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RyanCarey comments on Kidney donation is a reasonable choice for effective altruists and more should consider it - Effective Altruism Forum

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Comment author: RyanCarey 16 November 2014 01:40:36PM 8 points [-]

On the face of it, it seems likely that removing one of your kidneys will decrease your life expectancy somewhat. For patients admitted to hospital, a substantial fraction, something like a quarter, have problems with mild or moderate impaired kidney function. When you donate your kidney, your remaining kidney compensates, but only to the point that it gives you 70% of your original kidney function. So on priors, we should favour the hypothesis that kidney donation increases your change of getting kidney failure.

Then, we take the evidence into account. The evidence, some of which you point out, has identified time after time that kidney donors have comparable risk of renal failure as the general population, despite being screened for diabetes, severe hypertension and kidney failure. This suggests again that donating a kidney increases your risk of kidney failure.

Then, let's look at more studies, mentioned in your footnote 25: Mjoen finds a large mortality risk from kidney donation. Kaplan effectively criticises Mjoen in relation to mortality rates, but concedes that there is likely to be a real effect on renal failure. Kaplan goes on to speculate that this risk of renal failure might arise from hereditary factors (from being related to the donor), rather than from donation itself. Muzaale, which you cite in relation to the claim that 'kidney donation has not been shown to measurably decrease long-term life expectancy.', shows that risk of renal failure is elevated, even for unrelated donors. By comparing related donors, unrelated donors and nondonors, one can see that the decrease in kidney failure is mostly correlated with donation, rather than heredity.

You cite Ibrahim in relation to the same point. To quote the article: "An increased incidence rate of ESRD in donors compared with non-donor controls is now also corroborated in a recently presented abstract on almost 100,000 living kidney donors from the United States.6 In that study, the incidence rate of ESRD was eightfold higher in donors (comparable to the 11-fold increase in the incidence rate in this Norwegian study). Thus, there are now at least two studies describing an approximately tenfold increase in the incidence of ESRD after donation, which is a serious concern."

All of this evidence strongly supports the common sense view that giving up a kidney will mildly increase the risk of end-stage kidney failure.

End-stage renal failure can often cut short a person's lifespan by many years. Beyond being bad from a selfish point of view, this could also decrease your physical capacity to help others. Kidney failure mostly afflicts people in their post-retirement years. However, this is not always the case, nor is it always the case that people cease useful altruistic activities when they retire. The question from an altruistic point of view is how big this opportunity cost has to be to outweigh the benefits of kidney donation.

It depends how many other ways there are of saving lives. By donating one's kidneys, one saves about 15 years of life. How much would it cost to save 15 years of life through a GiveWell donation? Maybe $2k. So if you care about individuals equally regardless of the country that they're from, then this is about how much one should be willing to pay to save a life. Is it reliable to apply GiveWell's estimates here? Maybe not. Are there other opportunities that will have even better impact? Plausibly. So let's use $2k as a target, ableit an approximate one.

How long would it take to create $2k of value? That's generally 1-2 weeks of work. So if kidney donation makes you lose more than 1-2 weeks of life, and those weeks constitute funds that you would donate, or voluntary contributions that you would make, then it's a net negative activity for an effective altruist.

Kidney donation makes you face a 1/4000 chance of death in the operation. If you've 40 years to live, that's 3 days of expected lifespan lost already. When you are admitted to hospital, you will run a substantial risk of having a recovery that is longer than your funded leave from work. So that's another expected week or so gone. Then, if you run a 1% chance of end-stage renal failure, that might rob you a few more weeks of time, although that time isn't taken from the prime of your life.

All things considered, it seems like if you care about people equally, irrespective of the medical condition they're suffering from and the country they're born in, and if you're prepared to donate your time or earnings, then you will actually be causing net harm by performing a random kidney donation.

