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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

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
    Why does being a minor celebrity mean you shouldn't donate your kidney? You don't think most Americans are "psychologically suited" to donate a kidney? Again, I don't think you would apply this level of paternalism to other situations. Would you tell the median person that they aren't "psychologically suited" to have a kid and therefore aren't allowed to? That's a dramatically more impactful and psychologically stressful decision, but we admit that the person best suited to make it is the person living it. I think you are just trying to justify a dumb bureaucratic decision that doesn't respect the suffering of people who actually need kidneys.
    - woodruffw 3y ago
      I didn’t say that. I think anybody should be able to donate their kidneys, provided that they are deemed competent to do so. Famous people and controversial people can be competent, and Scott almost certainly is. As a society, we treat organ donation differently because it comes with significant opportunity for abuse and regret. The sole point of my comment was to highlight how prominent EA writers can demonstrate a hypocritical blindness in a way that dispassionate observation can reveal. I’m not especially interested in UCSF’s actual decision.
      - mquander 3y ago
        OK, acknowledged.
the_shivers 3y ago
You make a good case, but I cant help but wonder if the people who will die from lack of a transplant agree with UCSF's decision.
- woodruffw 3y ago
  I’m absolutely positive they don’t. That’s why they don’t get to choose other peoples’ organs, and why we don’t let the families of victims determine the suitable punishment for the criminal.
OfSanguineFire 3y ago
What’s the "community/cult" here? I’m apparently missing context.
- TheDong 3y ago
  Effective Altruists. See also SBF/FTX, and https://time.com/6252617/effective-altruism-sexual-harassment/ https://time.com/6252617/effective-altruism-sexual-harassmen...
- woodruffw 3y ago
  Effective altruism, which is both a general (and not especially objectionable) variant of act utilitarianism, and also a specific community that has (fairly, to my eye) been accused of diverting money towards a particular set of reactionary worldviews held by its leadership.
  - caturopath 3y ago
    EA isn't a form of act utilitarianism. Though EA certainly has a consequentialist flavor, it isn't the case that all (or even most?) EAs endorse utilitarianism (utilitarians aren't the only ones who care about scale). For example, Holden Karnofsky is explicitly non-utilitarian and Will MacAskill advocates making decisions based on considering (fundamentally, not just for optics) non-utilitarian ethical systems, though he is more utilitarian than someone like Karnofsky.
  - nyssos 3y ago
    The main recipients of EA political funding (what little there is: the majority of money goes to global health and development, with AI safety as a distant second) are centrist Democrats. They're too right-wing for my taste too, but calling them "reactionaries" dilutes the word into meaninglessness.
    - eru 3y ago
      I'm not sure woodruffw necessarily talked about donations to US politicians when they mentioned 'diverting money towards a particular set of reactionary worldviews held by its leadership.' Perhaps they just don't like malaria nets? See https://www.givewell.org/charities/top-charities https://www.givewell.org/charities/top-charities
TheDong 3y ago
We have a long waiting list for recipients, and we don't have an excess of donors to be picky with. Why are you assuming Scott was not "able to see" the explanation you laid out, when in all likelyhood that thought has crossed his mind (he's thought about this far more than you, a commenter who speculated that in 5 minutes)? Perhaps he thought of it, and decided saying it would be even meaner to the hospital... which frankly, I think that framing is far crueler to the hospital. Like, if they rejected him from bureaucratic incompetence as they tried to filter out people who can't consent to surgery? Fine, incompetence is bad, but fine. If they rejected him because they could give someone with kidney failure 10 more years of good life, they thought he had a healthy kidney and could consent, but they had a personal grudge or moral judgement... That's a much more repugnant way to operate a hospital than simple incompetence. Reducing the quality of life of a potential kidney recipient for any of those reasons intentionally is far crueler than mere incompetence. I also suspect saying anything other than the hospital's purported reason would be grounds for libel.
- woodruffw 3y ago
  > We have a long waiting list for recipients, and we don't have an excess of donors to be picky with. That’s not how this works. Organ donation is inherently picky and fallible: without that pickiness, you get coerced organ donation and people undergoing mental crises seeking a form of salvation. I don’t understand where the moral judgement or grudge determination came from: everything I’ve said is a prima facie plausible reason to reject a donation candidate on basic medical ethics grounds.
  - eru 3y ago
    > Organ donation is inherently picky and fallible: without that pickiness, you get coerced organ donation [...] What is your evidence for this claim?
    - woodruffw 3y ago
      The international organ trade[1], for one. Survival is our strongest instinct; otherwise reasonable people will do reprehensible things to stay alive. (There’s also familial coercion, but that wasn’t present in this case presumably.) [1]: https://sgp.fas.org/crs/row/R46996.pdf https://sgp.fas.org/crs/row/R46996.pdf
DoreenMichele 3y ago
He was officially rejected due to mild childhood OCD. If you take that stated reason at face value, his rant about it is completely reasonable. If their "real reason" is more like your description, perhaps they should have found a way to try to say that.
- woodruffw 3y ago
  I agree. But we also only have Scott’s telling; it’s entirely possible that they expressed other concerns to him and only concluded with a final point.
  - DoreenMichele 3y ago
    This is true.
- ryanbrunner 3y ago
  I know at least for directed organ donation transplant teams will frequently lie - for instance, if a donor backs out, the clinic will default to telling the recipient it isn't a match rather than them backing out. I wonder if there's similar things going on here.
  - DoreenMichele 3y ago
    The not PC version of my thoughts is you have to be nuts to want to give away a perfectly good kidney to a random stranger. The system doesn't agree with me and has criteria for who can "reasonably" do that. My experience is that insanity is essentially rooted in "buying the BS" and actual reality is the best antidote for it. If they really are concerned for the mental health of donors whose reasoning worries them, they should find a means to effectively express that to them. The policy you describe is likely a factor here. It's also a form of gaslighting which is an effective means to drive someone insane. It's not gaslighting or headfuckery to come up with polite explanations for someone changing their mind. It's just a practical matter. But telling someone repeatedly "Get therapy" if* you have misrepresented what you see as mentally wrong is pointless. * Granted, as someone else pointed out, we are only hearing his version of events and it may not be "The truth, the whole truth and nothing but the truth."

