main article confidently makes one claim, then anything that might weaken that claim is hidden in a footnote. Predictably, many of the comments on HN questioning the radiation numbers are met with "he addressed that in the footnote" comments that try to shut down the debate, so the strategy clearly works. Something about hedging in footnotes inoculates certain readers against questioning the main article. It's another pattern that becomes obvious once you start seeing it.
• at_a_remove 3y ago
  "It starts with wanting, just once, do a good thing that will make people like you more instead of less." Oh this poor soul. The people who do not like you will not care what you do. I know he's been through the ringer with the Blue Tribe and all but this is the reaction that just makes them keep on pounding away.
• giardini 3y ago
  tldr;
• pb060 3y ago
  Well he really inspired me to consider kidney donation, if only I hadn't just discovered that I have only one.
• mitthrowaway2 3y ago
  > Yet only about 200 people (0.0001%) donate kidneys to strangers per year. Why the gap between 25-50% and 0.0001%? Scott is right to point out the gap, but I don't expect him to donate another kidney next year. Even for those who follow through on their good intentions, kidney donation is a one-time event not an annual event, so it shouldn't be compared to an annual rate. Assuming that would-be kidney donors have a window about 50 years to follow through on their good intentions, the gap should be between 25-50% and 50 x 0.0001% = 0.005%.
• Willamin 3y ago
  Great article! I'd never considered the mathematical risks associated with this. Now I'm curious what the numbers would look like if it were a cultural norm for everyone (who passed the screening exam) to donate their kidneys in this non-directed fashion. My incredibly unscientific gut-feeling, back-of-the-napkin math seems like it would be plausible to reduce kidney failures to zero in no time: most people have two functioning kidneys and there are significantly less than 50% of people that need donated kidneys. Of course that gut-feeling math doesn't factor in the increase in risk for the donors (the radiation during screening, botched surgeries, etc), but those risks seem low enough that I imagine we'd net positive on a large scale.
• blueyes 3y ago
  > I make fun of Vox journalists a lot, but I want to give them credit where credit is due: they contain valuable organs, which can be harvested and given to others. One of the funniest things Scott has ever written...
• pcl 3y ago
  Now that we're talking about kidney donation -- you might also consider becoming a blood donor! It's easy, and you get free tracking of cholesterol, blood pressure, and a battery of other blood tests when you do so. If you're in the US and have been told in the past that you're not qualified, you might want to look and see if that's still the case. The US relaxed a bunch of restrictions during the COVID-induced blood donation shortages of the last few years, and is in the process of removing some more. https://www.hhs.gov/givingequalsliving/giveblood/can-i-give https://www.hhs.gov/givingequalsliving/giveblood/can-i-give
• Vecr 3y ago
  One thing to note for HN comment readers is that this guy is a MD with experience in kidney function despite not being a nephrologist. He's also not a teenager or in his 20s. That's important due to remaining expected lifespan, as well as the vital importance of functioning kidneys (preferably plural) after a car crash or a gunshot wound.
• dkural 3y ago
  A man has so much cognitive dissonance, has to donate kidney to align internal narrative to create resonance with castles again.
• cvalka 3y ago
  [flagged]
  • the_shivers 3y ago
    Why?
    • cvalka 3y ago
      If your spouse does not oppose your decision to donate your kidney to a random person, get a divorce asap.
      • caturopath 3y ago
        This is why no firefighters are married: people don't want their spouse to take any risks to save others' lives.
        • cvalka 3y ago
          Comparing the two makes no sense. Your "analogy" is silly beyond belief.
• monero-xmr 3y ago
  [flagged]
  • fshbbdssbbgdd 3y ago
    How many kidneys have you donated?
    • monero-xmr 3y ago
      My brother has a kidney ailment, so the expected value of me donating to a stranger is less than the expected value of me donating to my brother. This is because my brother has the potential for children. If he has children, they may become doctors. If they become doctors, they will potentially save a huge number of people. Of course the risk of them not becoming doctors is high. So I should investigate who around me is a doctor that needs my kidney. But then I need to assess if their doctoring is based upon sound methodology, and the correlation of their GPA vs. their schooljg mathcex the ideal numberr of utils to balances dfcsslmksn;kzknfvknzlgn;lz;lnzglzll
      • FeepingCreature 3y ago
        As the article said, if you donate, you can get your brother prioritized for a donation later.
    • cvalka 3y ago
      Your point being?
  • caturopath 3y ago
    It looks like you've interacted with some nasty folks who were EAs - I don't think this was a typical cross-section of EAs. Sorry to hear about your bad experiences
    • monero-xmr 3y ago
      As one example, a friend of mine lost over $20 million to SBF / FTX, which funded said castle. However he did not sell his claim and is optimistic he will get most of it back. Money seems like a number on a page until you see how it affects real people! As another example, I had an EA VC investor nuke one of my seed investments in order to have a different one of his portcos acquire the IP for scrap because he had a far higher stake in the other portco, which was in the same vertical. Ruined a lot of employees' ISOs as well as my equity. But hey he's an EA - can't blame him! His expected value was simply higher.
• BobaFloutist 3y ago
  I respect the British organizers’ willingness to sacrifice their reputation on the altar of doing what was actually good instead of just good-looking. Surely their reputation is a factor in their ability to do good? Optics sometimes necessitate sacrificing the "mathematically superior choice" for one that's worse in the name of not pissing off a ton of people the support of whom you rely upon.
