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By Kristin Brethel-Haurwitz and Abigail Marsh
Each year, nearly 200 individuals in the United States donate one of their kidneys to a total stranger.
If you are like many people, your first reaction to hearing this may be that anyone who would give an internal organ to someone that they have never met may be, well… a little crazy. The title of an early research article on the motives of altruistic kidney donors neatly summed up this sentiment: “The living anonymous kidney donor: Lunatic or saint?”
Ironically, this very common gut reaction may be one of the reasons it remains so difficult to donate a kidney. Altruistic donors must clear a number of hurdles before surgery, including necessary assessments of their medical and psychological health. But would-be donors also face additional, and perhaps unnecessary, obstacles that may reflect common but mistaken beliefs about human nature and altruistic motivation.
The widespread belief that people are fundamentally selfish, looking out only for themselves, is called the norm of self-interest. A norm is a widespread belief about what kinds of behaviors are common and appropriate. According to the norm of self-interest, all human behavior is—and should be—driven by selfish motivations. Altruistic kidney donation is a clear example of a behavior that flies in the face of this assumption. After all, if it’s really true that all human action is ultimately motivated by selfishness, anyone who sacrifices for a stranger must be either irrational (a lunatic) or somehow not human (a saint).
The norm of self-interest is problematic for many reasons, one of which is that it is simply wrong. People act in genuinely selfless ways with impressive frequency. As the 2016 World Giving Index shows, billions of people around the world offer money, time, and help to strangers every month, even when they get nothing for it in return. In online computer experiments, when people are given the opportunity to share resources with an anonymous stranger, most of them do, at least some of the time. Cooperation and generosity are the norm, not the exception. And as our lab’s research has found, even extraordinary altruism can be explained in terms of established neurocognitive processes. For example, we’ve recently shown that whereas altruistic kidney donors value close family and friends’ welfare to same degree as other people, altruists extend such care even to very distant others.
But the norm of self-interest may nevertheless fuel suspicion, even resistance, of anyone who chooses to sacrifice to help a stranger. As recently as a decade ago, many transplant centers refused to perform altruistic kidney donations—despite the technology being available, and despite the fact that tens of thousands of Americans were on the waiting list for a kidney—because many transplant professionals simply couldn’t imagine any sane reason that a person would want to give a stranger their kidney. Even now, would-be altruistic donors often face significant skepticism regarding their motives. One altruistic donor we have worked with recalled that the social worker evaluating her prior to her transplant began their interview with the comment: “You know this is a crazy thing to want to do, don’t you?”
Altruistic kidney donors cannot receive any pay. But persistent suspicions of kidney donors’ motives may contribute to needless restrictions on even fair compensation. The travel costs, missed work, and even in some cases medical bills that living donors incur often go uncompensated, leaving many donors in essence paying to donate their kidney. One recent study found that donating a kidney costs the average living donor over $2,000 in direct and indirect costs. And the costs of donating greatly exceed this average for some donors, like Lisa Tabor, an altruistic kidney donor who has participated in our laboratory’s research. Lisa recounted to us that, in addition to the ongoing pain and nerve damage she incurred following her donation, she was required to pay out-of-pocket medical expenses that totaled over $5,000. Because donating a kidney is considered an elective procedure, her insurance did not cover the follow-up surgeries she required to repair damage incurred from her donation. Unable to work while experiencing these symptoms, Lisa has been on disability since her donation, and she says the her costs now exceed $38,000. Her own experiences have driven her to become an advocate for better insurance coverage for living donors.
Altruism isn’t crazy. As our research has shown, known psychological processes can explain the urge to help others. What seems more crazy is to block those who genuinely wish to help others from doing so.
The good news is that new efforts are afoot to make kidney donation less expensive by reimbursing donors for costs during their donation and afterward. Removing unnecessary hurdles to donating is an important step toward increasing the pool of potential donors and saving lives. Beyond this, it is also an important step toward normalizing altruistic behavior and ultimately rejecting the norm of self-interest.
To learn more about becoming a living kidney donor, visit the National Kidney Foundation.