Comment author: Carl_Shulman 17 November 2014 10:11:54PM 8 points [-]

When you save the life of a kidney recipient in a rich country, you add a lot more to the global economy than when you save someone who would otherwise die of malaria in a poor country, even if the direct QALY impact is similar. There are also larger effects on scientific progress, geopolitics, etc.

In other contexts, e.g. in the Open Philanthropy Project's assessment of cause areas, such non-QALY impacts (and the indirect effects of those over time) are considered to be of substantial importance beyond the direct QALYs.

I worry about selectively including or discounting non-QALY impacts from situation to situation (e.g. claiming a charity is n times better because it trades higher QALY benefits for lower non-QALY benefits, but when pressed agreeing that non-QALY effects are not negligible) in general, and in this specific case.

At least, the calculation should include both QALYs and monetary earnings of recipients.

Comment author: RyanCarey 19 November 2014 01:31:13PM 1 point [-]

Yes, although the monetary earnings of recipients could not be rated the same as if they were going to be donated to for example AMF because the value of funds donated to AMF is likely greater from an impartial point of view than if they went into a random individual's pocket.

Comment author: Nicholas_Bregan 17 November 2014 10:45:31PM 0 points [-]

There is still low-hanging fruit in bringing gifted children online. A small percentage of kids in developing nations are potential high achievers, autodidacts and could be given access to all the world's knowledge at reasonable costs.

If you think malaria nets aren't leveraged enough to beat kidney donations, other interventions might be.

Legalizing voluntary organ markets could be most effective, since it would both make the poor richer and solve the kidney shortage. But perhaps politics is too hard to change.

Comment author: mhpage 05 May 2015 03:36:13PM *  6 points [-]

I'm a bit late to the party, but a couple quick thoughts from a kidney donor who also does earning to give. First, I used paid vacation time to donate my kidney, so the entire discussion about salary trade-off is inapplicable to me (and I assume would be for most high-earning people). Second, I was working again about five days after surgery. I used those five days to read books I had been planning to read but for which I didn't have the time.

Another benefit of kidney donation that needs to be taken into account: My understanding is that most forms of kidney failure affect both of a person's kidneys, meaning whether you have one or two is irrelevant. But because I donated a kidney, if I ever need a kidney, I go to the top of the waiting list. Therefore, I have actually hedged against the risk of (certain types of) kidney failure by donating a kidney.

Comment author: Toby_Ord 19 November 2014 03:18:08PM 5 points [-]

I'm inclined to agree with Ryan's argument here. One way I look at it is that I wouldn't donate a kidney in order to get $2,000 (whether that was to be spent on myself or donated to effective charities), or equivalently, that I am prepared to pay $2,000 to keep my second kidney. This means that, for me at least, donating is dominated by extra donations.

I am surprised that this comes out as close as it does though. If we didn't have quite so effective charities, kidney donation would be a great option.

Comment author: RyanCarey 19 November 2014 04:36:29PM 0 points [-]

Yes, so long as you decide your actions in a purely impartial manner. If some self-interest is mixed in, then kidney donation doesn't look so good anymore.

Comment author: Alexander_Berger 22 November 2014 07:49:46PM *  4 points [-]

I think this argument is wrong for broadly the reasons that pappubahry lays out below. In particular, I think it's a mistake to deploy arguments of the form, "the benefit from this altruistic activity that I'm considering are lower than the proportional benefits from donations I'm not currently making, therefore I should not do this activity."

Ryan does it when he says:

How long would it take to create $2k of value? That's generally 1-2 weeks of work. So if kidney donation makes you lose more than 1-2 weeks of life, and those weeks constitute funds that you would donate, or voluntary contributions that you would make, then it's a net negative activity for an effective altruist.

Toby says:

One way I look at it is that I wouldn't donate a kidney in order to get $2,000 (whether that was to be spent on myself or donated to effective charities), or equivalently, that I am prepared to pay $2,000 to keep my second kidney. This means that, for me at least, donating is dominated by extra donations.

