My Left Kidney

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OCT 27, 2023

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A person has two kidneys; one advises him to do good and one advises him to do
evil. And it stands to reason that the one advising him to do good is to his right
and the one that advises him to do evil is to his left.
— Talmud (Berakhot 61a)
I.
As I left the Uber, I saw with horror the growing wet spot around my crotch. “It’s not
urine!”, I almost blurted to the driver, before considering that 1) this would just call
attention to it and 2) it was urine. “It’s not my urine,” was my brain’s next proposal -
but no, that was also false. “It is urine, and it is mine, but just because it’s pooling
around my crotch doesn’t mean I peed myself; that’s just a coincidence!” That one
would have been true, but by the time I thought of it he had driven away.
Like most such situations, it began with a Vox article.
II.
I make fun of Vox journalists a lot, but I want to give them credit where credit is due:
they contain valuable organs, which can be harvested and given to others.
I thought about this when reading Dylan Matthews’ Why I Gave My Kidney To A
Stranger - And Why You Should Consider Doing It Too. Six years ago, Matthews
donated a kidney. Not to any particular friend or family member. He just thought
about it, realized he had two kidneys, realized there were thousands of people dying
from kidney disease, and felt like he should help. He contacted his local hospital,
who found a suitable recipient and performed the surgery. He described it as “the
most rewarding experience of my life”:
 As I’m no doubt the first person to notice, being an adult is hard. You are
consistently faced with choices — about your career, about your friendships,
about your romantic life, about your family — that have deep moral
consequences, and even when you try the best you can, you’re going to get a lot
of those choices wrong. And you more often than not won’t know if you got them
wrong or right. Maybe you should’ve picked another job, where you could do
more good. Maybe you should’ve gone to grad school. Maybe you shouldn’t have
moved to a new city.
So I was selfishly, deeply gratified to have made at least one choice in my life that
I know beyond a shadow of a doubt was the right one.
Something about that last line struck a chord in me. Still, making decisions about
internal organs based on a Vox article sounded like the worst idea. This was going to
require more research.
III.
Matthews says kidney donation is fantastically low-risk:
The risk of death in surgery is 3.1 in 10,000, or 1.3 in 10,000 if (like me) you don't
suffer from hypertension. For comparison, that’s a little higher and a little lower,
respectively, than the risk of pregnancy-related death in the US 1. The risk isn’t
zero (this is still major surgery), but death is extraordinarily rare. Indeed, there’s
no good evidence that donating reduces your life expectancy at all [...]
The procedure does increase your risk of kidney failure — but the average donor
still has only a 1 to 2 percent chance of that happening. The vast majority of
donors, 98 to 99 percent, don’t have kidney failure later on. And those who do
get bumped up to the top of the waiting list due to their donation.
I checked the same resources Matthews probably had, and I agreed.
It was my girlfriend (at the time) who figured out the flaw in our calculation. She was
both brilliant and pathologically anxious, which can be a powerful combination: her
zeal to justify her neuroses gave her above-genius-level ability to ferret out medical
risks that doctors and journalists had missed. She made it her project to dissuade
me from donating, did a few hours’ research, and reported back that although the
risk of dying from the surgery was indeed 1/10,000, the risk of dying from the
screening exam was 1/660 .
I regret to inform you she might be right. The screening exam involves a “multiphase
abdominal CT”, a CAT scan that looks at the kidneys and their associated blood
vessels and checks if they’re all in the right place. This involves a radiation dose of
about 30 milli-Sieverts. The usual rule of thumb is that one extra Sievert = 5% higher
risk of dying from cancer, so a 30 mS dose increases death risk about one part in
660. There are about two nonfatal cases of cancer for every fatal case, so the total
cancer risk from the exam could be as high as 1/220 2. I’m not a radiologist, maybe
I’m totally wrong here, but the numbers seemed to check out.
I discussed this concern with transplant doctors at UCSF and the National Kidney
Foundation, who seemed very surprised to hear it, but couldn’t really come up with
any evidence against. I asked if they could do the kidney scan with an MRI (non-
radioactive) instead of a CT. They agreed 3.
The short-term risks taken care of, my girlfriend and I moved on to arguing about the
longer-term ones. One kidney starts out with half the GFR (glomerular filtration rate,
a measure of the kidneys’ filtering ability) of two kidneys. After a few months, it
grows a little to pick up the slack, stabilizing at about 70% of your pre-donation GFR.
70% of a normal healthy person’s GFR is more than enough.
But you lose GFR as you age. Most people never lose enough GFR to matter; they
die of something else first. But some people lose GFR faster than normal and end up
with chronic kidney disease, which can cause fatigue and increase your chance of
other problems like heart attacks and strokes. If you donate one kidney, and so start
with only 70% of normal GFR, you have a slightly higher chance of being in this
group whose GFR decline eventually becomes a problem. How much of a chance?
According to Matthews, “1 to 2 percent”.
The studies showing this are a bit of a mess. Non-controlled studies find that kidney
donors have lower lifetime risk of kidney disease than the general population. But
this is because kidney donors are screened for good kidney health. It’s good to know
that donation is so low-risk that it doesn’t overcome this pre-existing advantage. But
in order to quantify the risk exactly, we need to find a better control group.
Two large studies tried to compare kidney donors to other people who would have
passed the kidney donation screening if they had applied, and who therefore were
valid controls. An American study of 347 donors found no increased mortality after
an average followup of 6 years. A much bigger and better Norwegian study of 1901
donors found there was increased mortality after 25 years - so much so that the
donors had an extra 5% chance of dying during that period (ie absolute risk
increase). But looking more closely at the increased deaths, they were mostly from
autoimmune diseases that couldn’t plausibly be related to their donations. The
researchers realized that most kidney donors give to family members. If your family
member needs a kidney donation, it probably means they have some disease that
harms the kidneys. Lots of diseases are genetic, so if your family members have
them, you might have them too. They suspected that the increase in mortality was
mostly because of genetic diseases which these donors shared with their kidney-
needing relatives - diseases which may not have shown up during the screening
process.
Muzaale et al investigate this possibility in a sample of 96,217 donors. They were
only able to follow for an average 7 years, but used curves derived from other
samples to project up to 15 years. They found 34 extra cases of ESRD (end-stage
renal disease, the most severe form of kidney disease) per 10,000 donors who were
related to their recipients, compared to 15 cases per 10,000 for donors who weren’t
(the difference wasn’t statistically significant, but I think it’s still correct for unrelated
donors to use the unrelated donor number). They estimated a total increased risk of
78/10,000 per lifetime; although I can’t prove it, I think by analogy to the earlier
statistic this number should plausibly be ~halved for unrelated donors. So I think that
if anything, Matthews is overestimating how worried to be - the real number could
be as low as an 0.5 - 1% increase.
On the other hand, I discussed this with my uncle, a nephrologist (kidney doctor),
who says he sees suspiciously many patients who donated kidneys 30+ years ago
and now have serious kidney disease. None of these studies have followed subjects
for 30+ years, and although they can statistically extend their projections, something
weird might happen after many decades that deviates from what you would get by
just extrapolating the earlier trend. I was eventually able to find Ibrahim et al, which
follows some kidney donors for as long as 30-40 years. They find no negative
deviation from trend after the 20 year mark. Even up to 35-40 years, donors
continue to have less kidney disease than the average non-donor.
This isn’t controlling for selection bias - but neither was my uncle’s anecdotal
observation. So although it does make me slightly nervous, I’m not going to treat it
as actionable evidence.
Still, my girlfriend ending up begging me not to donate, and I caved. But we broke up
in 2019. The next few years were bumpy, but by 2022 my life was in a more stable
place and I started thinking about kidneys again. By then I was married. I discussed
the risks with my wife and she decided to let me go ahead. So in early November
2022, for the second time, I sent a form to the University of California San Francisco
Medical Center saying I wanted to donate a kidney.
IV.
Something else happened that month. On November 11, FTX fell apart and was
revealed as a giant scam. Suddenly everyone hated effective altruists. Publications
that had been feting us a few months before pivoted to saying they knew we were
evil all along. I practiced rehearsing the words “I have never donated to charity, and if
I did, I certainly wouldn’t care whether it was effective or not”.
But during the flurry of intakes, screenings, and evaluations that UCSF gave me that
month, the doctors asked “so what made you want to donate?” And I hadn’t
rehearsed an answer to this one, so I blurted out “Have you heard of effective
altruism?” I expected the worst. But the usual response was “Oh! Those people!
Great, no further explanation needed.” When everyone else abandoned us, the organ
banks still thought of us as those nice people who were always giving them free
kidneys.
We were giving them a lot of free kidneys. When I talked to my family and non-EA
friends about wanting to donate, the usual reaction was “You want to what?!” and
then trying to convince me this was unfair to my wife or my potential future children
or whatever. When I talked to my EA friends, the reaction was at least “Cool!”. But
pretty often it was “Oh yeah, I donated two years ago, want to see my scar?” Most
people don’t do interesting things unless they’re in a community where those things
have been normalized. I was blessed with a community where this was so normal
that I could read a Vox article about it and not vomit it back out.
This is surprising, because kidney donation is only medium effective, as far as
altruisms go 4. The average donation buys the recipient about 5 - 7 extra years of life
(beyond the counterfactual of dialysis). It also improves quality of life from about
70% of the healthy average to about 90%. Non-directed kidney donations can also
help the organ bank solve allocation problems around matching donors and
recipients of different blood types. Most sources say that an average donated kidney
creates a “chain” of about five other donations, but most of these other donations
would have happened anyway; the value over counterfactual is about 0.5 to 1 extra
transplant completed before the intended recipient dies from waiting too long. So in
total, a donation produces about 10 - 20 extra quality-adjusted life years.
This is great - my grandfather died of kidney disease, and 10 - 20 more years with
him would have meant a lot. But it only costs about $5,000 - $10,000 to produce this
many QALYs through bog-standard effective altruist interventions, like buying
mosquito nets for malarial regions in Africa. In a Philosophy 101 Thought Experiment
sense, if you’re going to miss a lot of work recovering from your surgery, you might
as well skip the surgery, do the work, and donate the extra money to Against Malaria
Foundation instead 5.
Obviously this kind of thing is why everyone hates effective altruists. People got so
mad at some British EAs who used donor money to “buy a castle”. I read the Brits’
arguments: they’d been running lots of conferences with policy-makers,
researchers, etc; those conferences have gone really well and produced some of the
systemic change everyone keeps wanting. But conference venues kept ripping them
off, having a nice venue of their own would be cheaper in the long run, and after
looking at many options, the “castle” was the cheapest. Their math checked out, and
I believe them when they say this was the most effective use for that money. For
their work, they got a million sneering thinkpieces on how “EA just takes people’s
money to buy castles, then sit in them wearing crowns and waving scepters and
laughing at poor people”. I respect the British organizers’ willingness to sacrifice
their reputation on the altar of doing what was actually good instead of just good-
looking.
I worry that people use suffering as a heuristic for goodness. Mother Teresa
becomes a hero because living with lepers in the Calcutta slums sounds horrible - so
anyone who does it must be really charitable (regardless of whether or not the lepers
get helped). Owning a castle is the opposite of suffering - it sounds great - therefore
it is fake charity (no matter how much good you do with the castle).
This heuristic isn’t terrible. If you’re suffering for your charity, then it must seem
important to you, and you’re obviously not doing it for personal gain. If you do
charity in a way that benefits you (like gets you a castle), then the personal gain
aspect starts looking suspicious. The problem is the people who elevate it from a
suspicion to an automatic condemnation. It seems like such a natural thing to do.
And it encourages people to be masochists, sacrificing themselves pointlessly in
photogenic ways, instead of thinking about what will actually help others.
But getting back to the point: kidney donation has an unusually high ratio of
photogenic suffering to altruistic gains. So why do EAs keep doing it? I can’t speak
for anyone else, but I’ll speak for myself.
It starts with wanting, just once, do a good thing that will make people like you more
instead of less. It would be morally fraught to do this with money, since any money
you spent on improving your self-image would be denied to the people in malarial
regions of Africa who need it the most. But it’s not like there’s anything else you can
do with that spare kidney.
Still, it’s not just about that. All of this calculating and funging takes a psychic toll.
Your brain uses the same emotional heuristics as everyone else’s. No matter how
contrarian you pretend to be, deep down it’s hard to make your emotions track what
you know is right and not what the rest of the world is telling you. The last Guardian
opinion columnist who must be defeated is the Guardian opinion columnist inside
your own heart. You want to do just one good thing that you’ll feel unreservedly
good about, and where you know somebody’s going to be directly happy at the end
of it in a way that doesn’t depend on a giant rickety tower of assumptions.
Dylan Matthews wrote:
As I’m no doubt the first person to notice, being an adult is hard. You are
consistently faced with choices — about your career, about your friendships,
about your romantic life, about your family — that have deep moral
consequences, and even when you try the best you can, you’re going to get a lot
of those choices wrong. And you more often than not won’t know if you got them
wrong or right. Maybe you should’ve picked another job, where you could do
more good. Maybe you should’ve gone to grad school. Maybe you shouldn’t have
moved to a new city.
So I was selfishly, deeply gratified to have made at least one choice in my life that
I know beyond a shadow of a doubt was the right one.
…and it really resonated. Everything else I try to do, there’s a little voice inside of me
which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just
doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to
figure any of this out. Maybe you should just give up.”
The Talmud is very clear: that voice is called the evil inclination, and it dwells in the
left kidney. There is only one way to shut it off forever. I was ready.
V.
You might not be a masochist. But hospitals are sadists. They want to hear you beg.
After I submitted the donation form, I was evaluated by a horde of indistinguishable
women. They all had titles like “Transplant Coordinator”, “Financial Coordinator”, and
“Patient Care Representative”. Several were social workers; one was a psychiatrist.
They would see me through a buggy version of Zoom that caused various parts of
their body to suddenly turn into the UCSF logo, and they all had questions like “Are
you sure you want to do this?” and “Are you going to regret this later?” and “Is
anyone pressuring you to do this?” and “Are you sure you want to do this?”
After clearing that gauntlet came the tests. Blood tests - I think I must have given
between 20 and 50 vials of blood throughout the screening process. Urine tests -
both the normal kind where you pee in a cup, and a more involved kind where you
have to store all your urine for 24 hours in a big jug, then take it to the lab. “Urinate
into a jug” ought to be the easiest thing in the world, but some of the labs have
overly complicated jugs that I, with my mere MD, couldn’t always get right - hence
my experience accidentally pouring urine on myself in an Uber.
Then came the big guns. Echocardiogram. MRI. One of my urine tests was slightly
off, so I also got a nuclear kidney scan, where they injected radioactive liquid in me
and monitored how long it took to come out the other end (I remember asking a
friend “Can I use your bathroom? My urine might be slightly radioactive today, but it
shouldn’t be enough to matter.”)
Finally, five months after I originally applied, I got a phone call from the Transplant
Coordinator. The test results were in, and . . . I had been rejected because I’d had
mild childhood OCD.
This was something I’d mentioned offhandedly during one of the psych evaluations.
As a child, I used to touch objects in odd patterns that only made sense to me. I got
diagnosed with OCD, put on SSRIs for a while, finally did therapy at age 15, hadn’t
had any problems since. I still go back on SSRIs sometimes when I’m really stressed,
and will grudgingly admit to the occasional odd-pattern-touching when no one’s
looking.
But it’s nothing anyone would know about if I didn’t tell them! It was mild even at age
15, and it’s been close-to-nonexistent for the past twenty years! Now I’m a
successful psychiatrist who owns his own psychiatry practice and helps other
people with the condition! I told them all this. They didn’t care.
I asked them if there was anything I could do. They said maybe I could go to therapy
for six months, then apply again.
I asked them what kind of therapy was indicated for mild OCD that’s been in
remission for twenty years. They sounded kind of surprised to learn there were
different types of therapy and said whatever, just talk to someone or something.
I asked them how frequent they thought the therapy needed to be. They sounded
kind of surprised to learn that therapy could have different frequencies, and said,
you know, therapy, the thing where you talk to someone.
I asked them if they actually knew anything about OCD, psychotherapy, or mental
health in general, or if they had just vaguely heard rumors that some people were
bad and crazy and shouldn’t be allowed to make their own decisions, and that a
ritual called “therapy” could absolve one of this impurity. They responded as politely
as possible under the circumstances, but didn’t change their mind.
I wasn’t going to waste an hour a week for six months, and spend thousands of
dollars of my own extremely-not-reimbursed-by-UCSF money, to see a randomly-
selected therapist for a condition I’d gotten over twenty years ago, just so I could
apply again and get rejected a second time.
This was one of the most infuriating and humiliating things that’s ever happened to
me. We throw around a lot of terms like “stigma” and “paternalism”, and I’ve worked
with patients who have dealt with all these issues (it’s UCSF in particular a surprising
amount of the time!). But I was still surprised how much it hurt when it happened to
me. Being denied the right to control your own body because of some meaningless
diagnosis on a chart somewhere is surprisingly frustrating, even compared to things
that should objectively be worse. I thought I was going to be able to do a good deed
that I’d been fantasizing about for years, and some jerk administrator torpedoed my
dreams because I had once, long ago, had mild mental health issues.
So I gave up.
I spent the next few weeks unleashing torrents of anti-UCSF abuse at anyone who
would listen. This turned out to be very productive! When I was unleashing a torrent
of anti-UCSF abuse to Josh Morrison of WaitlistZero, he asked if I’d tried other
hospitals.
I hadn’t. I’d assumed they were all in cahoots. But Josh said no, each hospital had
their own evaluation process. Weill Cornell, a hospital in NYC, was one of the best
transplant centers in the country, and had a reputation for fair and thoughtful pre-
donor screening. Why didn’t I talk to them?
NYC was far away, and I hate to travel, but I was just angry enough to accept. At this
point I’d forgotten whatever good altruistic motivations I might have originally had
and was fueled entirely by spite. Getting my kidney taken out somewhere else felt
like it would be a sort of victory over UCSF. So I went for it.
Cornell was lovely. They tried to do as much of the process as they could via
Californian intermediaries, so that I only had to fly to New York twice. Their
psychiatrist evaluated me, listened to me explain my weak history of OCD, then
treated me like a reasonable adult who tells the truth and can handle his own
medical decisions. They were concerned that I sometimes self-prescribed Lexapro
to deal with anxiety. But we agreed on a compromise: I found another psychiatrist,
let her give me the exact same prescription of Lexapro at a much higher cost to my
insurance, and that resolved the problem.