  • joy_void_joy 3y ago
    I'm a bit taken aback at the replies who say that EA never takes that into consideration. It had been actually exactly the kind of discourse I was seeing back in 2019 in the EA sphere. Actually, the reason this changed is exactly to avoid another SBF disaster: If you focus too much on consequentialism and convoluted reasons for why you're doing is the highest EV, you are incentivizing very unlawful and unwanted behaviours. EA pivoted to a more deontological framework to avoid those kind of dangerous reasonings at that point On the object level, about your point, Scott alludes to it in his linked article: https://www.astralcodexten.com/p/the-prophet-and-caesars-wife https://www.astralcodexten.com/p/the-prophet-and-caesars-wif...
  • lmm 3y ago
    Reputation has a value but that value is not infinite. Presumably they made a guess at how bad the hit would be. (Also, with the right audience, being willing to make tough choices like this would enhance their reputation)
  • raverbashing 3y ago
    > Surely their reputation is a factor in their ability to do good? True. But the EA crowd has a hard time understand perception or empathy and has to resort to mathematical calculations I could think of a couple of ways better than "buying a castle" for conferences.
    • Version467 3y ago
      e/acc is short for effective accelerationism and not effective altruism. Those groups are interested in very different things.
• zabzonk 3y ago
  Wow. Bonkers. Also, prolix. Evolution has equipped us with two kidneys for presumably good reasons. Don't go giving one away unless you really have to.
  • caturopath 3y ago
    This is a pretty odd remark. The effect of living with one kidney isn't some sort of unknown thing we need to reason about from first principles, we know pretty well what life is like for kidney donors. And I don't know about 'really have to', but it doesn't seem like 'saving someone's life' is a trivial or stupid reason.
    • zabzonk 3y ago
      the article struck me as something hannibal lecter might have used as a case-study in his paper on surgical addiction.
  • TheDong 3y ago
    > Evolution has equipped us with two kidneys for presumably good reasons As the article pointed out, on average you live a totally fine life with only 1 kidney, so clearly no. Like, that same argument would be "evolution gave us poor eyesight, so glasses must be bad. Why else would evolution make so many people's vision fail? Blurry eyesight must have an evolutionary advantage", or "evolution made some people white for a reason, don't use sunscreen, skin-cancer research says to sunscreen up, but we shouldn't second-guess evolution and play gods". Evolution is random mutations with a very course-grained utility function. Rejecting evidence in favor of it gives you nothing but nonsense. And fad diets, but mostly nonsense.
    • eru 3y ago
      Going off a tangent: the modern myopia epidemic seems to be related to lots of time spent indoors when growing up. People in the past weren't so myopic, and we have difference between modern countries that also track pretty well with that explanation. However the science isn't quite settled on that.
• datadrivenangel 3y ago
  Good for Scott for actually looking at the research and then following through in a charitable action that is consistent with his beliefs. I'm surprised by how relatively risky the scan creening seems to be though.
  • eru 3y ago
    Well, he found a less risky substitute.
• matisseverduyn 3y ago
  "But looking more closely at the increased deaths, they were mostly from autoimmune diseases that couldn’t plausibly be related to their donations." Kidneys make calcitriol. One kidney means you'll make less, and if you don't supplement, you'll become deficient. Deficiency would (possibly) lead to autoimmune diseases. Also EPO (erythropoietin). One kidney means less, and less (possibly) means fewer new red blood cells, then (possibly) anemia. Anemia wreaks havoc. And bicarbonate. To be clear, if you want to donate a kidney, then do it if it's the right choice. It's very kind. Just know what to pay attention to to keep yourself in good health.
  • threefour 3y ago
    I was born with one kidney, a condition called renal agenesis. I’m 53 years old and in perfect health. Doctors don’t recommend any particular action. As an aside, I’m also Buddhist so if the kidney goes I’m going with it. This obsession with prolonging life is just a distraction from living it.
    • nurettin 3y ago
      > This obsession with prolonging life is just a distraction from living it. Does brushing teeth twice a day also distract you from living? I think the opposite.
  • mpreda 3y ago
    About erythropoietin (EPO), I understand it's a hormone whose amount is regulated by the need for oxygen in the blood (i.e. a feedback loop which regulates the amount of red blood cells to be just what is needed to satisfy the oxygen needs of the body). So EPO is not limited by the ability of the kidneys to produce it (I expect, by a large margin). So one kidney would just as well be able to produce all the EPO you may need, the kidney is not the limiting factor.
    • deleted 3y ago
      [deleted]
    • 3y ago
• elromulous 3y ago
  Can anyone (with a better understanding of radiation risks) confirm the math for the added mortality risk from a single CT? I know a CT is a lot of radiation, but the mortality risk seems very high.
  • unholiness 3y ago
    His footnote says as much as I could: > Maybe. Kind of. Our knowledge of how radiation causes cancer comes primarily from Hiroshima and Nagasaki; we can follow survivors who were one mile, two miles, etc, from the center of the blast, calculate how much radiation exposure they sustained, and see how much cancer they got years later. But by the time we’re dealing with CAT scan levels of radiation, cancer levels are so close to background that it’s hard to adjust for possible confounders. So the first scientists to study the problem just drew a line through their high-radiation data points and extended it to the low radiation levels - ie if 1 Sievert caused one thousand extra cancers, probably 1 milli-Sievert would cause one extra cancer. This is called the Linear Dose No Threshold (LDNT) model, and has become a subject of intense and acrimonious debate. Some people think that at some very small dose, radiation stops being bad for you at all. Other people think maybe at low enough doses radiation is good for you - see this claim that the atomic bomb “elongated lifespan” in survivors far enough away from the blast. If this were true, CTs probably wouldn’t increase cancer risk at all. I didn’t consider myself knowledgeable enough to take a firm position, and I noticed eminent scientists on both sides, so I am using the more cautious estimate here.
