People are dying because their kidneys have failed, and you probably have an extra one: should you donate it? A dialysis machine can do most of the work of a kidney, but it's not as good. A donated kidney gives someone an average of 10 additional years. [1] (Some of them reject it right away, others live for years before having problems.) This is pretty good: if you volunteer to be a kidney donor and are selected as a match, you give someone an average of another 10 years of life. [2]
A kidney donation is a surgery, however, and does have some risk for you. It's hard to calculate the risk because people who are selected for kidney donation are a weird group: they're heavily screened (so they tend to be healthier) but they're likely to be related to the person they're donating to (so they tend to be at risk for kidney problems themself). An ideal study on the dangers of kidney donation would compare donors with people who were going to donate and then didn't for some nearly-random reason. I can't find such a study, but I've heard people give odds of around 1:3000 for dying due to donating. You also spend several days in the hospital, miss some weeks of work, and take several months to fully recover. [3] This sounds like a lot, but giving someone 10 years of life is a lot too.
The question isn't so much "does this do good," however, but "does this maximize the good I can do for the amount of sacrifice I'm willing to accept?" GiveWell estimates that each $1600 given to the AMF for antimalarial net distribution prevents the death of someone with an average life expectancy of maybe 40 years [4]. So another way to give a stranger 10 more years of life is to give $400 to the AMF. Kidney donation is in the same ballpark as this, in terms of the ratio of benefit (to others) to cost (to you) [5], but even ignoring the risk of death [6] I would pay that $400 just to avoid the hospital and recovery time.
Update 2012-06-22: BDan and Alexander Berger have convinced me I was wrong to write off chains. At least right now there are more possible chains than kidneys to start them, and they can be quite long. My updated estimate is that this gets you a 3x multiplier on the value of a donated kidney, bringing the $400 charity equivalent to $1200. Which is still less than the $10-$100K at which I think I would sell a kidney, but substantially higher.
(I also posted this on my blog)
[1] Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. (1999), table 3. This is from a longitudinal study on 23,275 people who got kidney transplants from cadavers and had never had one before. In our case we're interested in live donation, but I would guess it's about the same.
[2] It's possible that you could do better than this if your donation to a stranger set off a chain of donations. The idea is that there are lots of people who would give their kidney to a friend of family member if they could, but are for whatever reason incompatible. You can make donor-donee-donor-donee chains where it just takes one altruistic person to set the whole thing off. (Cycles are also possible, but they don't need someone to get them started.) The question is, though, how likely are these chains to happen anyway? And how long a chain can you reasonably expect? My understanding is that these are quite rare, with most altruistic kidney donors not starting one. I'm going to ignore chains.
[3] Someone who gave their kidney wrote in a Guardian article: "I was in hospital for four days--the worst part of the whole ordeal was removing the catheter. In just two weeks I was back at work (the full recovery is supposed to be three months)."
[4] I would love to find a GiveWell estimate of what life expectancy for the people who don't die of malaria because of a net, but I can't find one. So this "40 years" is a guess after looking at life expectancies for different ages in the countries where the AMF works.
[5] There are huge costs to both dialysis and kidney transplant, so as a health intervention distributing antimalarial nets [makes much more sense]. From the perspective of a prospective donor, however, I don't think this matters.
[6] You might think that if you're someone who gives a substantial fraction of their earnings to effective charity, a 1:3000 risk of death would be pretty bad because you'd be able to help other people much less. But 3000 is really big: if you're giving $20K/year and have an expected additional 30 years of working life, a 1:3000 chance of not being able to do that has an undiscounted expected value of only $200 less donated. [7]
[7] $20K * 30 years * 1:3000 = $200
At the framework level
The basic framework you envision seems to have a certain fixed level of charitable resources (potential "sacrifice"), to be stewarded and spent in a utility-optimizing way over time. Once spent, these resources are gone. In this framework, asking "is the amount I would have to donate to the best charity to accomplish the same benefits as donating a kidney less than the price for which I would sell my kidney?" is a coherent and useful question, because you plan to offset your charitable contributions by that amount if you decide to donate a kidney, in order to maintain a stable level of personal welfare.