So in late September 2023 - ten months after I started the process - I finally got fully
cleared to donate, surgery set for October 12.
VI.
I knew, in theory, that anaesthetics existed. Still, it’s weird. One moment you’re lying
on a table in the OR, steeling yourself up for one of the big ordeals of your life. The
next, you’re in a bed in the recovery room, feeling fine. The operation - this thing
you’ve been thinking about and dreading for months - exists only as a lacuna in your
memory. Not even some kind of fancy lacuna, where you remember the darkness
closing in on you beforehand, or have to claw yourself back into consciousness
afterwards. The most ordinary of lacunas, like a good night sleep.
There was no pain, not at first. The painkillers and nerve blocks lasted about a day
after the surgery. By the time they wore off, it was more of a dull ache. The hospital
offered me Tylenol, and I wanted to protest - really? Tylenol? After major surgery?
But the Tylenol worked.
Some people will have small complications (I am a doctor, pretty jaded, and my
definition of “small” may be different from yours). Dylan Matthews wrote about an
issue where his scrotum briefly inflated like a balloon (probably this is one of the
ones that doesn’t feel small when it’s happening to you). I missed out on that
particular pleasure, but got others in exchange. I had an unusually hard time with the
catheter - the nurse taking it out frowned and said the team that put it in had “gone
too deep”, as if my urinary tract was the f@#king Mines of Moria - but that was
fifteen seconds of intense pain. Then a week afterwards, just when I thought I’d
recovered fully, I got bowled over by a UTI which knocked me out for a few days. But
overall, I was surprised by the speed and ease of my recovery.
A few hours after the surgery, I walked a few steps. After a day, I got the catheter out
and could urinate normally again. After two days, I was eating “SmartGel”, a food
substitute that has mysteriously failed to catch on outside of the immobilized-
hospital-patient market. After three, I was out of the hospital. After four, I started
easing myself back into (remote) work. After a week, I flew cross-country.
. . . and then I got the UTI. If this section sounds schizophrenic, it’s because it’s a
compromise between an original draft where I said nothing went wrong and it was
amazing, and a later draft written after a haze of bladder pain. Just don’t develop
complications, that’s my advice.
Still, I recently heard from the surgeon that my recipient’s side of the surgery was a
success, that my kidney was in them and going fine - and that put things back into
perspective. To a first approximation, compared to the inherent gravity of taking an
organ out of one person and putting it in a second person and saving their life - it
was all easy and everything went well. When I look back on this in a decade, I’ll
remember it as everything being easy and going well. Even now, with some lingering
bladder pain, modern medicine still feels like a miracle.
VII.
In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in
need.
This sentence fascinates me because of the hanging “would”. Would, if what? A
natural reading is “would if someone needs it”. But there are 100,000 strangers on
the waiting list for kidney transplants. Between 5,000 and 40,000 people die each
year for lack of sufficient kidneys to transplant. Someone definitely needs it. Yet only
about 200 people (0.0001%) donate kidneys to strangers per year. Why the gap
between 25-50% and 0.0001%?
Some of you will suspect respondents are lying to look good. But these are
anonymous surveys. Lying to themselves to feel good, then? Maybe. But I think
about myself at age 20, a young philosophy major studying utilitarianism. If someone
had asked me a hypothetical about whether I would donate a kidney to a stranger in
need, I probably would have said yes. Then I would have continued going about my
business, never thinking of it as a thing real-life people could do. Part of this would
have been logistics. I wouldn’t have known where to start. Do you need to have
special contacts in the surgery industry? Seek out a would-be recipient on your
own? Where would you find them? But more of it would have been psychological: it
just wasn’t something that the people I knew did, and it would be weird and
alienating for me to be the only one.
This is going to be the preachy “and you should donate too!” section you were
dreading all along, but I’m not going to make a lot of positive arguments. If 90% of
the people who answer yes on those surveys are lying to feel good, then only 3 - 5%
really want to donate. But bringing the donation rate from 0.0001% of people to 3 -
5% of people would solve the kidney shortage many times over. The point isn’t to
drag anti-donation-extremists kicking and screaming to the operating table. The
point is to reach the people who already want to do it, and make them feel
comfortable starting the process.
20-year-old me was in that category. The process of making him feel comfortable
involved fifteen years of meeting people who already done it. During residency, I met
a fellow student doctor who had donated. Later, I got involved in effective altruism,
and learned that movement leader Alexander Berger - a guy who can easily direct
millions of dollars at whatever cause he wants - had donated his personal kidney as
well. Some online friends. Some people I met at conferences. And Dylan Matthews,
who I kept crossing paths with (most recently at the Manifest journalism panel). After
enough of these people, it no longer felt like something that nobody does, and then I
felt like I had psychological permission to do it.
(obviously saints can do good things without needing psychological permission first,
but not everyone has to be in that category, and I found it easier to get the
psychological permission than to self-modify into a saint 6.)
So I’m mostly not going to argue besides saying: this is a thing I did, it’s a thing
hundreds of other people do each year, getting started is as simple as filling out a
form, and if it works for you, you should go for it 7.
When I woke up in the recovery room after surgery, I felt great. Amazing. Content,
peaceful, proud of myself. Mostly this was because I was on enough opioids to
supply a San Francisco homeless encampment for a month. But probably some of it
was also the warm glow of having made a difference or something. That could be
you!
VIII.
The ten of you who will listen to this and donate are great. That brings the kidney
shortage down from 40,000 to 39,990/year.
Everyone knows we need a systemic solution, and everyone knows what that
solution will eventually have to be: financial compensation for kidney donors. But so
far they haven’t been able to get together enough of a coalition to overcome the
usual cabal of evil bioethicists who thwart every medical advance.
My kidney donation “mentor” 8 Ned Brooks is starting a new push - the Coalition To
Modify NOTA - which proposes a $100,000 refundable tax credit - $10,000 per year
for 10 years - for kidney donors. There would be a waiting period and you’d have to
get evaluated first, so junkies couldn’t walk in off the street and get $100K to spend
on fentanyl. No intermediate company would “profit” off the transaction, and rich
people wouldn’t be able to pay directly to jump in line. It would be the same kidney
donation system we have now, except the donors get $100,000 back after saving the
government $1MM+.
(the libertarian in me would normally prefer a free market, but “avoid taxes by selling
your organs” also has a certain libertarian appeal)
This came up often when I talked to other donors. They all had various motivations,
but one of the things they cared about was being able to advocate for these kinds of
systemic changes more effectively. I personally have been wanting to push this in an
essay here for a while, but it seemed hypocritical to play up the desperate kidney
shortage while I still had two kidneys. Now I can support NOTA modification whole-
heartedly . . . full-throatedly? . . . it’s weird how many of these adverbs involve claims
to have still all of your organs.
This is also one of the answers to the question I asked in section IV: how do you
balance acts of heroic altruism that everyone will love you for vs. acts of boring
autistic altruism that will make everyone hate you, but which will accomplish more
good in the end?) Coalition To Modify NOTA is full of previous living kidney donors,
who are using the moral clout and recognition they’ve gotten to get attention and
change the system in an unglamorous way. I find this an admirable way of squaring
the circle: do the flashy heroic things to gain social capital, then spend the social
capital on whatever’s ultimately most important.
If you get one takeaway from this, let it be that those guys who bought the castle
were good guys. Two takeaways, and it’s that plus modify NOTA. Three takeaways,
and you should feel permission to (if you want) donate a kidney. You can sign up
here. 9 Feel free to email me at [email protected] if you have questions
about the process.

1 Further perspective: I’m 38, which gives me a 2/million total chance of dying per day. So
the likelihood that I would die during my kidney operation equals the likelihood that I
would die during a randomly chosen two months of everyday life.
2 Maybe, kind of. Our knowledge of how radiation causes cancer comes primarily from
Hiroshima and Nagasaki; we can follow survivors who were one mile, two miles, etc,
from the center of the blast, calculate how much radiation exposure they sustained, and
see how much cancer they got years later. But by the time we’re dealing with CAT scan
levels of radiation, cancer levels are so close to background that it’s hard to adjust for
possible confounders. So the first scientists to study the problem just drew a line
through their high-radiation data points and extended it to the low radiation levels - ie if
1 Sievert caused one thousand extra cancers, probably 1 milli-Sievert would cause one
extra cancer. This is called the Linear Dose No Threshold (LDNT) model, and has
become a subject of intense and acrimonious debate. Some people think that at some
very small dose, radiation stops being bad for you at all. Other people think maybe at
low enough doses radiation is good for you - see this claim that the atomic bomb
“elongated lifespan” in survivors far enough away from the blast. If this were true, CTs
probably wouldn’t increase cancer risk at all. I didn’t consider myself knowledgeable
enough to take a firm position, and I noticed eminent scientists on both sides, so I am
using the more cautious estimate here.
3 I told them I had an aunt who died of radiation-induced cancer. It’s true, but I feel
grubby for bringing her into this; I thought doctors would be more likely to listen to an
emotional story than cold logic.
4 EAs have been debating the exact effectiveness of kidney donations for a long time.
You can find good skeptical arguments by Jeff Kaufman and Derek Shiller, and good
arguments in favor by Alexander Berger and Tom Ash.
5 Outside of Philosophy 101 thought experiments, there’s a nonprofit that will often
reimburse you for lost wages from your donation.
6 Self-modifying into a person who can act boldly without social permission is a more
general solution and has many other advantages. But the long version involves living a
full life of accumulating moral wisdom, and the short version starts with removing
guardrails that are there for good reasons.
7 But here are some practical points you might not already appreciate:
You shouldn’t have to pay much money. If, like me, you need to travel (eg to New
York), kidney related charities will reimburse your travel costs (in theory, I haven’t
yet proven this, and a few costs were illegible and I decided not to submit them).
You shouldn’t have to lose too much money from work. Kidney-related charities
will pay for lost wages during recovery, again read the small print before trusting
this 100%.
 You don’t need to worry about not having a kidney when a friend or family member
needs one. When you donate, you can give the organ bank the names of up to five
friends or family members who you’re worried might end up in this situation. In
exchange for your donation, they will make sure those people get to the top of the
list if they ever need a transplant themselves.
95% of donors say if they could do it all over, they would donate again. My
impression is the most common reasons people wouldn’t is because they donated
to a family member and it made things awkward (not a problem for nondirected
donations), or because they learned that the recipient died from the procedure
and that was too depressing. I asked that I not be told how my recipient did - most
likely everything would go well, I was happy to keep assuming this, and more
information could only make things worse. This request didn’t get communicated
to the surgeon and he told me anyway - but luckily everything did go well.
8 What’s a kidney donation mentor? I still don’t really know: I was told that I was assigned
him as a mentor, and every so often he called me and asked if I was doing okay. I
appreciate it, but hope it didn’t take him away from more important work.
9 Kidney donation is a complicated and exhausting process, and I couldn’t have done it
without the help of many other people. Thanking them in no particular order:
My ex-girlfriend, who helped me figure out to ask for an MRI instead of a CT.
My wife, who was amazing through the whole process and didn’t freak out at all.
My parents, who freaked out somewhat less than they could have, all things
considered. My father in particular, for giving good medical advice during my
recovery.
My cousin Harvey and his wife Pam, who let me stay at their house on Long Island
while I recovered, and their son Will, for visiting me in the hospital.
My uncle Mark for a quick nephrology consult.
Clara Collier, Georgia Ray, Taymon Beal, and Sam Rosen, for various forms of
emotional support and offering to visit/stay with me in the hospital.
Elissa F, Miranda G, and especially Dylan Matthews, for talking to me about
altruistic kidney donation, providing social proof of its acceptability, and letting me
know the option existed. Probably there are other people in this category, sorry if I
forgot you.
Fellow psychiatrist and ACX reader Dr. Brown, who covered my patients while I was
away.
 Josh Morrison of WaitlistZero (now of 1DaySooner), who encouraged me and gave
me good advice.
The doctors, nurses, social workers, etc at Weill Cornell who did the actual work.
You were all great. Except the guy who said getting my catheter out “won’t be bad,
I promise”, I’m still mad at you.
The subset of doctors, nurses, social workers, etc at UCSF who were helpful
during the intake process there and weren’t responsible for their final decision not
to accept me.
Everyone who expected me to do things for them this past month and hasn’t made
a fuss about me being out of commission for a few weeks. That includes all of you
blog readers; sorry for the recent lack of articles. Normal business resumes next
week, situation permitting.