    • elromulous 3y ago
      The non linearity intuitively makes sense. If I (naively) assume that DNA has some built in correcting codes (iirc it at least has some redundancy), one would be able to damage it up until the error rate that can be corrected without any deleterious effect.
    • chris_va 3y ago
      There is this story: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477708/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477708/ The conventional approach for radiation protection is based on the ICRP's linear, no threshold (LNT) model of radiation carcinogenesis, which implies that ionizing radiation is always harmful, no matter how small the dose. But a different approach can be derived from the observed health effects of the serendipitous contamination of 1700 apartments in Taiwan with cobalt-60 (T1/2 = 5.3 y). This experience indicates that chronic exposure of the whole body to low-dose-rate radiation, even accumulated to a high annual dose, may be beneficial to human health. ... though some evidence against it with leukemia it seems, but this is not my field.
• sashank_1509 3y ago
  This does honestly kind of shock me, it’s respectable that he did something like this for a random person but I could never imagine myself doing it for anyone except close family. I used to think EA was some kooky AI safety Cult but if so many EA folks donate their kidney, my opinion of them has improved far more. They at least have balls!
  • ajkjk 3y ago
    Well... maybe they're both. Plus a kooky crypto-embezzlement cult. Probably depends on who you get. My skepticism to the EA movement is of the form: I can respect the underlying idea but I have very little faith in many of the actual people to do it. Also, EA sorta bakes in utilitarianism as a premise and (from my experiences in the ACX comment section) basically finds any non-utilitarian argument to be literally unintelligible, which doesn't work for me because I think there are more important things in life than optimizing numbers (... but since they evaluate the worth of things by number-optimization they seem to be unable understand this perspective at all).
    • charia 3y ago
      This is a quite uncharitable view of things. EA utilitiarians aren't spending their life on optimizing numbers, they're trying to use numbers to guide decisions on how to better impact life. People can follow a value systems and still understand that other value systems exist. The EA view of things is pretty simple to understand. Given the premise of limited resources, and a belief that all lives are worth the same, how can you best improve human livelihood? Different people approach giving back to society in different ways. The EA way to approach the above is to crunch numbers and find what they think is the place where their limited resources can have have the largest impact. My best friend's family does their part by joining their church to volunteer at food kitchens in poorer neighborhoods and hosting fundraisers for various causes throughout the year. A Vietnamese coworker of mine used to give back by donating to a charity that gave scholarship opportunities to high achieving low income students in Vietnam. It's not that complex to understand that different people have different value systems and how they view their tribe, people and the world. And yes I agree that lots of people find people who hold differing views incomprehensible, but that's also normal aspect of humanity and not unique to those in EA. From political differences, to philosophical differences, to religious differences, to any topic, many people have a hard time comprehending the worldview of others. You can even just take the perspective from this article. There are a whole swath of people I've known that could not comprehend the idea that someone would be willing to give their kidney to a total stranger. They might understand if its someone the person knows, but a total stranger? Some might say that's insane and irrational behavior. Lots of people can't see past their own perspectives on things, but I think it's uncharitable to suggest that EA is not just like any other group with some portion of people like that.
• rednerrus 3y ago
  Hopefully the Ozempic breakthroughs will alleviate some of the need for kidney donation as it lowers the occurrences of End-Stage Renal Disease (ESRD).
  • pkaye 3y ago
    There was recent news on an Ozempic study that shows reduced risk kidney conditions for diabetic patients. > Based on the trial’s design, Ozempic needed to reduce the absolute risk of one of those kidney-related conditions by at least 3.5% when compared to placebo, or a relative risk reduction of around 16.5%, Akash Tewari, a Jefferies analyst who covers Lilly, wrote in a note to clients. https://www.biopharmadive.com/news/novo-nordisk-ozempic-kidney-outcomes-trial-semaglutide/696273/ https://www.biopharmadive.com/news/novo-nordisk-ozempic-kidn...
• DoreenMichele 3y ago
  It's a good read. I enjoyed the data analysis and his snarky wit about a few things. I enjoyed him finding out he could apply to another hospital and doing it "out of spite." I know he wants to encourage you to donate a kidney. I still wish we tried harder to heal the "original equipment from the manufacturer" we are all born with. I have been on the record a long time with this opinion. I get a lot of hatred for it, though I have a condition that frequently results in being a transplant recipient and my only wish here is for better baseline care for people like me instead of razzle-dazzle headlines about flashy "tech" solutions. Good solutions tend to be boring. I want a boring life where I just get to have good health and not an "exciting" one where I get to tell you how I was dying until some kind stranger died in a motorcycle accident at a shockingly young age and let me have their leftover body parts. (Because people like me need body parts that are a little hard to spare as an act of charity.)