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
  Why does being a minor celebrity mean you shouldn't donate your kidney? You don't think most Americans are "psychologically suited" to donate a kidney? Again, I don't think you would apply this level of paternalism to other situations. Would you tell the median person that they aren't "psychologically suited" to have a kid and therefore aren't allowed to? That's a dramatically more impactful and psychologically stressful decision, but we admit that the person best suited to make it is the person living it. I think you are just trying to justify a dumb bureaucratic decision that doesn't respect the suffering of people who actually need kidneys.
  - woodruffw 3y ago
    I didn’t say that. I think anybody should be able to donate their kidneys, provided that they are deemed competent to do so. Famous people and controversial people can be competent, and Scott almost certainly is. As a society, we treat organ donation differently because it comes with significant opportunity for abuse and regret. The sole point of my comment was to highlight how prominent EA writers can demonstrate a hypocritical blindness in a way that dispassionate observation can reveal. I’m not especially interested in UCSF’s actual decision.
    - mquander 3y ago
      OK, acknowledged.

the_shivers 3y ago

You make a good case, but I cant help but wonder if the people who will die from lack of a transplant agree with UCSF's decision.

woodruffw 3y ago
I’m absolutely positive they don’t. That’s why they don’t get to choose other peoples’ organs, and why we don’t let the families of victims determine the suitable punishment for the criminal.

OfSanguineFire 3y ago

What’s the "community/cult" here? I’m apparently missing context.