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267 Comments
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Chronological

Leah Libresco Sargeant Writes Other Feminisms 11 hrs ago

I’d love to know if other women have considered this and have better info on the risk of
being one kidney’d for future pregnancies. I know pregnancy taxes your kidneys more
than ordinary life, and since I have a history of miscarriage I’ve been reluctant to add
any new risks.
(I’m also curious if having one kidney means being risked out by eg a birthing center or
a midwifery practice).
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spiracular 7 hrs ago · edited 7 hrs ago
I think it's a fair consideration? At a skim this turns up:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747242/
They did note some pregnancy-associated risk increase post-donation, such as a
higher likelihood of fetal loss (19.2% vs. 11.3%), gestational diabetes (2.7% vs.
 0.7%), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and
preeclampsia (5.5% vs. 0.8%). Also, a lower likelihood of full-term deliveries
(73.7% vs. 84.6%).
These outcomes were more likely in people's post-donation pregnancies, than
their pre-donation pregnancies. Sounds like they tried to model age in, but they
admit that it is hard to be fully sure they factored out age effects. Kidney donation
screening seems to have meant the pre-donation baseline started out at better
than genpop, and they characterized the post-donation numbers as similar to
genpop and lower than individuals with kidney disease? Looks like a risk-increase,
though.
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malatela 6 hrs ago · edited 6 hrs ago
Now that I have two kids, I wouldn't actually do it.
One of my kids is disabled (autism) and even a tiny increased risk of death or
shortened lifespan is too risky for me, because he's probably going to need life
long support from me.
It's also reduced my donations to charity significantly for the same reason, I need
to save all the money I can for after I die because he's unlikely to be able to have a
job in the future.
In retrospect I should have skipped having kids entirely and done kidney donation
instead, but hindsight is 20/20.
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Stephen Pimentel 11 hrs ago
I believe that bodily integrity has a value in and of itself, independent of any utilitarian
calculation around whether you will need a particular organ. (I don't mean "integrity" in
some metaphorical sense. I mean it in the literal sense of keeping the physical
phenotype in accord with its basic genotypic design.) Obviously, there will be a
thousand and one exceptions in practice. (Fair warning: if you respond by giving me
examples of such exceptions, I will be extremely unimpressed.) Every time one gives
oneself a paper cut, one is violating bodily integrity in some small way. Of course. But I
try not to do that on purpose, except perhaps to treat some greater medical ailment.
If you insist on utilitarianism, I suppose you could justify my position with some kind of
rule-utilitarianism as opposed to act-utilitarianism. But I'm not a utilitarian at all.
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Scott Alexander 10 hrs ago Author
I guess I don't understand what it means to assert a strange moral rule that
there's no a priori reason to expect, admit that there are many exceptions where
it's not true and you can't explain why, then continue to assert that it's a moral
rule rather than a heuristic.
A: "I went to the park yesterday"
B: "What? You should never go to things beginning with P!"
A: "But don't people go to the port and the parlor and the palace all the time? And
you never object to that?"
B: "Yes, obviously there are a thousand and one exceptions in practice. But you
shouldn't go to the park. That's just how moral law works."
I don't know how you could possibly argue with B at this point, it just doesn't
seem like there's any positive reason to believe him.
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Sally Satel Writes Sally Satel 10 hrs ago
Keep your bodily integrity, if you must, and celebrate those who save lives in
real time in the real world! If Sam bankman Fried just gave a body part instead
of his soul, we’d all be better off
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Stephen Pimentel 9 hrs ago · edited 9 hrs ago
Is "keep one's body intact" really a "strange moral rule?"
Your story about "not going to places that begin with P" is the kind of story
I'd expect a utilitarian to tell. And yet, "keep my body intact" doesn't seem
anything at all to me like "don't go to places that begin with P."
Why might that be? Perhaps the utilitarian stories are constructed ––
designed? –– to filter out consideration of factors that cannot easily be
verbally articulated and weighed for calculation, on the assumption ––
undemonstrated and dubious! –– that such factors must be unimportant. But
it seems to me that such factors, especially in regard to matters of the body,
sex, and relations, might be very important indeed.
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Shankar Sivarajan Writes Shankar’s Newsletter 9 hrs ago ·
edited 9 hrs ago
To ward off annoying evangelical utilitarians, you just tell them that you
have a utility function different from theirs (I think that's actually just
true, even if you reject the label, but I might be using the term
idiosyncratically). They ought to know they can't argue with that.
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Stephen Pimentel 9 hrs ago
You're right –– but only in the trivial sense that any norm can be
reproduced by sculpting a custom utility function for it. I understand
that, but consider it an unhelpful exercise.
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Shankar Sivarajan Writes Shankar’s Newsletter 9 hrs ago ·
edited 8 hrs ago
Yeah, I agree: I don't think it's a useful exercise either. It's just
that "utilitarianism" is as meaningful a name of the doctrine as
"do-the-right-thing-ism," when it usually means something like
"maximize-the-total-global-QALYs-ism" which doesn't
correspond very closely to mine. (The alternative doctrines that
try to describe themselves without reference to to utility
functions strike me as either incoherent or downright evil, so
this kind of trivial description is the best I've got. The detail is
then in WHAT my utility function is, loyalty, honor, duty, etc.)
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Mr. Doolittle 48 mins ago
That's one of many reasons I don't consider myself a utilitarian.
You can game the system to come up with any outcome you
want, and it gives you the freedom to justify that. SBF probably
still feels justified, even with the outright fraud.
If you posit that there are more utils in murdering people, you
can justify that too. Maybe you're the Punisher, killing the worst
people that the law can't handle. Or you've done the math and
some people's lives just aren't worth living, so it's worth the hit
to your utils to save them.
I'm a deontologist, so I just say that murder is wrong.
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Seth Schoen 9 hrs ago

There's a complexity about that which is about comparison of utility
between people and aggregation of utility across populations.
Most kinds of utilitarianism say that you should aspire to maximize
total or average utility (or some variant of those meant to address
paradoxes and counterintuitive results), of "everyone". In that case
your different utility function would mean that *your personal
contribution* to total (or average or whatever) global utility would
 be weird or hard to predict, but that doesn't change the utilitarian
goal of trying to maximize something globally, nor the utilitarian
moral intuition that *you, too* should being trying to maximize
something globally!
(There's a whole set of criticisms of utilitarianism based on the
conceptual difficulties of how to compare or aggregate utilities
between different subjects-of-experience.)
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Xpym 4 hrs ago
This is called consequentialism-but-not-utilitarianism.
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MissingMinus 3 hrs ago
A more considering stance would recognize that humans don't have
complete degrees of freedom in their divergence in values, and so
while there can be a legitimate underlying value difference, it can be
exacerbated beyond the value it would have on reflection! So it can
still be worthwhile to talk over it.
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Martin 4 hrs ago · edited 4 hrs ago
"I want to keep my body intact because it feels right to me" is perfectly
fine and unsurprising.
"As a moral rule, one ought to keep one's body intact" is weird as hell
and you haven't even made an attempt to justify it. The only way I could
even imagine making an attempt to justify it would be through some form
of divine command theory... but if you think you have a decent
justification, I'm all ears.
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MissingMinus 3 hrs ago
> Perhaps the utilitarian stories are constructed –– designed? –– to filter
out consideration of factors that cannot easily be verbally articulated
and weighed for calculation, on the assumption –– undemonstrated and
dubious! –– that such factors must be unimportant.
There's a bunch of posts on the EffectiveAltruism forum and LessWrong
about considerations like these, acting like EA is just naive utilitarianism
is just a strawman imo.
 You can infact have a higher value for bodily integrity than others! It just
does actually seem like an odd value to settle on, especially when its
qualified with a bunch of exceptions, which is what Scott is getting at.
This is still compatible with consequentialism, and would just mean that
you have a higher personal-cost for certain kidney operations.
I agree that having my body altered is significant, but that's primarily due
to a combination of the unpleasantness, cost, and the possible problems
that come from it (Scott's description of how the surgery before and
after made my mind rate the cost for donating a kidney higher than I
thought it was from vague thoughts before the post). But also, while it
would be very uncomfortable to get a cybernetic eye that works better
than human eyes (once we have them), I'd still be very interested to get
them. It would just be worth the cost.
I think what Scott is getting at is that your form of bodily integrity value
is an odd sort of rule, that makes less sense than other rules that are
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Scott 15 mins ago
Yeah, maybe; how do you feel about blood donation?
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Scott 13 mins ago
Or lifting weights? Footraces? Tattoos? Haircuts?
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Theragra Chalcogramma Writes Cycling in the digital world 9 hrs ago
I am not sure I really follow. So you would deny LASIK, acl reconstruction, bariatric
surgery?
All of these are not strictly necessary, so I expect your logic says you should not
do them
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Stephen Pimentel 9 hrs ago
Those are all procedures that restore normal phenotypic function.
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Dauphin 9 hrs ago
I had LASIK to treat myopia, which was a phenotype caused by my
genotype.
 Genetics certainly play a role in obesity, and I wouldn't bet against
genetic predispositions towards torn ACLs (or at least predispositions
towards the foolhardy things we do to tear them).
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Stephen Pimentel 8 hrs ago · edited 8 hrs ago
I got evaluated for LASIK. (Sadly, I turned out not to be a good
candidate.) LASIK pretty straightforwardly restores a normal
function (seeing). It doesn't impinge on bodily integrity in the
functional sense I have in mind.
Sure, it ablates tissue at the micro level. You can press that point if
you like, but I'll consider it a kind of quibbling that doesn't interact
with my actual position. Ditto with similar examples of medical
repairs.
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Mark 7 hrs ago
Kidney donation restores someone else's normal phenotypic function.
Does that count for anything?
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Jerden 5 hrs ago
So does a kidney transplant! Not saying that you should value other
people's bodily integity as highly as your own, but presumably it should
factor into your decisions if it is indeed something of value? I'm not
saying anyone should do it, I'm still pondering it myself, but we come
back to weighing up the loss to you (both definite and potential) against
the gain to others.
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AB 7 hrs ago
If you don’t care whether others do it, and just regard organ donation as too
risky/dangerous to consider for yourself, isn’t that just a matter of personal risk
tolerance? Or would you advocate for shutting down voluntarily organ donation
programs and the like, and enforcing strict restrictions on various surgical
procedures?
I personally have very low risk tolerance for surgery (ex/ avoiding LASIK) but don’t
think there’s a generalizable *moral* principle there.
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 Calion Writes Substack Industrial Complex 7 hrs ago
So what *is* your justification for this belief?
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Jon Bradley 4 hrs ago
Did you ever trip and cut your knee at school? Bye bye bodily integrity...
I have a fair bit of metal in my body from motorbike accidents and some polymers
in my spine for other reasons.
Bodily integrity would seem to rule out even simple surgery or even something as
crucial as the removal of a ruptured appendix.
We're a bio mechanical machine, parts are removable and hot swappable, within
reason. I don't see any advantage to the pure state you are alluding to.
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The Ancient Geek Writes RationalityDoneRight 3 hrs ago
Neither deontology not utilitarianism would favour rules that are unenforceable.
"bodily integrity has a value in and of itself" sounds like something that would
guide decision making without being a rule.
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Leo Abstract 1 hr ago
There's something very interesting going on with this section of the concept
space. I can't quite puzzle it out. It's worthy of further consideration, but perhaps
of a style better suited to Sam Kriss than Scott Alexander.
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JohanL 1 hr ago · edited 1 hr ago
But _why_? Is it about outcomes? Sure, ”don’t do weird things to your body for no
reason” could be a fine heuristic, but the whole point here is that there _is_ a
reason. So that doesn’t seem to work.
But if it’s not about outcomes, what _is_ it. about? Aesthetics? Some unusual
theory of value where your bodily integrity is _inherntly_ valuable but the life of a
stranger isn’t? And how did you arrive at this highly unusual and ideosyncratic
moral system?
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Eleanor Konik Writes Obsidian Iceberg 11 hrs ago
I'm kinda surprised they prescribed Tylenol instead of Ibuprofen honestly. Anybody
know why they did? I had anaesthesia for a cortisone shot to help with postpartum
osteitis pubis, so no painkillers really needed, but I can't remember the last time a
doctor prescribed me Tylenol when I wasn't pregnant.
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Scott Alexander 11 hrs ago Author
NSAIDs acutely decrease kidney function, and people immediately post kidney
surgery don't have any to spare.
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Jeremiah Johnson Writes Infinite Scroll 4 hrs ago
I always tell people that the single way in which my life has changed post-
donation is that I now take acetaminophen instead of aspirin.
That's it. That's the whole list of things that changed about my life.
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Erica Rall 10 hrs ago

