Tyler Johnston: Kidney Donation for College-Aged Altruists
Kidney donation is an opportunity that has gotten a fair amount of attention in effective altruist circles, especially in recent years. Thanks to modern medicine, the risks of kidney donation today have become relatively slight, and the potential benefits remain enormous. In America, twelve people die on the kidney waitlist every day, and a single non-directed kidney donation can lead to a transplant chain, facilitating an average of three (but as many as 100) total kidney transplants.
On the Effective Altruism Forums, Thomas Kelly and Josh Morrison provide a detailed cost-benefit analysis, and a 2018 Vox article by Dylan Matthews offers an in-depth look at the donation process. It was thanks to these resources, in part, that I donated my own kidney through the NKR on December 30, an experience that I (like many donors) found both surprisingly easy and deeply rewarding.
However, a recurrent theme in my donor evaluation process was a focus on my young age. The NKR doesn’t consider any non-directed donors under the age of twenty-one, and the nephrologist, social worker, and others who evaluated me made clear the unique risks they saw as possible when donating a kidney while still college-aged. One option that was suggested, and which I considered seriously, was returning in five or ten years to donate then.
Due to these specific concerns facing young donors, I wanted to compile a brief overview of what I’ve learned to be some of the main arguments for and against donating young versus waiting. While I came to the decision that donating now was the perfect time for me, there are strong arguments for both, and I hope this resource helps other college-aged prospective donors. (For overall non-age-specific risks and benefits, Waitlist Zero provides a great overview of the relevant data).
Potential Risks of Donating Young
Medical Uncertainty
This is the age-related risk factor that seems to get the most attention in the literature, and which I heard about the most during my own donor evaluation process. The thinking goes: at the age of twenty-one, and born at the turn of the century, many of us have a long life expectancy ahead— easily fifty more years, but possibly seventy or more if technology advances and life expectancy continues to trend upward. However, many young people don’t have a long medical history needed to accurately evaluate their lifetime risk of kidney failure or its related conditions. Also, while donor kidney function deteriorates over time at a similar rate to non-donor kidney function, my nephrologist explained to me that kidney donation is still a relatively new procedure and there isn’t a huge wealth of data on long-term outcomes for individuals who donate in their twenties. For some, the potential uncertainty of medical outcomes may present an argument for postponing the decision.
Personal Uncertainty
The common trope of young people feeling invincible isn’t totally off-the-mark. Psychological findings suggest that adolescents exhibit riskier behavior and only become more sophisticated in their thinking as they age. While the procedure is relatively safe and the overwhelming majority of people who donate a kidney report being glad to have done so, there are rare cases of individuals who change their minds and regret their decision later on (especially if a family member or loved one goes on to need a kidney themselves). There is an argument to be made that waiting to make the decision at 25, with a slightly more developed prefrontal cortex, might help mitigate those rare cases of regret.
Logistical Challenges
Finally, pursuing kidney donation requires a substantial time commitment. I first contacted the NKR over a year and a half ago, and spent last Fall completing multiple long screening sessions (including a full day of evaluation in Denver, multiple blood draw appointments, a twenty-four hour urine collection, etc.). After the surgery, I needed around one week for immediate recovery, and two more to get back to working full-time again. For many students who can’t spare a day in the busy semester and pack their winter and summer breaks with internships, it could make sense to wait until they’re settled into a full-time job that offers paid leave to pursue donation (NKR also offers reimbursement for lost wages).
Potential Reasons to Donate Young
Future Scarcity (Or Lack Thereof)
The exponential rate of progress in science, technology, and medicine is astounding. With this comes the exciting promise of potentially ending the national kidney shortage much sooner than we expect— two potential solutions could be the increasingly-popular proposals for ethical organ markets, as well as the potential development of new implantable artificial kidney technology. While I suspect these won’t eliminate the excess demand for kidneys within the next decade, exponential growth and technological progress can surprise us, and the near-certain need for donors today is (thankfully) an open question in the future. With this in mind, it isn’t certain that our kidneys will always hold the life-saving potential they do now.
Opportunity Cost Argument
One of the arguments against kidney donation that is somewhat unique to effective altruism regards the opportunity cost of donation, especially in financial terms. The median starting salary for a Harvard graduate is over $1,000 a week— in a little over two weeks (the usual time that an average donor might take off work to recover), the average graduate might earn enough to save a life through donating to a highly-effective charity, while circumventing the discomfort and medical risks of surgery. I don’t think this argument holds for a number of reasons (including the aforementioned wage reimbursement program currently offered by the NKR). However, I know it is an argument effective altruists take seriously, and for that I propose to fellow student EAs in particular: maybe college is the perfect time for kidney donation. I didn’t expect to earn much money over winter break anyway, and recovering with netflix on the couch for a few weeks coincided nicely with my much-needed mental break before the upcoming semester.
Social Domino Effect
Finally, one of the reasons I chose to donate now instead of waiting is related to the reason I’m writing this article in the first place— just as others did for me, I want to encourage and support those with an interest in helping end the kidney waitlist. Many past donors I’ve heard from have discussed something akin to a domino effect: people in the donor’s life who didn’t know how relatively safe the procedure was, or who had an interest in donation but didn’t know where to start, ended up going on to personally donate later after hearing the donor’s story. I only chose to donate because of others who have shared their experience with me, to the extent that altruism can be contagious, any donation today could lead to many more in the coming years through a beautiful display of memetic altruism— a possibility cut short by the choice to wait a decade.
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Tyler is a Junior at Harvard College hailing from Colorado. He is studying English and Global Health and is passionate about healthcare policy and animal welfare.