TheDong 3y ago
Effective Altruists. See also SBF/FTX, and https://time.com/6252617/effective-altruism-sexual-harassment/ https://time.com/6252617/effective-altruism-sexual-harassmen...
woodruffw 3y ago
Effective altruism, which is both a general (and not especially objectionable) variant of act utilitarianism, and also a specific community that has (fairly, to my eye) been accused of diverting money towards a particular set of reactionary worldviews held by its leadership.
- caturopath 3y ago
  EA isn't a form of act utilitarianism. Though EA certainly has a consequentialist flavor, it isn't the case that all (or even most?) EAs endorse utilitarianism (utilitarians aren't the only ones who care about scale). For example, Holden Karnofsky is explicitly non-utilitarian and Will MacAskill advocates making decisions based on considering (fundamentally, not just for optics) non-utilitarian ethical systems, though he is more utilitarian than someone like Karnofsky.
- nyssos 3y ago
  The main recipients of EA political funding (what little there is: the majority of money goes to global health and development, with AI safety as a distant second) are centrist Democrats. They're too right-wing for my taste too, but calling them "reactionaries" dilutes the word into meaninglessness.
  - eru 3y ago
    I'm not sure woodruffw necessarily talked about donations to US politicians when they mentioned 'diverting money towards a particular set of reactionary worldviews held by its leadership.' Perhaps they just don't like malaria nets? See https://www.givewell.org/charities/top-charities https://www.givewell.org/charities/top-charities

TheDong 3y ago

We have a long waiting list for recipients, and we don't have an excess of donors to be picky with. Why are you assuming Scott was not "able to see" the explanation you laid out, when in all likelyhood that thought has crossed his mind (he's thought about this far more than you, a commenter who speculated that in 5 minutes)? Perhaps he thought of it, and decided saying it would be even meaner to the hospital... which frankly, I think that framing is far crueler to the hospital. Like, if they rejected him from bureaucratic incompetence as they tried to filter out people who can't consent to surgery? Fine, incompetence is bad, but fine. If they rejected him because they could give someone with kidney failure 10 more years of good life, they thought he had a healthy kidney and could consent, but they had a personal grudge or moral judgement... That's a much more repugnant way to operate a hospital than simple incompetence. Reducing the quality of life of a potential kidney recipient for any of those reasons intentionally is far crueler than mere incompetence. I also suspect saying anything other than the hospital's purported reason would be grounds for libel.

woodruffw 3y ago
> We have a long waiting list for recipients, and we don't have an excess of donors to be picky with. That’s not how this works. Organ donation is inherently picky and fallible: without that pickiness, you get coerced organ donation and people undergoing mental crises seeking a form of salvation. I don’t understand where the moral judgement or grudge determination came from: everything I’ve said is a prima facie plausible reason to reject a donation candidate on basic medical ethics grounds.
- eru 3y ago
  > Organ donation is inherently picky and fallible: without that pickiness, you get coerced organ donation [...] What is your evidence for this claim?
  - woodruffw 3y ago
    The international organ trade[1], for one. Survival is our strongest instinct; otherwise reasonable people will do reprehensible things to stay alive. (There’s also familial coercion, but that wasn’t present in this case presumably.) [1]: https://sgp.fas.org/crs/row/R46996.pdf https://sgp.fas.org/crs/row/R46996.pdf

DoreenMichele 3y ago

He was officially rejected due to mild childhood OCD. If you take that stated reason at face value, his rant about it is completely reasonable. If their "real reason" is more like your description, perhaps they should have found a way to try to say that.

woodruffw 3y ago
I agree. But we also only have Scott’s telling; it’s entirely possible that they expressed other concerns to him and only concluded with a final point.
- DoreenMichele 3y ago
  This is true.
ryanbrunner 3y ago
I know at least for directed organ donation transplant teams will frequently lie - for instance, if a donor backs out, the clinic will default to telling the recipient it isn't a match rather than them backing out. I wonder if there's similar things going on here.
- DoreenMichele 3y ago
  The not PC version of my thoughts is you have to be nuts to want to give away a perfectly good kidney to a random stranger. The system doesn't agree with me and has criteria for who can "reasonably" do that. My experience is that insanity is essentially rooted in "buying the BS" and actual reality is the best antidote for it. If they really are concerned for the mental health of donors whose reasoning worries them, they should find a means to effectively express that to them. The policy you describe is likely a factor here. It's also a form of gaslighting which is an effective means to drive someone insane. It's not gaslighting or headfuckery to come up with polite explanations for someone changing their mind. It's just a practical matter. But telling someone repeatedly "Get therapy" if* you have misrepresented what you see as mentally wrong is pointless. * Granted, as someone else pointed out, we are only hearing his version of events and it may not be "The truth, the whole truth and nothing but the truth."