Also, ibuprofen is a mild blood thinner, and as such is probably not ideal for
someone recovering from surgery.
I was hospitalized a few years back for a possible brain bleed (head injury with an
ambiguous CT read), and I was specifically not given ibuprofen because of the
blood thinning effects. Between that and having an intolerance to Vicodin
(unknown whether of not this extends to other front-line opioids), they apparently
decided that my only two painkiller options were Tylenol or Fentanyl.
Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to
your brain by bypassing first-pass metabolism in the liver.
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magic9mushroom 10 hrs ago
>Fortunately, IV Tylenol is magical. Apparently, you can get a much higher
dose to your brain by bypassing first-pass metabolism in the liver.
Yes, I'd imagine so. For most drugs you can simply compensate by taking
more orally than you would IV, but if the liver gets too much paracetamol it
breaks it down wrongly and kills itself, so that's a non-option (hence the
warnings on all paracetamol packages to not do this). Hadn't actually
considered it before, but it makes perfect sense.
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Erica Rall 10 hrs ago
It also gave my the idea of buying the oral dissolving powder form of
Tylenol and taking it sublingually in hopes of getting similar effects. It
 isn't as dramatic as IV tylenol, but it does seem to kick in faster and work
at least a little better than swallowing pills.
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Chris Writes How to Commute 9 hrs ago
I'll be expanding my at-home medkit with that, thank you. I never
knew that existed. It makes sense, just never crossed my mind.
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Shabby Tigers 2 hrs ago
It depends. Ibuprofen is routinely used for post-op pain where the surgical
procedure is not associated with any specially elevated bleeding risk.
Possible brain bleed is very much the opposite situation!
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Matt 11 hrs ago
Reading about all these studies reminds me of this classic SSC post
https://slatestarcodex.com/2017/08/29/my-irb-nightmare/ and the thought I had while
reading it - why aren't there places that make medical research more frictionless in
order to benefit (somehow) from everyone being incentivized to do their research
there? You know, like the Delaware or Switzerland of medical research? Could some
similar kind of clustering benefit organ donation as well as the attendant research? I'm
sure there's a reason why this doesn't happen, but what is it?
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Scott Alexander 11 hrs ago Author
Partly this is because most medical research is done with an eye to eventually
pleasing regulators in a specific country, and those regulators want the studies to
be done in their country by their rules. For example, to get a drug approved by the
FDA, you need to show them studies done in America.
Some people advocate testing a drug in another country to see if it really works,
and then, if it does, doing the study in the USA to please the FDA. The advantage
there is that if it doesn't work, you can avoid the expensive US trial entirely.
But another reason is normal human and systematic limitations. If you are an
ordinary medicine professor at (let's say) Harvard, and you want to know whether
some heart thing you do in the hospital every day is beneficial or not, you
probably don't have the money or capacity to get someone in China to study it on
a Chinese population. You might just want to study the thing you're doing, in your
own hospital, to see if it works, and then write the paper yourself.
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 Shabby Tigers 10 hrs ago
To this topic, it’s worth checking this out when you have a minute and
sufficient energy to get angry about the kafkaesque inefficiency of US clinical
trials recruitment. https://open.substack.com/pub/bessstillman/p/please-be-
dying-but-not-too-quickly
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Sammy G. 11 hrs ago
My Goodness! I found this quite moving and overwhelming. Nothing but love for this
man.
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Jason 11 hrs ago
Even if one thought UCSF's screening criteria were reasonable, they sound badly out
of order. If a history of childhood mental illness is potentially disqualifying in their eyes,
they need to ask about that history very early in the process and not proceed with CT
scans (for most), nuclear kidney scans, or even time-consuming and expensive
investigations until they decide if that history is a dealbreaker for them. Asking a
candidate donor to incur risk, meaningful expense, and/or serious inconvenience
before addressing disqualifiers like this just isn't respectful.
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Scott Alexander 10 hrs ago Author
I've been thinking about this. Their current method is "do all tests, including psych
tests and radiologic tests", then "convene committee to see if any tests are
disqualifying". You could imagine a two-step process, where they convene the
committee once for the psych tests, then a second time after all tests. I'm nervous
demanding this because I imagine it makes things more expensive and longer for
everyone to catch a tiny number of people in this situation.
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Mr. Doolittle 39 mins ago
Perhaps they could develop a system where anything potentially disqualifying
gets flagged before they continue the testing. At the testing level that could
be a checklist, which isn't good, but then they could convene the committee
or a smaller sub-committee to evaluate.
It really doesn't make sense for them or especially the donor to go through a
bunch of other tests if they can tell that the person is going to be disqualified
earlier.
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anon 11 hrs ago
This reinvigorated my desire to donate a kidney, thanks Scott.
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Scott Alexander 10 hrs ago Author
Good luck!
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AJKamper 11 hrs ago

I'm very happy for you, and completely unable to evaluate this rationally because a
friend of mine died donating her kidney to her dying husband.
If you asked her in the afterlife, she'd probably be OK with the choice, but the
incredible guilt that her husband felt afterwards is almost unimaginable.
Once again, I am being irrational and this should not dissuade anyone else; I merely
was triggered to share my story.
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Scott Alexander 10 hrs ago Author
I'm sorry to hear that. You're under no obligation to give details, but my model
expected this to be pretty rare, so I'm interested in hearing any details you feel
okay providing.
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The Lone Ranger 29 mins ago
Yeah this is what I was thinking the whole time reading this article. Like, great, you
have a bunch of studies and stuff (you know, the things that are constantly being
dinged here for being full of fraud or just plain old incompetent) telling me that
having my body cut open and removing an organ I'm using isn't a problem.
And I don't believe them. Sorry, but generally speaking if I have a thing, it's
because it evolved to be there despite the costs of growing it (modulo the
appendix?).
That's why people don't donate kidneys unless it's to their family. It's clearly risky.
A bunch of discredited health people saying it's not risky isn't gonna change that
- COVID showed clearly that they are the sort of people who will lie at the drop of
a hat if they think it'll make people behave in ways that are somehow more "pro
social" regardless of actual risk.
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Ivan Fyodorovich 10 hrs ago

Congratulations Scott! I became a non-directed donor 14 years ago. I was inspired by a
New Yorker article by Larissa MacFarquhar, you may decide whether that's better or
worse than Vox.
In addition to the very obvious benefits to the recipient, who is still doing well, I think
donating helped me solidify my adult identity. Not in any public way, no one in my
current city of residence even knows except my wife and whoever has read my medical
file. My experience is that much as the rite of circumcision is meant to bind us Talmud-
readers to God, kidney donation binds one to principles of altruism in a way no amount
of donated money ever will. Even as I've gotten older and less idealistic, I remind
myself that I am a man who once donated a kidney, that I should never let my character
stray too far from that of the younger man who was capable of such things. No regrets.
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degrews 1 hr ago
I find that very compelling and inspiring. Thank you for sharing it.
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Erica Rall 10 hrs ago · edited 10 hrs ago
>a ritual called “therapy” could absolve one of this impurity
When I read this section, I had the following thoughts in rapid succession:
- As a psychiatrist yourself, you are qualified to perform therapy. And you do mention
that OCD is one of the conditions you treat in your patients.
- So could you do therapy on yourself? It would certainly be simpler and more
convenient than going to a non-self therapist. Probably not as effective if you actually
had an active problem you needed help with, but it seems more than adequate for an
exercise in warding off evil spirits.
- Autotherapy could defensibly be described as "talking to yourself", which put that
way is usually considered a sign of not being sane.
- So for mental health professionals who are qualified to perform therapy, does talking
to yourself make you more sane, less sane, or have no net effect?
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Seth Schoen 10 hrs ago
There is a minor psychoanalytic tradition of "autoanalysis" or "self-analysis" but I
don't think it gained that much support from most theorists, although it seems like
it's not particularly impossible that it could be very helpful to some people. (After
all, apparently you can make pretty consequential changes in your own mind in
other ways, like meditation practices.)
I kind of doubt that the panel would have accepted anything like "I promise to
perform therapy on myself to treat my OCD, if necessary" or "I promise that, as a
psychiatrist, I would not currently diagnose myself with OCD". :-(
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JQXVN Writes JQXVN’s Substack 10 hrs ago
The effectiveness of autotherapy would heavily depend on the approach--anyone
can do a workbook on their own, for example. Some people, professionals and lay,
have a lot of discipline and insight and can do this kind of thing very well
independently. But not all people, and not for all problems. In some approaches
the relationship with the therapist is a functional part of the technique, which can't
be replicated alone. Being a mental health professional likely aids a personal quest
for better mental health but the physician cannot always heal thyself. In medicine
self-practice is at best frowned upon and at worst disallowed, for reasons that
also apply to autotherapy. It's difficult to be objective, it's easy to take advantages
that hurt you in the long run.
Talking to yourself is not inherently pathological. While "taking to yourself"
conures up an image of someone walking around in public muttering to the voices
in their head (and that's obviously not a good sign when it does occur) most self-
talk is just a way of augmenting thought, with no ill implications.
(Sorry, I know it's kind of a joke, I can't help myself sometimes.)
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Jon Bradley 4 hrs ago
I think if you switch chairs during a self therapy session that implies a degree
of objectivity 🤓
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Michael Watts 9 hrs ago

> Autotherapy could defensibly be described as "talking to yourself", which put
that way is usually considered a sign of not being sane.
By who? Talking to yourself is something everyone does all the time. It's widely
depicted in popular TV shows as being completely normal behavior. (And in this
case, the TV shows are correct.)
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Erica Rall 8 hrs ago
I'm being facetious. The joke is that "talking to yourself" in the literal sense is
a common and usually harmless and occasionally beneficial behavior, but the
same phrase is also often used as a shorthand for specific behaviors
 symptomatic of schizophrenia: either disordered ramblings directed at
nobody in particular or conversations held where the other party is the
product of delusions.
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John R Ramsden 5 hrs ago
On reading that Scott was turned down for kidney donation on account of having
had mild OCD in the past, my first thought was amazement that something
apparently so unrelated could be a factor in their decision. He may as well have
been rejected for once having an ingrowing toenail!
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Jon Bradley 4 hrs ago
Could you not also attend a Zen retreat for ten days of non-Self therapy?
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garymar 3 hrs ago
That would be a Theravada therapy session. Zen would be a "True Self"
therapy session.
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Bench Writes Bean Sprugget's blog 10 hrs ago
What was the radiation risk from a "nuclear kidney scan"?
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Scott Alexander 10 hrs ago Author
Almost zero, surprisingly!
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Seth Schoen 10 hrs ago · edited 10 hrs ago
It's amazing how much radiation dose you get from a CT.
https://xkcd.com/radiation/
I guess the issue is that the radioactive dye in the scan is very specifically
absorbed by the kidneys (whereas the CT is just kind of "throwing X-rays at
all the tissue and seeing what bounces off"), and also that the nuclear kidney
scan is essentially 2-D while the CT is 3-D?
According to
https://www.ncbi.nlm.nih.gov/books/NBK562236/
the dose from the nuclear kidney scan can be on the order of 1/10 that of a
CT scan, so it might not be appropriate to think of it as totally negligible,
 unless they're talking about a slightly different procedure.
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Bhavin Jankharia Writes Man From Matunga 10 hrs ago
The radiation cancer risk argument is just wrong. This is from modelling studies not
from prospective or retrospective studies. After 127 years of X-ray use there is not one
study in adults that has shown increased risk. The low no-threshold LNT theory makes
no sense and even if it were true it should be proven in a longitudinal studies.
Radiologists and others who work with radiation despite protection would have
increased risk of cancer because there is always some radiation absorbed. There has
been no extra risk reported except in the early days when they did not understand risk
of high doses.
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Scott Alexander 10 hrs ago Author
X-rays are 1/300th the radiation level we're talking about here, so not comparable.
I don't think anyone has been irradiated by CT scans enough to empirically
discredit LNT, but I'm interested in seeing any studies you might have available.
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Andrew Clough 55 mins ago
We've also done a lot of experiments in fruit flies to demonstrate that radiation
effects on health are non-linear in them as well. But nobody knows where they
start to go non-linear in humans and the dreaded bioethicists would surely
prevent any good experiments determining that. So in the absence of good data
we must make do with the simple rule we know is wrong for legal limits etc.
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JQXVN Writes JQXVN’s Substack 10 hrs ago

I've wished I could do this for years, but thanks to a life-saving, kidney-wrecking
medication I'll be on in perpetuity both of my kidneys will be needed by me. I saw the
headline "my left kidney," correctly guessed the topic, and immediately started
sputtering about my own bad luck. Congratulations Scott, I am happy for you, your
donor, and to see this issue publicized in a forum where I'm sure it'll get traction.
Happy, and a little jealous.
Of course now I'm sitting here stewing on whether I'm a really a 200-in-a-few-
hundred-millioner who would really go through with it or just a 25%-er with a fond
intent and a pat excuse. It does feel like the easy, obviously correct choice--a life you
can save that will be practically right in front of you--but now I'm very suspicious of
this little fantasy and the role it plays in my psyche, with no skin (er, organ) in the
game...
(If anyone else is worried they just have a hero complex and their heart isn't entirely in
the right place, don't let that deter you from putting your kidney in another one. We all
appraise ourselves in creative ways.)
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Finn 10 hrs ago
How do they(or can you decide?) choose which kidney they take from you?
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Scott Alexander 10 hrs ago Author
Unless tests reveal some unusual asymmetry, they take whichever one has longer
blood vessels that are easier to manipulate surgically, which is almost always the
left.
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uncivilizedengineer 9 hrs ago
How does it feel knowing that your evil kidney is likely now directing some
poor stranger to turn to the dark side? The writer that you are, that kidney
may be too persuasive for them to resist...
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Anonymous Dude 9 hrs ago
https://en.wikipedia.org/wiki/Body_Parts_(film)
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BRetty 10 hrs ago

My immediate reaction to the apparent mystery of : "25-50% of Americans say they
*would* donate a kidney to somebody in need..."
I think those 25-50% are thinking of a scenario somewhere in between
-rushing to pull people out of a sudden immediate fiery car crash right in front of them
- donating or volunteering in a natural disaster
- John Cleese showing up at their door asking, "Could we have your kidney, then?
Won't be much trouble for you."
When the choice or opportunity is suddenly presented, and following through is
relatively simple, logistically, people and Americans in particular have almost no limits
or thought of risk/cost. In the scenario of a crash/wreck I am sure 95% of people would
risk their life for a total stranger without a moment's thought.
The barrier to high leverage humanitarian intervention is not courage or selfishness but
attention span. Even you, a person who thinks and cares about doing good, who
inspires others to likewise try to improve the world, and an MD with major cheat codes
for Health Care and Medical melee combat, you were discouraged and almost gave up.
Until a Mysterious Mentor suggested a Surprise Approach, One Weird Trick of trying
another donation pathway, tvtropes etc.
Leaders can be described as getting people to do good stuff they should do anyway.
Personally, I always tell people that when thry ask somebody for a favor, make it *AS
EASY AS POSSIBLE* for that person to help you. The path to better more effective
Altruism, and government as well, should keep those things in mind.
BRetty
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Moon Moth 10 hrs ago
Congratulations!
> And it encourages people to be masochists,
And sadists! Suffering is a sign of virtue, so therefore by making people suffer one can
increase the amount of virtue in the world. Just look at all those stories of people who
went through adversity and came out better. Who wouldn't want to have moral
justification? Any reluctance on their part is simply akrasia. (Or at least, that's what my
PTSD says.)
> Would, if what?
Quite possibly, if my life were more together. But thanks for writing all this.
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Anonymous Dude 9 hrs ago
Just find a nearby munch.
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Gunflint 10 hrs ago