The problem with these comparisons is that they're totally made up. There's a potential one-off activity (donating a kidney) which, Thomas argued above, has large benefits to recipients relative to costs to the giver. There's also a question about how much you donate to charity. Based on the rationales you're giving here, someone who is happy with the cost/benefit tradeoff of donating a kidney as a one off, but is convinced that it's not as good cost/benefit as further donations, should actually increase their donations. However, my impression is that that has not been the reaction to these arguments; instead they justify current behavior/levels of altruism. (Toby, Ryan, correct me if I'm wrong here.) But donating a kidney would, according to most parties to the discussion, be net beneficial on its own terms. So the net impact of these arguments is to prevent people from taking positive sum altruistic actions, thereby reducing value.

There are kinds of costs that do mix between these two activities - genuinely foregone wages. And if your foregone wages were large and you decided that you would offset donations rather that consumption or savings with them, it would be perfectly appropriate to conduct this comparison. (Similarly, if the financial risk to future donations were higher, that would also make sense to offset.) But idly speculating about how much you'd have to be paid to do something, while taking the current level of donation as fixed, results in net negative impacts.

I think it's a problem when the "effective" side of "effective altruism" is used as a argument against the "altruism" side. I should note that Jeff Kaufman and I had this framework argument on his post on this topic a while back on Less Wrong.

Comment author: joshcmorrison 24 November 2014 10:39:58PM 2 points [-]

To follow up on Alexander's point a bit, I think applying the charitable benefits standard to non-charity decisions leads to some really weird results. For example, say someone who identifies as an EA chooses to give 10% of her income each year to a GW charity, and she’s choosing employment between being a schoolteacher for $50K a year or a job that’s not especially prosocial that pays $55K a year; say she has no innate preference between them, prefers to make more money all things being equal, and that being a schoolteacher would be worthmore than the $500 donation.

According to the logic Alexander points to about kidney donation, when deciding whether to forgo the $5000 to choose a socially beneficial job, the right calculus is -- 1. does giving up that money do as much good as donating to a GW charity (i.e. saving a life) and 2. if no, EAs shouldn't do it. That leads to the really weird result, though, of committing EA ideology to rejecting socially positive choices even if they involve fairly small sacrifices (here $5,000).

Let me give one final thought experiment on this point, which can be a variant of the child-drowning-in-the-puddle -- let's say instead of a child drowning, it's an older woman, and you're wearing expensive clothing that'll be ruined. If the EA standard is -- don't do altruistic acts that aren't of similar value to GW charitable donations -- that principle could very well commit you to not saving the older woman, which, again, seems bizarre.

To be clear, that's not to say that should mean donating a kidney -- far from it. Instead considering kidney donation is a way of broadening the options available to EAs beyond giving money.

Comment author: RyanCarey 24 November 2014 11:05:35AM 1 point [-]

"The problem with these comparisons is that they're totally made up." I don't think this is true. I think Toby has been giving >50% of his funds and works on FHI full-time. I've used my savings to implement a career change that I wouldn't pursue for selfish reasons. So I do think we're bottlenecked substantially by our available resources at this point, making the comparison legitimate.

I think that it's good to be a bit softer on people who are partially altruistic though. Dewey has said that effective altruism is what he calls the part of his life where he takes the demandingness of ethics seriously. Jeff Kaufman has written about making a budget for spending on others so one does not go insane about self/other tradeoffs during every visit to the supermarket. Utilitarianism gets roundly criticised for its vulnerability to this objection of 'demandingness' and some people find it quite psychologically challenging to (Jess' recent post here). So I lean toward including people who give only a smaller fraction of themselves to others.

I guess this might be the underlying disagreement. You see this as harmful because it will discourage a beneficial act (even though I don't think it's that beneficial, I admit that this is the part that gives me the most pause), whereas on balance, I think the main issue at stake here is our inclusiveness.