  • jodrellblank 3y ago
    Grant Generoux claims his chronic kidney disease ("incurable, fatal") was healed by his low vitamin A diet. We know from studying technical outages and systems failures that the more checks and balances we put in place, the weirder the cause of any outage will be - because only the weird things get through where the gaps between the checks all line up. Of course the claim isn't wrapped up in a simple package with conclusive proof and widely agreed on - if it were, it would be mainstream accepted knowledge. Why hasn't it been noticed? Because the damage is cumulative and long term - years or decades. Because it's fat soluble, so the effects are modified by the amount of fat eaten at the same time. Because the effects are diffuse - it's not showing up in one single organ. Because the effects look like other things - autoimmune attacks, for example. Because historic mistakes in studies have caused 'vitamin A toxicity' to get mixed up with 'Vitamin A defficiency'. Because it varies with different people with different liver storage capacity and historic retinol compound buildup. Because it may be masked by protective effects of Vitamin C or other dietary components. Because stopping eating it offers no quick fix, healing might be "wait years for damaged cells to die and new ones to grow". Because there's no money in telling people to eat less of somethings, so there's little industry funding incentive or research grants. Here for example, one of the other people who agrees with the claim of Vitamin A being harmful shows their working: https://ggenereux.blog/discussion/topic/biotransformation-of-retinol-finally-revealed/ https://ggenereux.blog/discussion/topic/biotransformation-of... - Under Discussion it says "It is now no longer difficult to imagine how retinoic acid [ed: Vitamin A/retinol related compound] could cause auto-immune disease, since the data appears to show that retinoic acid is essentially a pro-inflammatory cytokine that is stored in the liver and, once the liver is saturated, in different types of tissue all over the body, especially in epithelial cells that constitute blood–tissue barriers, and in adipocytes, both of which were shown to express STRA6 (Amengual, Zhang et al. 2014). [... explanation continues]" I am never going to study enough chemistry, biology, biochemistry, statistics, medicine, to be able to make a judgement call of my own about that page, let alone all the other studies people have linked to and pulled apart. At least it's cheap and relatively easy and low risk to try, but even if my health improves (I don't have kidney damage) it could easily be attributable to many other factors - placebo, for example.
• Quinzel 3y ago
  I’m keeping both my kidneys for if someone I love needs one. When I am dead however, they can take my kidneys, heart, lungs, liver and whatever else that is salvageable and give them to whoever needs them (assuming I die in the right circumstances that this is possible).
  • silveraxe93 3y ago
    He covers that in the post. If you donate your kidney, you can nominate up to 5 people to be first in line if they (or you) ever need a transplant. Given compatibility concerns, it's probably safer for your family member for you to donate than not.
    • Quinzel 3y ago
      If you donate a kidney knowing that if something goes wrong to the one you have left you can skip the queue of people who have been suffering potentially longer than you have with end stage renal failure, is your donation truely an altruistic one?
    • benjaminikuta 3y ago
      But can you change the names later? What if you divorce and remarry, or have a kid later?
  • sadtoot 3y ago
    just so you know, around 1% of people die in conditions where their organs are elligible for transplantation. then there's the factor that kidneys from living donors generally last longer for the recipient
    • Quinzel 3y ago
      My grandmother donated both her kidneys before her life support was switched off she was brain dead tragically due to having a brain aneurysm at 51, but she was technically living when she donated since they keep people alive until they’ve completed the organ harvest. She also donated her heart, but unfortunately the transplant wasn’t successful at all. One kidney failed after 3 years, the other kidney is still going strong. That person she saved has gone on to have 17 years of good health and counting, our family get’s anonymous letters letting us know the kidney is still going strong. It’s kind of nice. If I don’t get to donate my organs to save lives, I’ll still donate them to science. I was Born with two kidneys and I like to think wanting to keep them for myself isn’t being greedy. If someone I love needs a kidney, I’ll donate to either them, or someone else so they can hopefully receive a kidney quicker, but otherwise, I have no desire to have a major surgical procedure, recovery etc. maybe I’m selfish, but I’ll at least be honest about it.
• Waterluvian 3y ago
  > The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation. Can’t help but picture a roller coaster queue wrapping around the back of a hospital, and some guy is cutting the “Singles” line, defending himself from scowls with, “I’m not cutting! I’m just getting my kidney back!”
  • caust1c 3y ago
    Just imagining a surgery gone sideways situation and they just decide to trade the one still in with the one they just took out. (Not even sure this is an option, orientation and all, just imaging)
    • ryanbrunner 3y ago
      Transplanted kidneys generally go lower in your belly than your "native" kidneys and they aren't swapped, the original kidneys are left in and they add another. Anyone who's had a transplant most likely has 3 or even 4 kidneys inside them.
      • Waterluvian 3y ago
        This is probably the most concrete “I had no idea it worked that way” this year for me. So you can collect kidneys!
        • Suzuran 3y ago
          They only remove them if they have some kind of immediate risk of damage to the body - Necrosis or similar. On top of that, while your original kidneys won't have enough function to sustain life, any function they do have will take some burden off of the transplant kidney(s).
          • Waterluvian 3y ago
            It makes complete sense once I think about it. My mental framing is too often based on technology. Ie. there’s two kidney slots that you can populate with one kidney each.
• manmal 3y ago
  > Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors. Another solution would be to tackle type 2 diabetes, since a big amount of kidney failures is caused by that. Apparently, 1/3 of Americans are at risk: https://www.health.com/cardiovascular-kidney-metabolic-syndrome-8356537 https://www.health.com/cardiovascular-kidney-metabolic-syndr... Having worked for a few years in the diabetes space, I‘ve been hearing that cheaper CGMs are coming from the big players, apparently for <= $1 a day. This will allow people with diabetes to keep their time in the ideal BG range longer, reducing risk for kidney disease _significantly_.
  • Metacelsus 3y ago
    Or, human-compatible kidneys grown in bioengineered pigs. GLP1 drugs are also very promising for reducing the rate of kidney disease.
  • refurb 3y ago
    The GLP-1 drugs should have a big impact for type II diabetes. Interestingly Fresenius, a massive dialysis provider, has taken a beating in terms of stock price with the GLP-1 data. That said, diabetes is a long-term disease and it's going to take a decade or two to see a measurable difference.