I am duly impressed.
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toolate 10 hrs ago
My one friend who did this feels like it was the most significant event in his life. And he
has lived a very full life.
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Desertopa 10 hrs ago
I've been torn about the prospect of donating a kidney for over fifteen years. On the
one hand, I see it as a really worthy form of altruism, and I recognize that in absolute
terms the risks are quite small. On the other hand, I'm quite vulnerable to anxious
intrusive thoughts, and the anxiety of having only one kidney, when evolution saw fit to
equip me with a spare, feels like the sort of thing which would genuinely weigh on my
sense of well-being for the rest of my life.
Do you think you might be open to a literature dive on the pros and cons of donating
regenerable organs and tissues, like liver or bone marrow?
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Scott Alexander 10 hrs ago Author
Maybe!
Anxious intrusive thoughts about only having one organ were a concern for me
too. I tried telling myself I would do some healthy things (stop adding salt to food,
go to the doctor more often) that would probably make up for it, and that sort of
helped. So far I haven't felt too anxious-intrusive-thought about it, but partly
that's because I'm still in the more acute kidney failure stage of recovery where
I'm expected to feel bad, and I don't really know what the future will bring there.
Ask me in a year.
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Mosiah Writes Incense.d 8 hrs ago
Cutting salt indefinitely sounds more masochistic to me than a one-time
surgery!
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Deiseach 1 hr ago
I know there's a renal diet for people with kidney disease/on dialysis (mainly
be very careful with potassium and if you eat potatoes, you have to twice-boil
them which reduces them to a mush that is difficult to eat so you may as well
cut them out altogether).
Seems there is a diet for kidney donors; moderate protein, reduce salt intake,
be careful with supplements:
https://www.ohsu.edu/sites/default/files/2019-
06/Healthy%20Eating%20After%20Kidney%20Donation%2004-25-2019.pdf
https://www.jrnjournal.org/article/S1051-2276(13)00211-2/fulltext
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Crimson Wool 2 hrs ago

 I looked into liver donation after getting denied for kidney donation and the risk is
way, way the fuck higher. Something like 1% fatality risk in the immediate
aftermath. I was comfortable accepting "twelve hour drive" risks to save
somebody's, or multiple somebody's, lives, but not "die at any point in the next
year or two" risks. If you do survive without issues, your liver returns to full
function.
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Some Guy Writes Extelligence 10 hrs ago
I did some sort of thing where I gave my dna via cotton swab to some charity and said
email or call me if anyone needs something I’ve got. It seemed legit, but no one has
ever contacted me. And I assume my superior Slavic-Irish-Norwegian ancestry would
greatly enhance a normal mortal life.
Asking because I suppose this group would know: Is that in fact a real thing? Or did I
give my DNA to skynet? I swear I got it from a flier at a hospital.
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Seth Schoen 9 hrs ago
I think that's probably about bone marrow?
Maybe they don't actually share DNA information about different kinds of
prospective tissue donations? (which I guess would be kind of wasteful, if not)
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demost_ 3 hrs ago
As Seth said, bone marrow data bases work like this. For a bone marrow
transplantation, you have to screen millions of people to find a match. So they
build huge databases (for example 7 millions just in Germany, ~10% of the
population), and only contact you if you are a match for someone in need. The
chance of ever being contacted is less than 1%, but the system only works
because of the huge DNA databases.
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Eremolalos Writes Inkbowl 10 hrs ago

Scott, have you thought about meeting the person who got your kidney? Of course it
might be awkward, meeting a stranger whose life you saved, and you two may be so
different that you're each incapable of comprehending the other's take on life. And yet
you had a meeting of the minds and kidneys when it comes to saving the person's life.
I'd want to shake their hand or hug them and say, "I hope that kidney makes possible
all kinds of wonderful things in your life" -- or something like that. Maybe just "enjoy
the hell out of that kidney."
There's something about direct giving to strangers that feels utterly different from EA.
It's profoundly satisfying, and makes you want to give *more.*. Maybe the way to think
of it is as a spiritual practice, one that people practicing EA need to do to stay in touch
with the point of helping others?
Anyhow, bless you, Scott. And if it would make you feel any better about the Uber
incident, I'd be willing to piss myself in an Uber for you.
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E1 9 hrs ago
I took the liberty of looking up Scott's recipient. He's a real stickler on an IRB and
eats an all-meat diet.
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Biff Wiss 9 hrs ago
Yeah, I looked him up too. You'd think a writer for the New York Times would
have been trickier to track down, sheesh!
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Eremolalos Writes Inkbowl 9 hrs ago · edited 9 hrs ago
But why be sure they'd loathe each other even under ordinary
circumstances? Scott himself could be called a real stickler by some, and
they'd have a point. In the most recent open thread I showed some people
Scott's kind-true-necessary, 2 out of 3, guidelines, and the people had a low
opinion of them -- saw them as suppressing free speech, suppressing
justifiable expressions of rage at various actors in the Palestinian-Isaeli
situation, so vague that any judgment could be defended, etc etc. And is
what people eat really such a big deal? Anyhow, even if Scott and Stickler
would have loathed each other in other circumstances, having a moment of
intense shared emotion is all the more special then. And I'm guessing that
even most meat-eating sticklers aren't so hard-boiled that they are not
moved by someone having saved their life.
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Eremolalos Writes Inkbowl 8 hrs ago
Where do you look such things up?
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Jo 8 hrs ago
Almost certain both of those people were joking, implying Scott's Kidney
went to someone he wouldn't like and who makes the world worse, in a
sort of "accidentally saving baby Hitler" scenario.
 There's probably no way *you* could look up Scott's Kidney recipient,
for medical privacy reasons (Scott might be able to, not sure).
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Eremolalos Writes Inkbowl 7 hrs ago
Oh -- duh, of course.
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Jon Bradley 4 hrs ago
Dudewheresmykidney.net
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Melvin 10 hrs ago
So there's a 1 in 10,000 chance of dying during the actual surgery, but there's a 1-2%
chance that you'll develop kidney disease later on in your remaining kidney and think
"boy, I sure wish I still had that extra kidney right now". BUT, you'll be put at the top of
the list for the next kidney. BUT, kidney recipients typically only live an extra 5-7 years
anyway. BUT, under these kidney disease circumstances you might not have been okay
with a second kidney anyway. Nonetheless, your chances of dying due to kidney
donation seem to be higher than 1/10,000 due to the whole lack of redundancy thing,
probably very much greater than the 1/660 risk you were concerned about.
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Scott Alexander 10 hrs ago Author
"Dying" isn't a very good binary variable. I think there's a 2% chance you'll die six
months earlier than you would have otherwise, but multiply that out and it loses
you 1.2 days of life. Dying during the surgery seemed important to me because it
loses you a lot of life as opposed to shaving off the very end when you have no
GFR left anyway.
Doing this properly would involve how many DALYS you expect to lose. I think I
looked at someone's calculation and it was in the range of a few weeks, probably
so much that the variation in length of your recovery period is bigger than the
amount contributed by early death or early disability considerations. I think the
Tom Ash post I linked might have those numbers on it, although I might be
misremembering.
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Edmund 3 hrs ago
Okay but this is all "present rate no singularity", yeah? If you have a
reasonably high probability of a good singularity, then dying a couple of years
 early in the coming decade might lose you many, many more highly enjoyable
years than a naive approximation would suggest.
(IIRC from your old cryonics post you don't care *that* much about your
mortality as distinct from suffering? Which, fair enough. But I would assume
that most people worried about life expectancy post-surgery are not like this,
so it feels worth mentioning.)
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Yuri Niyazov 10 hrs ago · edited 10 hrs ago
the “UCSF lost to waking up in an ice bath” chart is absolute gold. Hadn’t laughed so
hard this entire week. Who said this community can’t do humor?
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Shankar Sivarajan Writes Shankar’s Newsletter 10 hrs ago
The bit about how you can get five other people get bumped to the top of the list if
they ever need it is a REALLY convincing point. I didn't know that: I heard about how
you personally get bumped up the list, but that's the bare minimum, not a good deal.
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spiracular 9 hrs ago
Worth noting that this is not very gamable, and they make it really clear that the
set of you share a priority-claim on up to 1 kidney. From the look of things, once
someone uses it, the others do not have the priority mark anymore.
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Shankar Sivarajan Writes Shankar’s Newsletter 8 hrs ago
Thanks for pointing this out. Then it's a non-obvious tradeoff between a
larger list of people you care about to whose kidneys yours are compatible,
and a smaller list (five people) which could include incompatible people.
That's … decidedly less convincing now.
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Joshua King 10 hrs ago

I suppose "Inside you there are two kidneys" is more accurate than having wolves
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Shaked Koplewitz Writes shakeddown 10 hrs ago
Re the people who say they would donate a kidney to help a stranger:
I think most people answering the survey question are imagining a case where they're
uniquely morally responsible for it in some way, in which case they'd do it.
Going by your numbers, the actual number of undirected kidney donations required to
plug the gap is about 0.01% of people per year. So IRL people are probably morally
responsible for about 0.01% of a kidney donation per year (probably more in practice
because some people can't or wouldn't donate, let's say 0.04% for safety), and going
beyond that is superegatory.
I'm on the list of people who'd answer "no" on the kidney donation question (I do feel
bad about it). But I would sign up for the service that picks 0.04% of people who sign
up at random each year to donate, if it solved the kidney shortage. I wonder how
universal this is.
(This does raise the question of why I don't just make my own service by throwing a
random number generator from 1 to 10,000 and donating if I get under 4. I did do this
before posting and got 5,143, so that's my new excuse for not donating. But I don't
know if j would have gone through with it if I actually had gotten a number under 4, so I
don't feel great about it).
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Alastair Williams Writes The Quantum Cat 3 hrs ago
I got 7127, so I suppose I am also excused!
Your comment got me thinking - I would probably also sign up for such a list, if it
existed and - I think this is important - if a lot of other people also signed up, so
that my odds of donating were "fair".
But then it occured to me that something similar already happened in the UK. A
few years ago we switched from opt-in organ donation to opt-out. Essentially that
means that if you die, you are now assumed to consent to organ donation unless
you explicitly said you don't consent.
In a way that is similar to drawing lots, since we can assume I have some chance
of dying randomly in the next year and some chance that my organs are suitable
for donation. I am not sure that enough people die in the right way to fill the gap,
but I suppose it should do something (especially as each suitable person would be
able to donate both their now unused kidneys, plus other organs like hearts, lungs
and livers).
Unfortunately I can't find much saying it has really had an effect. Partly that
seems to be because it was introduced just before covid, which has muddied the
numbers. In essence, though, the number of people on organ waiting lists seems
to be pretty much unchanged or even slightly higher.
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demost_ 3 hrs ago
 The difference between opt-in and opt-out is notable, but does not change
the order of magnitude, unfortunately. Looking at different countries who
changed one way or the other, the number of donations may increase by 30-
40%. (Less if relatives still have veto rights, which they do in some countries.)
In practice, most donors are young people who die in accidents, like bikers.
Most of them haven't declared their will, so usually relatives are asked to find
out their will. In most countries it boils down more or less to the same
decision for the relatives, regardless whether it's opt-in or opt-out.
30% more makes a difference! The supply is not THAT much smaller than
demand. But it is still not enough to get enough organs. The number of
people whose organs can be used (who die young from accidents) is just
small, and the number of people who would need organs is pretty high.
A thorough literature review with in-depth discussion for Italy, France, Wales,
Greece, Chile and Singapur is here (in German, so you need an auto-
translator)
https://www.bag.admin.ch/dam/bag/de/dokumente/biomed/transplantationsm
edizin/literaturbeurteilung-einfluss-von-zustimmungsmodellen-
spenderegistern-und-angeh%C3%B6rigen-entscheid-auf-
Organspenden.pdf.download.pdf/Literaturbeurteilung-Zustimmungsmodelle-
Organspende.pdf
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demost_ 3 hrs ago
I am also on the list of people who'd answer "no". But on the other hand, I did
register for bone marrow transplantation. There they screen huge databases for
the best match, and you are only contacted if you are a best mathc. Which
happens for less than 1% of registered potential donors.
This system works very well. If you are contacted and told that they particularly
need your bone marrow because there is this one person who needs it, then I do
believe that many people would say yes. Perhaps the 25-50% who answer yes in
the surveys.
In principle, this could also work for kidneys. Build a huge data base, for each
patient try to find the best donor, and ask them whether they would help this
particular patient, because their help would work better than anyone else's.
It's almost a shame that kidneys are compatible between so many different
people. Because that might be the main reason why the solution doesn't work.
(Even if chosen, you are not really a much better pick than many other people.) So
the ethical pressure is diluted. We might have much less trouble to find kidney
donors if they weren't so widely compatible.
 Or the solution does work, and we just need to try it.
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Shankar Sivarajan Writes Shankar’s Newsletter 10 hrs ago · edited 10 hrs ago
How old is too old to do this? (As in, at what age will they refuse to take your kidney?)
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Scott Alexander 10 hrs ago · edited 10 hrs ago Author
I don't think there is an official age, and it probably depends on your health, but I
think being older than 50 probably changes the risk calculus to a point where I
would be reluctant to do it, though this is just a gut feeling and I haven't looked
into it too hard.
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Shankar Sivarajan Writes Shankar’s Newsletter 10 hrs ago
Yeah, I guess I was wondering if this is a good way to effectively buy kidney
insurance for the family. I think it might be.
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David Khoo 10 hrs ago