There's a further question of how seriously to take these opportunity cost arguments in general, which I think will be picked up in Katja's thread on vegetarianism.

Comment author: ruthie 17 November 2014 03:41:55AM 2 points [-]

$2K in a couple of weeks is only the case for very high-earning people. With a more typical income, donating a kidney is probably worth the lost income.

It seems like by donating, you expect to lose a few weeks of life and a few weeks of work (which may or may not be paid, depending on your situation). I'm not sure I correctly remember the QALY/"life saved" ratio, but what I remember is 35 QALYs/saved life, which seems reasonable. If you're making $55,000 and donating 10% of your income, it would take a little less than two months of lost income to make that much. It seems like you're still ahead with the kidney donation at that rate.

Comment author: Ben_Kuhn 17 November 2014 05:45:04AM 4 points [-]

Your calculation with the $55,000 dollars assumes that if you work for a week you're only donating 10% of the marginal income that you get, but if you give up that time to kidney donation you're giving 100% of the marginal time cost to charity. That's an unfair comparison.

In an apples-to-apples comparison where a person earning $55,000 gives up 100% of their pre-tax income for the marginal time, it would only take 2 weeks for them to make $2,000.

Comment author: pappubahry 17 November 2014 06:24:14AM 0 points [-]

That's an unfair comparison.

But it might be a relevant comparison for many people. i.e., I expect that there are people who would be willing to forego some income to donate a kidney (and they may not need to do this, depending on the availability of paid medical leave), but who wouldn't donate all of that income if they kept both kidneys.

Comment author: ruthie 17 November 2014 07:46:07PM 5 points [-]

I think Ben's criticism is fair, in that a perfectly rational altruist wouldn't make it. That is, if you are willing to give up three weeks of income to donate a kidney, you should be willing to work for three weeks and donate all of your income, not just whatever percentage you donate normally. This is not to say that it's an unreasonable decision in all cases-- taking three weeks off of work to donate a kidney has all sorts of other consequences (you probably get to do a lot of reading while you're stuck in bed), but from a first order altruistic standpoint, at the income level I mentioned it still wouldn't make sense.

Comment author: pappubahry 18 November 2014 01:24:09AM 7 points [-]

Yes, I agree with that, and it's worth someone making that point. But I think in general it is too common a theme in EA discussion to compare some possible altruistic endeavour (here kidney donation) to perfectly optimal behaviour, and then criticise the endeavour as being sub-optimal -- Ryan even words it as "causing net harm"!

In reality we're all sub-optimal, each in our own many ways. If pointing out that kidney donation is sub-optimal (assuming all the arguments really do hold!) nudges some possible kidney donors to actually donate more of their income, then great. But I still think that there are people who would consider donating a kidney but who wouldn't donate an extra half-month's salary instead.

Comment author: Paul_Christiano 17 November 2014 05:40:34AM 1 point [-]

$2K in 2 weeks is $52K / year. For reference, this is less than US GDP per capita. Admittedly it's above the median (it's about the median household income in the US), but still not that far.

Comparing to the fraction of income you donate seems wrong when accounting for lost work, you want to compare to donating all of the foregone income (since other expenses don't generally stop while you miss work).

Comment author: pappubahry 17 November 2014 06:48:07AM 0 points [-]

How long would it take to create $2k of value? That's generally 1-2 weeks of work. So if kidney donation makes you lose more than 1-2 weeks of life, and those weeks constitute funds that you would donate, or voluntary contributions that you would make, then it's a net negative activity for an effective altruist.

This can't be the right comparison to make if the 1-2 weeks of life is lost decades from now. The (foregone) altruistic opportunities in 2060 are likely to cost much more than $2000 per 15 DALY's averted.

I think the basic shape of your argument still holds, based on foregone income that you could donate today, but a slightly shorter retirement doesn't look like it makes much difference to one's total altruism (especially if you leave donations to charity in your will).