• Aurornis 3y ago
  > Obviously this kind of thing is why everyone hates effective altruists. People got so mad at some British EAs who used donor money to “buy a castle”. This feels like a spin on how this all went down. A lot of the anger about that group utilizing funds to, literally, buy a castle came from EA groups too. Trying to downplay the situation and pretend that the anger was only coming from uninformed outsiders feels like a dishonest attempt to rewrite history. If you’re not familiar with this story, here’s a source: https://www.newyorker.com/magazine/2022/08/15/the-reluctant-prophet-of-effective-altruism#:~:text=Last%20year%2C%20the%20Centre%20for%20Effective%20Altruism%20bought%20Wytham%20Abbey%2C%20a%20palatial%20estate%20near%20Oxford%2C%20built%20in%201480.%20Money%2C%20which%20no%20longer%20seemed%20an%20object%2C%20was%20increasingly%20being%20reinvested%20in%20the%20community%20itself https://www.newyorker.com/magazine/2022/08/15/the-reluctant-... There was a lot of debate about it in EA circles. A lot of it turned into mental gymnastics as they tried to find ways to explain how spending a amount of money on a literal castle so they could meet in it somehow had an expected value that was positive for humanity or something. Weird to see this incident pop up in an article about kidney donation, but even weirder to see the critics of the decision downplayed and sneered as uninformed outsiders when so much of the anger came from inside the EA community. Really feels like a subtle signal that if you don’t toe the line on every EA organization decision, you must be an outsider.
  • germyj 3y ago
    >Really feels like a subtle signal that if you don’t toe the line on every EA organization decision, you must be an outsider. Bingo. I like Scott's writing in general, I've interacted with him a few times, and EA criticism is one of three or so topics where disagreement gets you the outsider treatment. He's slightly more amenable if you can provide an example that would've been "more effective," but "this was a bad decision"-type critiques will default to "the bigwigs are smarter than you."
• kushan2020 3y ago
  It's human nature to feel good about themselves by doing certain "altruistic" things. Make no mistake the donor benefits more than the recipient.
  • mquander 3y ago
    > So in total, a donation produces about 10-20 extra quality-adjusted life years. How much would you say the donor benefits?
    • aidenn0 3y ago
      It depends on the QoL improvement factor you assign to self-satisfaction I suppose? Just multiply that by the expected number of years left in their life.
      • Crimson_Wool 3y ago
        Damn, moral self-righteousness must be better than fuckin' heroin, shocking more people aren't out here donating kidneys given that.
        • aidenn0 3y ago
          Yeah, I'd cap that factor at 1% (and it's probably less) which would mean you'd have to live 100+ years to get more out of it than the recipients.
  • deleted 3y ago
    [deleted]
  • mitthrowaway2 3y ago
    You almost make it sound like a bad deal for the recipient.
    • Suzuran 3y ago
      Speaking as a kidney transplant recipient it is most certainly not a walk in the park. I mean that literally; I cannot walk in the park without taking precautions against covid/influenza and my increased risk of skin cancer...
• woodruffw 3y ago
  I know a few people who have donated kidneys (both to friends and strangers), and I find it admirable (and supererogatory). At the same time, I think this post demonstrates a kind of selective unawareness that I’ve seen members of the EA community demonstrate. A significantly less charitable summary of Scott’s situation is “our prospective kidney donor is newly-married high-stress professional with a history of SSRI usage who has recently experienced significant negative public attention and belongs to an actively-imploding community/cult.” This is almost certainly what the UCSF administrators perceived, and his latent hostility to them almost certainly didn’t help. This doesn’t necessarily justify their decision (maybe they are just bureaucrats), but it’s a framing that’s roughly as plausible as the bucolic EA one that’s presented. A community that has a self-stated mission in rationality should be able to see that.
  • mquander 3y ago
    Your summary literally doesn't even sound more stressful than the median American adult life. He has a job? He got married? He has taken psychiatric drugs before? Some people don't like him? There exists social drama sort of nearby him? So what? These are incredibly superficial assessments. Why is the standard for donating a kidney that your life has to be, in the opinion of some bureaucrats who just met you, super chill? Nobody applies this standard to any other similarly-risky (i.e. not very risky) decision. The standard should be whether you are a person in sound mind who wants to donate it and is physically fit to donate it.
    • woodruffw 3y ago
      The average American isn’t donating half of their kidneys, as the post points out. It’s entirely possible that the average American isn’t psychologically suited to do so without an extensive (and fallible) filtration process. But beyond that: the author is not an average American, and we both know that. Most Americans don’t find themselves in the NYT, or somewhat central to a large, wealthy controversial community that’s actively imploding.
      • mquander 3y ago
• pcthrowaway 3y ago
  While I've appreciated some of the author's articles in the past, I think the numbers in this one miss the mark quite a bit. > the risk of dying from the screening exam was 1/660 > The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660. Well not quite. First of all, this assumes that exposure events are additive over a lifetime (rather than individual events being more damaging at higher doses). This does seem to be the case, though I'm curious if we really know. More to the point, it's a 5% increase of chance of death from cancer. Combining 5% with 30mSv/1Sv, you get an extra 0.15% chance of dying of cancer indeed. But the chance of dying of cancer in the U.S. is something like 17.5%, although that does increase (and then decrease) with advanced age. According to https://usafacts.org/articles/americans-causes-of-death-by-age-cdc-data/ https://usafacts.org/articles/americans-causes-of-death-by-a... , something like 29% deaths in the 65-74 age group are cancer, while in the 75-84 year age group it drops again to 25%. Regardless, this means if you figure out your lifetime chance of dying by cancer based on your current age, it's 30% at the most (in aggregate, obviously personal risk factors vary a lot from person to person). A 0.15% increase in that is 0.045% additional chance of dying by cancer, or 1 in 2,222. Using the average mortality incidence of 17.5% its more like 1 in 3800. And for someone who's this concerned about dying of cancer and I assume limiting risk factors much more than the average citizen, perhaps it's a 1 in 5000 chance. All in all you're much more likely to reduce your chance of death by cancer by much more than a CT will increase it, via a number of lifestyle changes: healthier eating, quitting alcohol, staying out of the sun.