Was there really a need to tell the whole world about the good deed you have done?
Performing good deeds for social affirmation is generally considered to detract from
the goodness of the deeds. Yes, I do understand that your intent is to encourage more
performance of such deeds. But conventionally, performing good deeds for external
rewards like social approval or money is considered suspicious, for some poor reasons
(like the masochism you mention) but also the tendency toward self-deception and
institutional corruption by those rewards.
This directly ties into the castle thing. Perhaps it's true that the castle actually would
encourage more good deeds be done. However, it's also true that if you start talking
yourself into buying comfy castles that actually do good, it becomes easier to talk or
trick yourself into comfy things that don't do good, and you start to attract people into
your organisation who will talk you into buying comfy things because they are solely
into comfy and not good deeds at all. We can try to be less wrong here, but can we be
sufficiently less wrong that this risk is worth running?
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E1 10 hrs ago · edited 10 hrs ago
Yup!
Edit: the "Yup!" applies only to your question at the end; I disagree with the
general thrust of what you're saying.
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Scott Alexander 10 hrs ago · edited 9 hrs ago Author
I think yes, for a few reasons:
1. If you tell other people about your good deeds, you feel good and get benefit
from them, which is an incentive. People do things that are incentivized more
often than they do things that aren't incentivized.
2. Normalizing donation, as above.
3. Realistically a bunch of people were speculating about where I was (see eg
https://www.astralcodexten.com/p/open-thread-299/comment/42439504 and
https://www.astralcodexten.com/p/open-thread-299/comment/42504375 ) and it
would seem weird to lie to them.
The castle thing seems like the opposite of people being corrupted by social
approval; they did a genuinely good thing even though they knew everyone would
hate them for it. I have immense respect for that. I agree that if (unlike them, but
like me) you do something that you could get social approval for, you have to
resist becoming a social approval slut rather than being focused on what's really
good, but I think it trades off against other considerations. And I think that if you
think about that *too* much, then at some level you start becoming an actual
masochist who is optimizing for your own suffering rather than make anyone
better (Should I help this orphan? No, I would enjoy seeing the smile on his face.
Better whack myself in the head with a cactus instead!) and that the point where I
worried about posting this for those considerations would cross that line.
I try to discuss these issues more at https://www.astralcodexten.com/p/the-
prophet-and-caesars-wife . I feel like there's an old (Robin Hanson?) post
promoting being public about your altruism, but I can't find it now.
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Xpym 3 hrs ago · edited 3 hrs ago
I'm finally reading Elephant in the Brain, which unsurprisingly is very
fascinating, but the most fascinating thing so far is that 95% of (monetary)
donations people make is due to solicitation (as opposed to unprompted
decision). For organ donations the percentage would likely be even higher,
and a respected public figure leading by example is up there in terms of
effective mass solicitation.
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Vaclav 1 hr ago
This is an impressively calm and polite response to an infuriating comment. If
I were in your position I would probably be banning myself from my own blog
 right now.
Congratulations on making such a big (& effective) altruistic sacrifice. Any
warm fuzzies & reputational benefits you get from this are very well
deserved!
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Sabiola 36 mins ago
Hear, hear!
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Deiseach 1 hr ago
I'm fairly sure that in a couple of years time they're going to end up selling the
castle because they'll find that they're not using it as much as they expected,
and the upkeep costs are way more than they imagined.
This doesn't mean they are not good people, nor am I saying they are not.
Just that the castle decision is not a good one.
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Shankar Sivarajan Writes Shankar’s Newsletter 10 hrs ago
Are you worried about people lying about donating kidneys to appear virtuous? Or
being peer-pressured into donating kidneys when they don't really want to?
Neither of these seem likely.
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YDYDY Writes YDYDY (youtube.com/@YDYDY) 4 hrs ago · edited 4 hrs ago
If you're virtuous, people *ought* to know it. Transparency existed in
(paleolithic/metaphoric) Eden. We abhor it today because we don't trust
others to follow suit and therefore fear society judging us uniquely anti-
virtuous, thereupon becoming subject to the tender ministrations for which
the mob is so rightly famous. The consolation of such correctives being
administered in the news and courthouses rather than on your doorstep fails
to assuage the perturbations of most minds.
But a standard of openness? Why that would be lovely. And it might just help
us choose the right people for leadership too.
On a personal note, I consider it a moral virtue to share about myself that I
donated two kidneys and also that despite lacking the normal executive skills
of even your average 10 year old, I managed against seemingly
insurmountable odds to save the life of an old man who was being tortured to
death in Chechnya.
 EDIT: I did not actually donate any kidneys. The most I did in this regard was
speak about Zell Krivinsky for 3 days straight on my radio show after after he
donated his own kidney.
But yeah, in an improved society we would definitely be taking into account
the red's "needs and abilities" thing, and thus through public discussion
come up with a means for resolving (among other things) the distribution of
kidneys.
Ideally we'dcomment
Expand full manage it with a lot less force and at least a touch less gulag.
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Moon Moth 9 hrs ago
But if even if you tell no one, you'll still know yourself, and it will affect your future
behavior. This is the missing factor that causes the "ice bath" solution to rise to a
score of 3, tying with the Weill center. By having charitable deeds thrust upon
them, the donor can remain uncorrupted by virtue.
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Shankar Sivarajan Writes Shankar’s Newsletter 8 hrs ago
Taking this further, the truly noble thing to do is to donate other people's
kidneys against their will.
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Eremolalos Writes Inkbowl 7 hrs ago · edited 7 hrs ago
And even nobler would be to force yourself, against your own will, to
shudderingly harvest other people's kidneys and donate them to save
people whom you'd rather be trolling.
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Moon Moth 7 hrs ago
Or even better, blackmail or take hostages to get someone else to
do the unwilling harvesting! We can keep adding extra layers of
rabbinic fences to protect us from the horror of altruism.
Come to think of it, this is probably how a D&D Lawful Evil society
arranges to do things that are socially useful but which also count
as "Good".
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YDYDY Writes YDYDY (youtube.com/@YDYDY) 4 hrs ago ·
edited 4 hrs ago
Heros have been doing this for a while.
 https://youtu.be/D_5nLxZVoPo?feature=shared
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Deiseach 1 hr ago
Isn't that the same kind of ethical dilemma as the trolley problem - the
surgeon who can kill one patient to save five others, or however it goes?
If it's the superior choice to pull the switch on the trolley, then becoming
a surgeon so you can harvest organs from non-consenting (because you
never asked them, because if you asked they might refuse) donors is
also the superior choice!
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Eremolalos Writes Inkbowl 7 hrs ago · edited 7 hrs ago
Hey David Khoop, does the same go for mean-spirited gotchas? I mean, isn't it
more dignified and pure to hit the recipient with them in private? If you do them on
a forum like this, there's a danger you'll slide into looking for an angle to gotcha
from just for the pleasure of being seen biting somebody's butt in public.
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Deiseach 1 hr ago
Was there really a need to tell the whole world you are a human faceache?
People were wondering even last night as to where Scott was or what he was
doing. Now he's told us. And he's told us about how to go about donating a kidney
if we want to do so.
This is not the charity of the Pharisees, this is informing us about the need for
organ donations and the way to go about it, and the likely obstacles in your way.
This is not "look at me, how virtuous I am" - which, by the way, is how *you* come
across; "I would *never* tell anyone about my good deeds, amn't I so special?"
Like the apostles complaining about the ointment that could have been sold and
the money given to the poor, yeah, you're so specially good.
Buying a castle is self-serving. Donating a kidney is not.
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Doug S. 10 hrs ago
My wife is in kidney failure and is on dialysis. We have the same blood type, and when
she becomes eligible for a transplant (she currently has other conditions that make her
ineligible in the United States), I intend to offer one of mine, assuming I'm qualified to
donate.
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 Scott Alexander 9 hrs ago Author
Good luck!
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Loweren Writes Optimized Dating 10 hrs ago
I'm happy for you! My apologies for complaining about the lack of posts just yesterday.
As a PhD student, I used to grow kidney organoids - small clumps of kidney tissue
derived from embryonic kidney progenitor cells (or Yamanaka-factors induced stem
cells). They were amorphous in shape and couldn't grow past a very small size limit:
there were no blood vessels inside, and the center of the organoid would begin to
necrotize from lack of oxygen. Growing a full-sized kidney in a lab would require a
much better understanding of vascularization during embryogenesis.
A cool workaround I once saw in a Finnish lab was to literally 3D-print a microchannel
tree, and populate it with thousands of mini-organoids. I haven't been following the
field since, so if anyone is aware how close we are to a 3D-printed kidney, let me know.
Also, whenever I told my casual dates what I'm working on, they used to ask "Are you
going to steal my kidney?". I would have to explain that I'm literally the least likely
person to steal kidneys, since I can just grow them in the lab.
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Seth Schoen 10 hrs ago
My only connection to this issue is that I have a friend who attempted to donate a
kidney to a stranger through UCSF, and I think ultimately also got rejected or else long-
term deferred, for a reason that seemed to also be like "we reject everyone who has an
issue that falls into this bucket" rather than "it's plausible that you would actually be
endangered if you donated your kidney".
This makes me wonder if UCSF is like super-paranoid about approving kidney donors.
Another thing that could fall under point #7: I think the kidney donation charities or
maybe insurance companies are also willing to pay some expenses of a friend or family
member to support you in connection with the kidney donation. So you might be able
to, for example, take a significant other with you at no charge to you, even if you had to
travel for the surgery.
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Zach Stein-Perlman Writes Not Optional 10 hrs ago
"Open Phil gave most of the funding for the purchase of Wytham Abbey (a small part
of the costs were also committed by Owen and his wife, as a signal of “skin in the
game”)." https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-
buy-wytham-abbey?commentId=3cLRAk98q8jMwhrEc
 REPLY SHARE
Anonymous Dude 10 hrs ago
I was really hoping you hadn't been posting because your wife had had a baby.
Oh well.
You're a better man than I. God bless you.
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Moon Moth 8 hrs ago
It's ... not exactly bringing a **new** life into the world, but the counter still got
incremented?
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Mark Writes DOPPELKORN 5 hrs ago
Not sure. If a certain ex-boss of mine got the kidney: Nope. - But you got me
thinking: What is the second best use of Scott's body tissue to better the
world? (The best is his use of his brain to write.) Obviously: sperm. Most
likely the UCSF would turn him down - If I were female, I would not. Now I
wonder: Why I do not see offers like this more often in the comment section (I
saw one on ssc)?
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Mark Writes DOPPELKORN 5 hrs ago

+1
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Firanx 4 hrs ago
I was afraid the pause had something to do with the 7th October massacre - e.g.
Scott decided to fight for Israel (unlikely as it sounds).
Still hoping to read whatever he has to say about it and the subsequent events.
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DavidC 9 hrs ago

> $10,000 per year for 10 years
Ah, I see, this is a "trick desperate or low-intelligence people into serving the greater
good" sort of deal. That's the only way to describe someone who would actually act
upon a promise by the government not to screw them over using the tax code for the
next 11 years.
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 Scott Alexander 9 hrs ago Author
Huh, I distrust the government in a lot of ways but this seems like the opposite of
the usual failure mode. Would you like to make a bet on whether the first person to
get promised this gets their full payout? Feel free to name the amount and any
other terms you find relevant.
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Edmund 3 hrs ago
My model of DavidC would be reluctant to take the bet. The *first* person to
get promised this might get a lot of media attention incentivising the
government to do everything smoothly, even if ten years down the line, when
the program has faded into normalcy, we expect things to regress to a mean
where the government casually screws later donors over.
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Shankar Sivarajan Writes Shankar’s Newsletter 9 hrs ago

It is a weird kind of desperation you're hypothesizing.
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Paula Amato 9 hrs ago
We find it acceptable to financially compensate women for egg donation. Not sure why
tax credits for kidney donation should be controversial. I believe Iran offers direct
payments for kidney donation which carries a higher risk of undue inducement.
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Melvin 4 hrs ago
I wonder what the actual free market value of a kidney would be. Probably much
smaller than $100K because there's plenty of people desperate enough to do it
for $10K... although many of these people would have issues (drug addiction) that
would disqualify them.
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Paula Amato 55 mins ago
Not sure. I know we pay $7-10,000 on average in the U.S. for egg donation. In
Iran, I believe they pay $4000 for kidney donation. I bet it would be a lot
higher in the U.S. but probably not $100K. The other question is who pays?
The recipient or the health insurer?
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Bram Cohen Writes Bram’s Thoughts 9 hrs ago

Have you found scientific studies which show that the phenomenon of being reduced
to only one kidney continues 30+ years after donation?
FWIW the linear no-threshold model of cancer risk from radiation is strongly countered
by parts of the world which have much higher background radiation, on the order of
the 30 millisieverts you avoided but every single year, and they don't appear to have
elevated cancer risk. Similar with airline pilots.
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Seth Schoen 9 hrs ago
> Have you found scientific studies which show that the phenomenon of being
reduced to only one kidney continues 30+ years after donation?
Like, that kidneys don't just grow back after a while?
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Bram Cohen Writes Bram’s Thoughts 3 hrs ago
Can't believe anything without scientific evidence!
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Calion Writes Substack Industrial Complex 7 hrs ago

He addresses the LNT thing nicely in a footnote.
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Biff Wiss 9 hrs ago
> In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in
need.
> This sentence fascinates me because of the hanging “would”. Would, if what?
The answer is a mix of "if they were introduced, perhaps in a superficial 21-minutes-
plus-commercial-breaks documentary fashion, to a particular stranger, who was
sympathetic and in need of a kidney" and "if it was 'call 1-800-KIDNEYS and book an
appointment sometime in the next month, have the surgery and spend a day or two in
the hospital recovering' instead of... well, the entire ordeal you describe, minus UCSF's
psychiatric proclivities.
It's also a pretty upper-middle-class sort of thing to do, and I think a fair amount of the
people answering "yeah, I'd donate a kidney" never have to really seriously consider
the question, because if you're not in a position to take a bunch of time off work and
life to go fuck around with hospitals and Zoom conferences and piss jugs and then, on
top of all that time, take a solid uninterrupted block of time off work and life to go have
the thing yanked out and recover then it's really not something you can ever seriously
really consider. Not at all trying to sound "check ur privilege, white kidney-donating
male" or scoldy. I just mean it in the sense that it's similarly easy for the fox to say he'd
easily resist the temptation of the grapes even if they weren't hanging ten feet
overhead.
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Shankar Sivarajan Writes Shankar’s Newsletter 9 hrs ago · edited 9 hrs ago
I worry that the Coalition To Modify NOTA is composed to people who are too nice to
think of this, so this suggestion might do good: include a provision that the tax credit
will not be INCREASED for, say, twenty years. (I don't know if the government is
capable of making such long-term commitments though.)
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Paul Goodman 9 hrs ago
Can you expand on why you think that would be necessary or helpful? It's not
obvious to me exactly what downside you're expecting.
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Shankar Sivarajan Writes Shankar’s Newsletter 8 hrs ago
Regret from having donated your kidney too early if the tax credit is, say,
doubled the year after you do so.
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Paul Goodman 8 hrs ago · edited 8 hrs ago
The obvious solution to that is just to make the credit and any future
changes to it apply retroactively to some extent.
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Shankar Sivarajan Writes Shankar’s Newsletter 8 hrs ago ·
edited 8 hrs ago
Yeah, sure, something like that will be at least as good.
There are lots of obvious solutions once you think of this problem
(once you accept that it IS one).
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Pratfins 9 hrs ago · edited 9 hrs ago

