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.
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 your questions about my framework as though I still follow it, because while your point is good enough that I may give it up, I haven't yet.)
$1600/life saved estimate assumes that the entire benefits of bednets come from protecting children under 5
I had forgotten that. In this case, then, you're right that our respective valuations of saving the life of an under-5 year old and giving an adult with kidney failure another ten years are going to be different. (My natural draw is actually even stronger towards saving/protecting children than a DALY approach gets you, but I think this is instinctive and excessive.)
I don't really understand why would you decide to keep more money in response to another, totally non-fiscal decision.
The big problem is that my money can go so much farther in generating happiness and reducing suffering when spent on other people that it has the potential to make every money-related decision really hard. If every dollar I spent on myself came with the question "why aren't you giving this to people that need it more?" I would be a wreck. I want all decisions I make in my daily life to have only minor consequences. So I set an "I will donate exactly $X this year to the best organization(s) I can find" limit, and don't have to be constantly struggling with whether I should be giving more. [1]
While this is phrased in terms of money, I convert all other potential utilitarian-virtuous actions into a dollar value so that I am not constantly being pressured to change my giving limit. Imagine I think fair trade chocolate is improves the world, but that it doesn't improve the world as much as the AMF. If I thought of my "chocolate buying decision" as totally separate from my "how much to donate decision" I might buy fair trade chocolate. But I also would believe that it would be better for me to buy the cheap chocolate, which I think tastes the same, and donate the savings to the AMF. Except my donation limit wouldn't allow that. So I set things up so that if I were to spend an extra $X to buy fair trade chocolate I would donate $X less to the AMF.
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?
Having to constantly evaluate how happy I was and whether that meant I could afford to give more or need give less would make me less happy. I do understand where you're going with this, and that if my rule is based around giving as much as I can while staying above a happiness line I'm unwilling to cross I need to be tracking my happiness level, but the problem is I'm not sure how to track my happiness level without setting up all sorts of nasty incentives. For example I could mark down on a sheet every evening how happy I was that day, with the idea that if I'm happy enough I can give more. But then Julia might start saying nice things to me she doesn't actually mean right before I fill out the sheet, or only bring up problems right after I mark things down for the day.
How do you deal with the repugnant conclusion?
I don't find it repugnant. The larger population has lives that are, on balance, after considering all the joy and suffering of being human, happy. And there are a lot of them. What's to object to?
(Reading your comments reminds me again how glad I am that GiveWell has such smart and reasonable people behind it.)
[1] I originally started doing this to keep Julia sane, but I find now it's helpful for me too.
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