  • kqr 3y ago
    > a number of lifestyle changes: healthier eating, quitting alcohol, staying out of the sun. On the other hand, maintaining these sound like a much larger effort than avoiding one CT scan. (That said, they do have other benefits so they might still make sense.)
    • jhugo 3y ago
      Staying out of the sun has significant downsides.
• yellowviking 3y ago
  I'm inclined to think there might undiscovered evolution advantage that we still have two kidneys today. (Most of our parts have two for good reasons)
  • Crimson_Wool 3y ago
    It's... not undiscovered, they screen you for kidney stuff before they let you donate because there's a negative health impact on kidney function from only having one.
• julianeon 3y ago
  This was actually really helpful to me as a person with CKD. Some of the possible risks & issues I’ve had clicked after reading it. I hadn’t considered that, even if I’m not actively dying of CKD, I could be experiencing degraded function in other ways. Useful to know.
• ckdot2 3y ago
  There are so many unknowns and unknown unknowns in medical sciense, especially regarding the human body. Did evolution really keep two kidneys if you actually just need one? I doubt it. When considering a donation you should also not only think about if you might die. There are more factors like quality of life. In the end, a whole organ will be removed from your body. This will have some effect.
  • guenthert 3y ago
    I was wondering about that, but not enough to do any actual research. I figure that hunter-gatherer's diet consisted of a whole lot of meat (seasonally perhaps) and then two kidneys were of advantage. My doctors recommended against eating big steaks. I wasn't eating much of those before and had no need to adjust. I can't tell the difference (six years after the procedure), but then, I'm no athlete monitoring his performance closely.
  • eru 3y ago
    Kidneys are relatively close to the surface. So you can injure them mechanically. Perhaps our ancestors kept their two kidneys around, but we can do with less, because our physical environment isn't as dangerous?
  • nyssos 3y ago
    > Did evolution really keep two kidneys if you actually just need one? I doubt it. Aside from the nervous system, pairing is the default condition of all mammalian organs which develop from the mesoderm or ectoderm: they can then go on to fuse into a single larger structure, as with the heart, but as far as I know they're never simply lost on one side during normal development.
  • jrockway 3y ago
    The real question is why didn't evolution give us two hearts and two brains?
    • XorNot 3y ago
      Kind of obvious for both of them though: evolving two hearts is putting two pumping systems in parallel on the same fluid reservoir. Given how the pump works (evolution can't handle making gears in general), you'd need a precise synchronization system to keep everything working properly - you're basically much more likely to die from the "high availability" system then a very robust single system (and the usual proviso: evolution doesn't need you alive, it needs you to reproduce and the offspring have some decent chance of survival. Percentage survival rates are just fine.) Same for the brain but I'd say writ large: easier to make an extra human then try and coordinate a redundant brain.
• laserlight 3y ago
  > People got so mad at some British EAs who used donor money to “buy a castle”. I read the Brits’ arguments: they’d been running lots of conferences with policy-makers, researchers, etc; those conferences have gone really well and produced some of the systemic change everyone keeps wanting. But conference venues kept ripping them off, having a nice venue of their own would be cheaper in the long run, and after looking at many options, the “castle” was the cheapest. Their math checked out, and I believe them when they say this was the most effective use for that money. For their work, they got a million sneering thinkpieces on how “EA just takes people’s money to buy castles, then sit in them wearing crowns and waving scepters and laughing at poor people”. I respect the British organizers’ willingness to sacrifice their reputation on the altar of doing what was actually good instead of just good-looking. When other organizations do so, they are wasting money that could have been well-spent. When effective altruists do so, they are “sacrificing their reputation for a good cause”.
  • low_tech_love 3y ago
    Whenever I read anything from these people I just keep thinking "Lies, damn lies, and statistics." They rely on "the math checks out" as an excuse for basically doing whatever they want. Here is some real-world math: how about "the math doesn't check out because people will look at your castle and think you're full of shit?"
    • deleted 3y ago
      [deleted]
    • eru 3y ago
      Have you donated a kidney recently?
      • low_tech_love 3y ago
        No, I’m an academic researcher which means I don’t blindly trust two or three papers in the subject. I don’t even trust them my two eyes wide open.
• himinlomax 3y ago
  Campaigning for live organ donations and donating yourself is such a waste compared to the real solution, which is opt-out organ donation.
  • Yvain 3y ago
    I looked into this and it isn't true - countries which switch to opt-out don't get significantly more than we do. I agree this is surprising. The best explanation I was able to find was that, of the few people who get in accidents/comas where their organs are useful, most have already opted it, and there's a lot of negotiation with the family around exactly what that means such that an opt-in/opt-out box doesn't make a big deal. See eg https://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_answer_to_solving_organ_shortage_in_us_researchers_say https://www.hopkinsmedicine.org/news/media/releases/presumed... .