I was wondering if you've considered getting on the bone marrow donor registry, and if
you could write about that at some point in the future? Two years ago at the age of 26 I
was diagnosed with acute lymphoblastic leukemia. It's the most common childhood
cancer, and one that is highly curable in children, but has a mortality rate that
increases sharply with age - my prognosis at the outset was about a 60% chance of
surviving five years.
For me, and people like me, our best chances at a cure depends on a bone marrow
transplant. Leukemia is a cancer of the bone marrow, so the surest thing to do is use
chemo and radiation to obliterate all of your bone marrow, and then replace it with a
stranger's who doesn't have cancer. But since your bone marrow makes all of your
blood, including your immune cells, putting any average Joe's marrow in there would
just cause your new blood to viciously reject your entire body, basically. So a recipient
and a donor have to be closely matched on a variety of different factors to reduce the
chances of this happening. This makes getting as many people on the registry as
possible extremely important, and this also means that when someone is contacted
about being a donor, you are often the only donor available for the recipient.
Unfortunately, I did not have a match on the registry, so my treatment consisted of
chemo only, without transplant. I am in remission but my chances of relapse are a coin
toss. Relapsed leukemia is harder to treat, and it would increase my odds for survival if
I had an eligible donor were I to have to return to treatment. It would mean a lot to me if
you would consider signing up for the registry (it's pretty easy) and writing about the
experience. Thank you!
Edit
Expandto full
addcomment
a couple of things after the fact: I'd also like to say that unlike many with
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Mark 7 hrs ago · edited 7 hrs ago
I second this. (I'm healthy and on the registry for many years now, never been
approached)
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Korakys Writes Marco Thinking 9 hrs ago
Despite having never experienced a catheter I was already a bit afraid of them. This
didn't help.
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Gunflint 9 hrs ago · edited 9 hrs ago
Never had one put in. The idea unnerves me more than the kidney removal. I’d
need a healthy helping of Midazolam just to get through that.
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Firanx 4 hrs ago
I had. Don't remember any problems. Compared to the things I do remember
from that time that suggests an upper bound of perhaps 4/10 pain lasting
seconds, but more likely just discomfort.
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 Shabby Tigers 2 hrs ago
FWIW: I have a phobia around tubes-in-my-tubes so catheters are a proudly
horrifying idea to me; even IVs are really upsetting. But when I had to have a
urinary catheter during and after abdominal surgery, it bothered me much less
than I ever would have imagined a priori. Initially, I was feeling too fragile and
exhausted and hit-by-a-truck to care -- these are standard postop feels;
painkillers help, even if you aren’t in much pain per se, and it passes -- to be able
to muster any f*cks, and when I returned to myself a bit more, it was an already
existing situation and causing me literally zero discomfort, so I took a deep breath
and focused elsewhere. Even removal was pedestrian. *Extremely* sympathetic
about Scott’s bad experience with that.
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Michael Watts 9 hrs ago
> It starts with wanting, just once, do a good thing that will make people like you more
instead of less.
Then consider this my contribution to the world: I think this behavior is about as
admirable as men castrating themselves for religious reasons, or Xhosa killing their
cattle for religious reasons.
A cult that talks you into handing over your money is vilified; why is a cult that talks you
into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
> I asked them if there was anything I could do. They said maybe I could go to therapy
for six months, then apply again.
On the other hand, I find this to be even weirder than the post presents it as being.
This remediation makes sense if the concern is that your OCD of 20 years ago might
be prompting you to make an unsound decision to donate a kidney today. If the
concern is that there's something wrong with your kidney, therapy is pretty well
guaranteed not to address that.
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1 new reply
Moon Moth 9 hrs ago
> A cult that talks you into handing over your money is vilified; why is a cult that
talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
Because it saves a life?
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Michael Watts 9 hrs ago
Sometimes the money will do that, and sometimes the kidney won't. The
judgment you're really making here is "the kidney recipient is more morally
worthy than the money recipient", which has not been established.
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Mo Nastri Writes Mo’s Reads 8 hrs ago
As someone who's considered donating their own kidney for a few years
(not from EAs), but is on the fence about it, I admittedly don't really
understand your line of reasoning here, since for my personal decision
making it's 'and', not 'either/or'. I also admittedly find your contentious
framing not very helpful, maybe you can rephrase in a way more
conducive to changing the minds of fence-sitters like me?
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Michael Watts 8 hrs ago · edited 8 hrs ago
> I admittedly don't really understand your line of reasoning here,
since for my personal decision making it's 'and', not 'either/or'.
I'm not really sure what the contrast you're drawing is. I was drawing
a contrast between people who pressure you into injuring yourself
financially ("bad") and people who pressure you into injuring
yourself physically ("good"). I'm not sure what the opinion of
society in general would be about a group that pressured its
members into doing both of those things, but I suspect it would lean
toward "bad".
My objections here are stronger than, but similar to, one of my main
objections to EA in general: I don't think it's a good idea to "make
charitable efforts" in the abstract. You should have a first-order
goal. If an EA's goal is "give to charities that are rated highly by
GiveWell", they are just as vulnerable to their donations being
wasted as everyone else is, because there's nothing they're actually
trying to accomplish. There is no future state of the world that
would inform them whether, when they previously donated to a
recommended charity, that worked out well or poorly.
So, according to me, your charitable efforts should be directed at
things that you think are problems. The tycoon who funds high-
powered basketball contracts for his local team is concretely
addressing a problem that he can perceive (and that other people in
his community share!). He counts as more charitable than the
person whose goal is "donate to the proper charity, whichever one
that is, I'll ask someone else".
If your advocacy for kidney donation is based on your need for a
kidney, or your personal scars left by a loved one who needed a
kidney, I will call it admirable. If you do the same advocacy because
you think calling on other people to donate kidneys sounds like the
type of thing you should do, I will call it reprehensible.
And similarly, if your donation of a kidney is motivated by the need
of someone you care about, I will call it admirable, but if your
donation of a kidney is motivated by the need of someone you've
never heard of, I will call it stupid.
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Shankar Sivarajan Writes Shankar’s Newsletter 8 hrs ago ·
edited 8 hrs ago
Your comment reminds me of something I read (I forget where)
denouncing "nonempathic altruism." The point was that you
ought to CARE about the people you're supposedly trying to
help.
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Seth Schoen 8 hrs ago
On the other side, Paul Bloom wrote a book *Against
Empathy* which partly argues that caring is sometimes
irrelevant or counterproductive.
I'm somewhat confused about my position on this.
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Michael Watts 6 hrs ago
> The point was that you ought to CARE about the people
you're supposedly trying to help.
But I don't agree with that point. I'm saying you ought to
be trying to solve things that are problems for you, and
you shouldn't be trying to solve things that aren't
problems for you. There are two primary reasons: (1) if you
follow this policy, you will be able to tell whether the
problems are getting better or worse; (2) the fact that you
personally have a problem serves as evidence that at least
one person has a problem.
This may intersect with your interpretation in that, if you
care about the people you're supposedly trying to help,
then their suffering is a problem for you. But the analysis is
different. Note that I called advocacy reprehensible (you
are setting out to hurt other people) and donation stupid
 (you are hurting yourself). By my reading of your
comment, you think I'm calling donation reprehensible.
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Moon Moth 7 hrs ago
If Scott had met the recipient beforehand, would that make a
difference? Even if the meeting was solely because of his prior
decision to donate? What about if he had the option of meeting
the recipient, but for some reason it didn't happen?
Do you have to know them in advance? I've volunteered at a
place that feeds homeless people. I knew no one involved when
I started, but got to know a few people while doing it. In a way,
it was a sacrifice of my time, which is like a sacrifice of my life.
But in another way, it was an experience that became part of
my life. Perhaps Scott wants this experience to be part of his
life.
There was a fascinating EconTalk podcast, almost a decade
ago: 2014-07-14, "D. G. Myers on Cancer, Dying, and Living". In
it, Myers said something that I think was profound, even though
I'm not religious: "[God] didn't *plan* it; this is the history He
wanted for me."
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Michael Watts 2 hrs ago
> If Scott had met the recipient beforehand, would that
make a difference? Even if the meeting was solely because
of his prior decision to donate?
To the second question, that would be the difference
between trying to address a problem that you have, and
trying to afflict yourself with a problem to address. I don't
see them as similar.
To the first question, let me answer in a larger scope: the
propriety of donating a kidney depends on how strongly
you are connected to the recipient. Having met them is not
necessary (but would, if the donation were appropriate,
almost always have happened) or sufficient.
> Perhaps Scott wants this experience to be part of his life.
That would not be enough to make his decision admirable.
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Moon Moth 8 hrs ago
Not really, it's more about directness and probability. The kidney goes to
a particular person, who has a known high probability of living because a
specific thing that was wrong got fixed. The money is fungible, and with
regards to "cults", the phrase "hookers and blow" comes to mind.
... Unless you're referring to Effective Altruism as a cult? While there are
cult-like aspects to EA, they're also quite good at providing the numbers
and math for what the money will do, which in this regard puts them
ahead of pretty much every other group out there.
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Michael Watts 5 hrs ago
> ... Unless you're referring to Effective Altruism as a cult? While
there are cult-like aspects to EA,
Look at Scott's description of his decision-making process:
> my girlfriend ending up begging me not to donate, and I caved.
> When I talked to my family and non-EA friends about wanting to
donate, the usual reaction was “You want to what?!” and then trying
to convince me this was unfair to my wife or my potential future
children or whatever. When I talked to my EA friends, the reaction
was at least “Cool!”. But pretty often it was “Oh yeah, I donated two
years ago, want to see my scar?”
> After I submitted the donation form, I was evaluated by a horde of
indistinguishable women.
> they all had questions like “Are you sure you want to do this?” and
“Are you going to regret this later?” and “Is anyone pressuring you
to do this?” and “Are you sure you want to do this?”
On the one hand, you have everyone close to Scott, plus the
impersonal medical system, stressing that this is a bad idea and he
shouldn't do it. On the other, you have a group of erratic weirdos
who like to talk each other into following through on bad ideas, and
they provide support, encouragement, and role models for this one.
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Moon Moth 5 hrs ago
One could say the same thing about a group of slavery
abolitionists 200 years ago.
Also, I wouldn't characterize the impersonal medical system as
saying that it's a bad idea. I take those questions literally.
 They're important things to ask. Sure, it sets off our social
sense because the same questions can be used as code for
"this is a bad idea and he shouldn't do it", but the context is
different.
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Michael Watts 2 hrs ago · edited 2 hrs ago
> One could say the same thing about a group of slavery
abolitionists 200 years ago.
I'm not sure what "the same thing" refers to. That they
were a cult? That their characteristic behaviors were due
to pressure from other abolitionists? That they liked to talk
each other into following through on bad ideas?
I don't quite see the parallels there. It would be easier to
say they could also be described as erratic weirdos, but I
don't really see that as a central theme of my comment
above. I included that to form a closer parallel to the
paradigm of "cult".
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Thegnskald Writes Sundry Such and Other 9 hrs ago
If it's irreplaceable you're concerned about, you could donate half your liver (it'll
grow back!) or some bone marrow.
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Drethelin Writes The Coffee Shop 8 hrs ago
"A cult that talks you into handing over your money is vilified; why is a cult that
talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?"
Because you're not handing it over TO the cult, duh.
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Moon Moth 8 hrs ago
"Indiana Jones and the Temple of Doom" would beg to differ.
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Tate 7 hrs ago

I agree, because the leaders of this movement are installing 90% of donated
kidneys into themselves, gaining the ability to filter spacetime itself.
For most people, the problem with giving your money to the cult is that it flows
into the pockets of the charlatan at the top rather than toward any sort of greater
 good. Perhaps you find altruism in general to be a repellant concept; this certainly
seems to be the case from subsequent responses. You claim to advocate for
altruism that solves some defined problem. Yet Scott's kidney was successfully
implanted in someone who needed one. That's a definite, concrete change in
world state, unlike giving money to a broad, generic 501(c)(3).
But at least this post was silly enough to get me to register.
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Scott Alexander 7 hrs ago · edited 7 hrs ago Author
With opinions like that, you'll always have a job available at the Guardian if you
want it!
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Boris 9 hrs ago
No arguments, no discussion, just: Im reading you for about twenty years now, and you
never stop to amaze me. Blessed be you.
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Scott Alexander 7 hrs ago · edited 7 hrs ago Author
<3
(either your calculation of years is off, or I somehow knew you in college - are you
an old friend under a different name)
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Boris 6 hrs ago
I found your very first blog by accident when a book review on native indians
you wrote became famous, I read it, loved it, and then went to the first of your
posts on that blog, where you described a hike after finishing high school.
Loved that and then never stopped reading your stuff since.
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1123581321 9 hrs ago

Just want to say how it never fails to surprise me to encounter people in their 30’s who
never have experienced anesthesia.
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CT 4 hrs ago
Out of curiosity, why? My prior is the opposite (assuming you mean general
anaesthetic) so I am metasurprised by your surprise. But I don't know the
numbers.
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Xpym 2 hrs ago
I'm in mid-thirties and only once had a minor surgery under anesthesia, which
happened due to a dumb mistake that I might as well not had made.
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John N-G 9 hrs ago
Three things:
1. How do you know it was zoom doing it? Maybe they were spontaneously donating
body parts and replacing them with UCSF insignia.
2. The Pros and Cons chart is flawed. It weights each factor equally. I, for one,
definitely value some more than others. Cornell may not be on top after all.
3. "previous living kidney donors" sounds more Halloweeny than was probably
intended.
Beyond that, congratulations!
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Coagulopath 9 hrs ago
lol'd:
"I make fun of Vox journalists a lot, but I want to give them credit where credit is due:
they contain valuable organs, which can be harvested and given to others."
"I practiced rehearsing the words “I have never donated to charity, and if I did, I
certainly wouldn’t care whether it was effective or not”."
"When I woke up in the recovery room after surgery, I felt great. Amazing. Content,
peaceful, proud of myself. Mostly this was because I was on enough opioids to supply
a San Francisco homeless encampment for a month."
"I had an unusually hard time with the catheter - the nurse taking it out frowned and
said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king
Mines of Moria"
I'm glad you didn't donate your sense of humor.
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George Writes Epistemink 8 hrs ago
I started typing a comment but I realized it would be so long I might as well work on a
"Contra" style article for "Why you should not donate a kidney".
If you are a person that's seriously considering donating a kidney please consider
contacting me at george @ cerebralab . com -- so that I may try to dissuade you.
I think this would help me write a better article by having a motivated adversary with
skin in the game.
P.S. In case Scott is reading this I'm obviously *not* claiming that donating a kidney
isn't an altruistic act. I think that you are a fantastic person as always for doing this, I
am just against encouraging people to do it because the uncertainty around outcomes
seems immense and potentially bleak. Which still means that on-average you saved
QALYs and contributed to social cohesion making you an all-around good person for
doing this.
P.P.S Hopefully no new rules around posting emails in comments, if one exists and I'm
breaking it, I'm sorry
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WilliamJamesKirk 8 hrs ago
How transferable is the 'kidney credit'? My wife is at elevated risk of someday needing
a kidney, so I always figured I should keep my spare in case she needs it. I would be
very upset if I gave it to somebody else now, and then 20 years later found myself
unable to leverage my past donation to bump her to the top of the current recipient
list.
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Scott Alexander 8 hrs ago Author
I'm not sure I understand your question. You could always put her as the only
person on your list of people you were giving a credit to. But I'm just guessing
here - if you're really interested in this, you should contact WaitListZero (link at
the bottom of the post) and ask them.
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WilliamJamesKirk 2 hrs ago · edited 2 hrs ago
Sorry for the confusion, I missed your footnote #7, it answers my question --
this is good to know! It actually makes it so that if I gave somebody else my
kidney now, I could designate my wife at present to be the beneficiary of
some other kidney in the future. It's like kidney insurance -- in the event she
that outlived me and needed a kidney when I'm no longer around to give her
one (or I'm just too old to be a donor) she could get one on account of my
having given one away before. Duly updated!
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Val 8 hrs ago