This sense of a broad scarcity of "charitable resources" (meant to include money, time, organs, etc.) is well-expressed by Julia's comment:
My framework is different. I think of moral sacrifice as something closer to a muscle: it can be used up, but it can also be worked out, flexed, strengthened. I think of donating a kidney as something more like a workout that will train the moral muscle than like a marathon that will exhaust it. If you think that donating a kidney would exhaust your moral capacity, I agree that you probably shouldn't do it.
Julia pointed to (a LessWrong writeup of) a study that purports to show that people behave less ethically after purchasing "green" products because they have "licensed" some immoral behavior with their positive actions. I think this dynamic makes a lot of sense with my experience in small actions but, big, life-changing decisions like donating a kidney or giving away a large portion of your income seem more likely to have the opposite effect: reinforcing an identity as a "charitable person" who is committed to the welfare of others. A couple weeks after I donated my kidney, I made my annual charitable donation; I'm nowhere near you and Julia, but I tithe. I don't think this is especially idiosyncratic: there's a psychology literature on "moral identity" that shows more or less the exact opposite of the literature on "moral licensing."
Of course, in these psych studies, the sample sizes are small and the conclusions are based on sample averages. The psych studies showing that any mention of statistics or more than one victim reduces donations clearly aren't characterizing GiveWell donors, and in the same vein I don't see much reason to think that these studies, even the one I cited, are characterizing people like me. So even if the "moral licensing" phenomenon is the dominant one in a broad swath of social activity or individuals, I think that gives me little reason to believe it dominates in my case or yours.
Details
Yep.
Agreed, though the far greater productivity of workers in the developed world (and the social support that they draw on when not working) means that the dollar magnitude of those economic gains will be much higher. Conversely, the higher baseline also means that the welfare returns to the developed-world economic gains are lower than the developing world returns for similar dollar values.
Agree that we don't literally have to use DALYs, but I don't think this is responsive. You're saying that you value saving the child's life at 4x the amount of extending the adult's life by 10 years; my point is that I value additional life for mid-life people much more than I do for infants, so I don't share your value here. I'm not sure what my multiple is, but it tilts the other direction (i.e. for your value of 4x, I have a value of less than one).
How do you deal with the repugnant conclusion?
AMF's benefits don't come from newborns, but the $1600/life saved estimate assumes that the entire benefits of bednets come from protecting children under 5.
I don't know the right answer to this question. I agree with what Holden wrote about why what you're asking for is too hard to do in a reasonable way.
I don't know of the general case here. I know a guy who got paid medical leave from his law firm, and I don't explicitly know of any cases where people had to take unpaid leave. The federal government offers 30 days of paid leave for organ donation for federal employees, as do many state governments (PDF). I would be mildly surprised if Google wasn't willing to give paid leave for altruistic kidney donation. My general guess is that this is going to track the overall generosity of the benefits of your employer. I do agree that this consideration could easily be decisive.
I tried to address this in the framework section, above. You've shown that you can live happily and healthily on the amount of income that you and Julia save for your own consumption. I don't really understand why would you decide to keep more money in response to another, totally non-fiscal decision.
To put it in a different context, let's say that your job becomes far more pleasant because you got new coworkers who you liked more. Should you thereby give a higher portion of your salary to charity, to offset the increase in pleasure? If something negative happened in your personal life, would you begin withholding a higher portion of your salary for personal consumption? I have a feeling that I'm probably not being fair with these examples, but I'm genuinely not sure why.
Anyway, as much as a I don't understand this approach, I do agree that the bar for donating a kidney should be high if it leads you to reduce your fiscal charitable contributions. If you would reduce your charitable contributions by $10K, I'm not sure if it's worth donating a kidney; if you would reduce your contributions by $50K, I'm pretty sure it's not (with the exception of the hard-to-quantify outreach benefits).
I addressed this in the framework section, but I wanted to add that I think "giving up meat is hard at first, but gets easier" dynamics are pervasive. I think giving a big portion of your income is hard at first but probably gets easier over time. If you weren't giving at all, giving 50% of one's income might seem inconceivable; after giving 25% for a long time, it might seem far more doable (even though the next 25% is harder). Most of the studies I've read on hedonic adaptation suggest that humans are quite good at adapting (over time) to new circumstances and new forms of suffering.
This is potentially a critical flaw in my framework. I wasn't think about it this way, but training myself to be ok with giving more would be a very good thing.
(Below I answer... (read more)