  • petesergeant 3y ago
    it's not either/or, tho
• illys 3y ago
  The author states: "the risk of dying from the screening exam was 1/660" And demonstrates with: "This involves a radiation dose of about 30 milli-Sieverts. The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660." Sorry but there is a flaw here: calculation seems good but conclusion is completely wrong. Calculation: increased risk ratio of cancer-related death for 30mS = 1.05^0.03S = 1.001465... So +0.15% = +0.0015 = around +1/660 (with less rounding +1/682)... fine! Conclusion: this is not your risk of dying, but the increase of your risk of dying. If it was X%, the exam brings your risk at X% x 1.0015 X depends on the medicine quality in your country, your access to it, your health, your exposure to cancer-triggers (pollution, tobacco, food...), your DNA, your gender... Let's state a depressing 1%, then the screening exam brings you to 1.0015%, or +0.0015% additional risk due to the screening exam = 0.000015 = rounded 1/67000. So your chance of dying from an exam-related cancer is absolutely not 1/660. Please correct me if I did it wrong...
  • tim333 3y ago
    I tried googling the risk and it's all a bit inconclusive but: >The linear no-threshold model is disputed by several health organizations, including the American Association of Physicists in Medicine and the Health Physics Society, both of which concluded that cancer risk estimation should be limited to doses greater than 50 mSv. Both organizations state that risks from doses below this threshold are too small to be detectable and may be nonexistent.
  • bradley13 3y ago
    You're not wrong, but he's probably farther off that that. Danger from radiation doesn't scale linearly, although (to be extra safe) standards are set as if it is. In fact, there is some evidence that small doses of radiation can even be beneficial (hormesis).
    • eru 3y ago
      That discussion is already in the linked article.
  • 3y ago
• lostmsu 3y ago
  An anecdote to go along with his rejection. Once I got rejected from doing a medical donation in US because in the giant table of family sicknesses they gave me I marked X next to one of the mental conditions for my father who was an alcoholic because apparently alcoholism technically is that kind of mental condition (yes, the X had to be explained in the form, which I did). As you can imagine alcoholism is not that heritable, and had more to do with the environment (I grew up in Russia where it was extremely prevalent), but for the clerks an X is an X.
  • gwern 3y ago
    > As you can imagine alcoholism is not that heritable Alcoholism is that heritable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345133/ At ~50% heritability, it is in no way unusually low, and entirely comparable with many other traits.
    • lostmsu 3y ago
      This is actually more heritable than appendicitis or leukemia. Hard to imagine what the mechanism could be.
      • gwern 3y ago
        Mechanism(s), it's going to be highly polygenic & mediated through many pathways. I don't see it as needing to be any more inherently mysterious than appendicitis: it's all cells doing very complicated chemical stuff in long causal pathways, in the end. 'Appendicitis' need be no more 'direct' or 'simple' than 'alcoholism'. For example, I expect that I have a very low genetic risk for alcoholism - no family history, and drinking more alcohol than a beer or two makes me miserably depressed. There is surely some sort of neurochemical explanation there, something something GABA depressive neurotransmitter positive reinforcement of alcohol-avoidance behavior yadda yadda, but the net effect is the same: I'm not going to become an alcoholic. If you could trace it out, it's not going to look any more mysterious than some appendicitis explanation starting with an immune-modulating SNP affecting T-cells modifying risk of random hepatitis virus infecting the appendix and triggering an autoimmune reaction... or whatever it is that is between 'SNP variant #123' and 'developed appendicitis at age 14'. It's all cause-and-effect, atoms-and-void, in the end.
• mort96 3y ago
  This was an enjoyable read. The solution of giving people money to donate their kidneys is terrifying to me however. I do not like the thought of desperate people selling their internal organs to survive one bit. Of course, if inequality was dealt with and nobody was desperately poor, it would be a different question. If everyone had enough money to comfortably get by, and the extra $100,000 from a kidney donation would just go to luxury goods, I wouldn't have a problem with it. But that's not the world we live in.
  • eru 3y ago
    Iran allows paying compensation to kidney donors. You can study how they are doing. Hint: they don't have much of a wait list. > I do not like the thought of desperate people selling their internal organs to survive one bit. See https://en.wikipedia.org/wiki/Repugnant_market https://en.wikipedia.org/wiki/Repugnant_market Do you prefer desperate people have fewer options? Especially, do you prefer taking options from people that they prefer to take?
    • mort96 3y ago
      > Do you prefer desperate people have fewer options? Yes. For an individual poor person, one could argue that the individual would be better off if they were allowed to sell their internal organs. But this isn't just about individuals, this is about societies. A society which pushes poor people towards selling their organs to survive is worse than a society which doesn't do that, in my opinion.
      • mort96 3y ago
        The extreme example would be: I think an IRL version of something like the Squid Game should be illegal, even though that means "desperate people have fewer options".
    • taylorius 3y ago
      Yes. Because the second order effects of giving those desperate people the option of donating their organs is worse for the society going forward.
• rutierut 3y ago
  It was completely baffling to me how someone as brilliant as SA could conclude that "the risk of dying from the screening exam was 1/660". However, the paper he references does contain the specific example: > For example, a 40-year-old woman undergoing CT coronary angiography is estimated to have a 1 in 270 chance of developing cancer at a radiation dose of approximately 20 mSv At this point I'm completely lost here.
  • deelly 3y ago
    Please don't be so quick https://news.ycombinator.com/item?id=38036113 https://news.ycombinator.com/item?id=38036113
• cromulent 3y ago
  The Vox article refers to the donation chain effect from the US kidney exchange, where one donor can trigger a cascade of donations. Economist Alvin Roth won the Nobel memorial prize in economics for this in 2012. https://www.bbc.com/news/business-50632630 https://www.bbc.com/news/business-50632630
• bowsamic 3y ago
  Really long article so I will only comment on one of the points that came to mind. He talks about the whole EA castle thing, and that it was actually mathematically calculated to be better to buy the castle, but it seems to me that something is always left out of the EA calculation. That is, the PR. It's better if there are more EAs, but the PR has been so bad that the number of EAs probably decreased quite significantly, but shouldn't that have been part of the calculation? If you only optimise for immediate effect and spend all of your PR to do it, this is just bad EA.
• atleastoptimal 3y ago
  Good for him. However I feel bad it seems like a misplaced sense of personal guilt over being an effective altruist compelled him to do this. Many empathetic people worry far much over the slight possibility they are a bad person even though they're miles away from one. Evil, psychopathic people never worry about being a bad person at all, and can sleep soundly even in perfect understanding of the deliberate suffering they've caused.
  • sadtoot 3y ago
    there's a lot of suffering in the world, and it doesn't matter too much to me who's fault it is (in the case of kidney failure, is it anyone's fault?). for me, morality isn't about avoiding being evil, or being better than my peers, it's just about increasing the amount of good in the world; particularly doing so if it's not too costly or inconvenient to me
• orwin 3y ago
  The linear non-threshold model is... Quite contested however. The truth is it's likely a threshold exists, likely under .1 Sv, but its really, really hard to determine becauses at those percentage cancer causes tends to mix up. I think US and German environmental agencies support the non-threshold model as a tool to absolutely reduce radiation contamination in the environment, but I know French doctors (or at least radiologists) think this is bullshit and think the model is both wrong (like all models) and useless in their discipline. I just checked to be certain I was right, and I am, in fact French doctors rejected the model in 2005, citing a boatload of work on radiation, and also epidemiologic studies (background radiation is more concentrated in areas that have decreased chances of developing cancers apparently, which is weird, but i'm taking a break and do not have time to check out more)
  • Smaug123 3y ago
    (This is discussed in footnote 2 of the article.)
• hcks 3y ago
  The whole benefits of kidney donation to a stranger comes down to an effective donation of $10,000 using the same logic. How is it effective when he could have probably raised 2 times that amount by working in place
  • astura 3y ago
    He addressed this >But it only costs about $5,000 - $10,000 to produce this many QALYs through bog-standard effective altruist interventions, like buying mosquito nets for malarial regions in Africa. In a Philosophy 101 Thought Experiment sense, if you’re going to miss a lot of work recovering from your surgery, you might as well skip the surgery, do the work, and donate the extra money to Against Malaria Foundation instead. >Obviously this kind of thing is why everyone hates effective altruists... >It starts with wanting, just once, do a good thing that will make people like you more instead of less. It would be morally fraught to do this with money, since any money you spent on improving your self-image would be denied to the people in malarial regions of Africa who need it the most. But it’s not like there’s anything else you can do with that spare kidney. >Still, it’s not just about that. All of this calculating and funging takes a psychic toll. Your brain uses the same emotional heuristics as everyone else’s. No matter how contrarian you pretend to be, deep down it’s hard to make your emotions track what you know is right and not what the rest of the world is telling you
• lusus_naturae 3y ago
  I skimmed over this so I am unsure if this was addressed in the article: what if you donate an organ to an asshole? If they're weak or sickly, there is less chance of them being an asshole. However, a recovered and healthy asshole has relatively greater chance of subjecting the world to themselves. The above may appear to be a crude (and maybe overly harsh and pessimistic) argument against organ donation, but I struggle with encouraging altruistic because some people suck and don't deserve your kindness. My question is this: does showing kindness to someone who is incapable of it themselves only perpetuate more unkindness? I worry that it does.
  • astura 3y ago
    What make a weak and sickly person less likely to be an asshole?
  • hnbad 3y ago
    Some people suck. Some people need kidneys. Some people who need kidneys are people that suck. I guess the answer to your question lies in whether you believe that humans are predisposed towards good or evil. Evolutionarily the argument goes that humans are predisposed towards cooperation (i.e. good) which also seems to be backed up by archeological evidence (e.g. unremarkable individuals clearly being cared for up to old age despite evident disabilities or injuries that would have made them unable to contribute to the group's survival). Thus it seems that a general predisposition towards "evil" (for lack of a better word) is rare or otherwise the result of circumstances, socialization and socio-economics (e.g. living in a system incentivizing competition over cooperation). On the other hand a devout Catholic would argue that man is inherently corrupt and sinful and requires deliberate salvation to become good. Or an economist might argue that a human is ideally a rational actor only interested in optimizing their own benefit (which most would probably characterize as "being a bit of a dick"). And then there's the old Greek dead guy's saying of "man is wolf to man" (i.e. people suck). And I'm sure depending on your life experiences and circumstances you have met plenty of people who suck as well. Of course there's the odd chance that your act of kindness as a donor may change a person who suck's outlook on life and make them suck less rather than die as a miserable husk of a person. But that's just rolling the dice at that point so the question still remains.
• ANarrativeApe 3y ago
  There is a flaw in the calculation of benefit. It makes no allowance for any domino effect resulting in other non-directed kidney donations.
• antiquark 3y ago
  Yeah but, what if his wife eventually needs a kidney transplant? "Oopsie, I already gave it to a stranger."
  • benjaminikuta 3y ago
    He addressed that in the article.