The only thing that bothers me about this is the opioids bit. When my father had issues
with a kidney stone, they gave him morphine, and he was in utter amazement of how
effective they were, and came out of the experience saying "I can understand how
people get addicted to this stuff." I've heard about how people getting their start on
opioids because they're prescribed them following surgery.
When I had a tooth extracted(which incidentally also included that kind of lying-in-
chair->timeskip->staggering down sidewalk anesthesia experience), I specifically
avoided taking the heavy duty pain killers they prescribed me because I didn't want to
roll the dice on going down the path of drug dependency.
It's all well and good that it's a relatively safe surgery, but I'm wary of any unnecessary
exposure to opioids and would need to know the risks there.
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Scott Alexander 8 hrs ago · edited 8 hrs ago Author
I was looking forward to trying opioids, in a sort of Ulysses-tying-himself-to-the-
mast way: I'd heard so many things about them, and wanted a chance to try them
without getting arrested.
I joked in the post about how good I felt, but it was actually just a normal amount
of pretty good - hard to bother, comfortably warm, easy to drift into pleasant
sleep. I tried a higher dose at home when I had my UTI, and had a similar
experience, then very unpleasant constipation for the next few days. I currently
have a bottle of unused opioid pills on my desk that I haven't touched for a couple
of days despite enough pain that I could easily justify it, mostly because of
constipation risk. My guess is I'll continue not to use them until the next time I'm in
extreme pain for some reason, even though I usually have a pretty experimental
approach to medication.
My impression is that happy people without pre-existing mental illnesses or
addiction problems rarely get addicted to opioids in the period after a surgery.
Partly this is because people with addictive personalities form a separate group
who already know this, partly it's because addiction is an interaction between
genes and how good your life is, and if your life is good you need to be very
genetically unlucky. Partly it's because you'd normally need higher doses, faster-
acting chemicals, and longer timespans than a typical post-surgical course to get
addicted. And if all else fails, most people won't have the
energy/interest/knowledge to find a new source after their prescription runs out.
I think all of this is compatible with the extent of the opioid crisis. I think I
remember seeing some studies that people who die in the opioid crisis mostly
aren't normal patients who got post-surgical prescriptions, but the people who
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Moon Moth 7 hrs ago
 I got a few opioid pills when I broke my arm a couple of years ago, even though it
mostly didn't hurt if I kept it still. I tried one the first day, and in addition to making
the pain go away, it also made my PTSD go away. I promptly stopped taking them
and have saved the rest in my closet in case things get very bad,. My prediction is
that they'll just sit there and eventually expire. Cannabis isn't as effective, and has
more side-effects (the whole "stoned" thing), but also is easy to acquire where I
am, and has much less potential to be addictive.
But now I have a suspicion about why heroin and Vietnam were so associated.
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Michael Watts 5 hrs ago
> When I had a tooth extracted(which incidentally also included that kind of lying-
in-chair->timeskip->staggering down sidewalk anesthesia experience), I
specifically avoided taking the heavy duty pain killers they prescribed me because
I didn't want to roll the dice on going down the path of drug dependency.
When I had my wisdom teeth out, they told me to take Valium beforehand.
Not for any medical reason. It would have provided no benefit at all. But my father
didn't know that and he said I should take the Valium because those were the
instructions.
My mother, a doctor in an unrelated specialty, supplied her opinion that the Valium
had no purpose, and I didn't take it.
But I experienced far more anxiety over the prospect of being forced to take
Valium than I did over the concept of having my teeth extracted.
As you might gather from my comment, I am still outraged about this.
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Steve Estes Writes Wonky Observations 8 hrs ago
I don't think I would donate my own kidney, due to various emotional reasons none of
which are all that thoroughly-considered... but I would gladly vote in favor of the tax
credit. That seems like a rare free lunch in national economics. I hope it gets traction.
Speaking of traction, glad to hear you're on the mend, and great write-up.
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Stephan 8 hrs ago
Typo: "They found 34 cases extra cases"
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Gregory Schmouse Writes Journal of working-class medici… 8 hrs ago
Soo, do journalists finally get to claim that AE is a cult that steals people's organs?
ALT
Simpsons did it first (S10E8).
On a less facetious note, I find the data on the safety of kidney donation incredibly
unconvincing. Vast majority of donors are elderly and have shared the lifestyle of the
recipient for decades (stereotypical old couple situation), so tons of confounders and
no good data for young people donating. To handwave a safety signal as genetic
confounding is incredibly disingenuous when you have no good data to suggest this
link, i.e. can't pinpoint the gene responsible.
In general, I find myself wishing sometimes transplant medicine would just, dunno, go
away. The results I see in my daily practice are always crap (I am the person who gets
to stare at the nice little pictures you had taken all day long). It's far from the miracle
everybody thinks it to be, and certain subpopulations might actually be worse of
getting an organ than without it. There are practically no randomised trials on
transplantation, and the devil kidney in me tells me it's because transplant docs know
well enough that it would fail when actually trialled in today's population.
The ethics is fraught with foregone conclusions and false causality (people don't die
from a lack of donor organs - they die from their illnesses - yet this language is
routinely used by patients and their families: I was recently told by an acquaintance her
grandfather had "died because no organ was available" - no seriously eff this gramps
died of his alcoholism and two packs a day you delusional excuse for a granddaughter
- he was my neighbour). If we are to believe all democracy becomes gerontocracy in
the end, I get the heebie-jeebies when thinking about what a government seriously
committed to placating the elderly would mandate in that respect.
I hope for your sake this turns out fine, lotsa people with only a single kidney end up as
old geezers, but I can't help to think the "advertise kidney donation like blood donation
to everyone" moment is a greivous error in the long run and this will fall medicine on its
feet colossaly in the years to come. In the short term, this article has demonstrated to
me that this blog now espouses values so far from me and mine own that it's probably
time to stop reading it.
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Scott Alexander 7 hrs ago · edited 7 hrs ago Author
"To handwave a safety signal as genetic confounding is incredibly disingenuous
when you have no good data to suggest this link, i.e. can't pinpoint the gene
responsible."
I think this comment ignores the past few decades of genetics. Figuring out the
percent of something which is heritable is vastly easier than figuring out what
genes are involved (it's never "the gene responsible", it's usually a mix of
hundreds or even thousands). Still, when we do get polygenic algorithms, they've
shown that the simpler gene-agnostic methods we used earlier to estimate
heritability were right.
Although I agree it's unfortunate that you can't do RCTs for kidney transplantation,
statistically adjusted studies continue to show the 5- 7 year lifespan and 20%
quality of life gain. Before-and-after surveys of the same people also show the
20% quality of life gain, and people say they feel much healthier. There are
obvious practical downsides to dialysis and everything we know about it
biochemically suggests it should work less well than a kidney. AFAIK every group
of nephrologists and medical evidence-setting body agrees kidney donation
works better than dialysis. See for example UpToDate,
https://www.uptodate.com/contents/overview-of-the-management-of-chronic-
kidney-disease-in-adults, ("Kidney transplantation is the treatment of choice for
ESKD. A successful kidney transplant improves the quality of life and reduces the
mortality risk for most patients when compared with maintenance dialysis") and
this paper by the National Kidney Foundation: https://sci-
hub.st/https://pubmed.ncbi.nlm.nih.gov/18256371/ . Curious if you have any links
or evidence supporting your position.
"People don't die from a lack of donor organs - they die from their illnesses"
sounds incredibly facile to me - not just "guns don't kill people, people kill people"
facile, but "that person didn't die because of the gunshot, he died of blood loss"
level facile. Just say that the result of getting one extra organ would be to save
one extra life over the counterfactual.
My understanding is that people who are extremely old and decrepit are
considered lower down on the list for transplants than everyone else. My
grandfather, who was pretty old when he got ESKD, AFAIK was never even told to
consider the options.
I agree that we seem to have some pretty irreconcilable value differences.
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Gregory Schmouse Writes Journal of working-class medici… 6 hrs ago
The main thing we learned from the last decade of genetics is that neither of
these methods work. The few diseases that have a strong genetic
contribution are practically monogenetic (ApoE4, PCSK9, ...). Whenever a
study reports these minimal point estimates for hundreds and thousands of
genes, that is essentially the result you would get from a non-genetic
disease: hundreds and thousands of genes that minimally contribute to or
detract from the overall resilience of the organism. Don't tell the geneticists,
though, they'll get upset because they'll loose their funding once the
agencies figure it out.
 There is a actually a very straightforward reason for the autoimmune kidney
disease they found: surgery introduces antigens from the kidneys to the
bloodstream, thereby causing immunisation. The mechanism would be the
same as in sympathetic opthalmia, where immune-privileged antigens from
the intravitreal space get introduced to the immune system at large by
trauma or surgery and then cause an autoimmune response to the entire
organ system, eventually destroying both eyes. Replace 'eyes' with 'kidneys'
and 'vitreal' with 'tubular' and you got yourself a deal, mate.
Re quality of life or survival gains: this is flawed evidence on all levels -
without an RCT, the Ioannidis principle comes to mind: in a null field,
observed findings are a measure of the prevailing bias. Control groups are
likely sicker or historical, i.e. generally worse off. Also, my claim wasn't that
this is a negative for all involved or even on average, but that selected
subgroups may be worse off with a donor organ. This changes the calculus
quite a bit from a medical perspective (you wrote so eloquently about that a
few years ago re/ death risk from seroquel), but since no reliable data is being
generated, nothing will change for a decade or so at least. When
transplantation goes awry, the disease is blamed. When it goes well, the
surgery is credited. This is as embarrassing as it has been effective in
cementing the practice.
Finally, the argument is not as facile as you would like it to be. There is no
moral causality between the availability of donor organs and deaths. Were
there, then everybody who is currently keeping their two kidneys for
themselves would be a murderer (or whatever your term would be for "person
who is obligated to help but doesn't, thereby causing death"). This obligation
doesn't exist, though, and previously this was an accepted view amongst
medical ethicists. Since the explosion of utilitarianist bullshit in the wake of
Singer's success in the academy, this slowly changing, and I dread to think
where it will lead us.
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Calion Writes Substack Industrial Complex 7 hrs ago · edited 5 hrs ago
I just wish to say that I am unironically very inspired by "Everything else I try to do,
there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re
stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe
you’ll never be able to figure any of this out. Maybe you should just give up.”"
If fucking *Scott Alexander*, possibly the smartest guy I know of, who is constantly
genuinely trying to get to the truth and do the right thing, feels that way, well, fuck it.
This is just dumb. I thought maybe I felt that way because…well, because they were
right. But there's *no way* that *you* should feel that way all the time, so why should I?
Fuck that.
Thank you, genuinely, for being you and allowing us to see who you are.
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Mark Writes DOPPELKORN 6 hrs ago
+1
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Eric Gorlin 7 hrs ago · edited 7 hrs ago
This is a banger and your writing style is great. "My IRB Nightmare" righteous-anger
vibes.
Also, typo: "I decided not to submit then)" should be "submit them)"
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Scott Alexander 7 hrs ago Author
Thanks, fixed.
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Daniel Reeves Writes Homo Economicus Wannabees 7 hrs ago

Holy nephrectomy, this is inspiring. How inspiring? Let's predict!
https://manifold.markets/dreev/how-many-people-will-follow-scott-a
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Muster the Squirrels Writes Muster the Squirrels 7 hrs ago
> This request didn’t get communicated to the surgeon and he told me anyway - but
luckily everything did go well.
Perhaps the surgeon actually did receive the request, and violated it only because the
recipient lived.
***
In countries where it is harder to sue hospitals than it is in the US, are decisions like
UCSF's re: OCD less common?
***
Do any kidney-transplanting hospitals publish their full list of medical conditions which
rule out a potential donor, either due to risk to the donor from the surgery, or risk to the
recipient from a potentially subpar kidney? I would appreciate seeing one.
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 Moon Moth 7 hrs ago
> Perhaps the surgeon actually did receive the request, and violated it only
because the recipient lived.
I suppose the game theoretical problem is ameliorated because no one (?)
donates kidneys more than once, so there's never a chance to figure out an
individual doctor's pattern of behavior.
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Noah Birnbaum Writes Irrational Community 7 hrs ago
Brachos is a 🔥 mesechta
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Hypatia Writes Hypatia 7 hrs ago
The Linear No-Threshold Hypothesis of radiation says that every milliSievert increases
your cancer risk. It does not. Humans cope and even seem to thrive with a background
level of radiation. Prof Richard A. Muller (the Physics for Future Presidents guy) has
thoroughly debunked LNT. That the NIH supports it is further evidence that it is
nonsense.
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Scott Alexander 7 hrs ago Author
I think there are two things going on:
1. Without saying outright that I trust the NIH more than I trust some person who is
"the Physics For Future Presidents guy", I don't trust the Physics For Future
Presidents guy *so much* more that I will totally ignore the NIH's view and not
even consider it at all.
2. 100 mSv has been empirically demonstrated to increase cancer risk, so if
there's a threshold, it's there or lower. The CT I was worried about was 30 mSv. So
to not worry about the CT, you would have to claim both that NIH is wrong and
there is a threshold, and also that the threshold is definitely between 100 mSv and
30 mSv (and not, say, 10 mSV). I don't really see any evidence for that, so even if
there is a threshold, I'm worried the test might fall above it.
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Hypatia Writes Hypatia 5 hrs ago
That's quite funny -- both points.
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Muster the Squirrels Writes Muster the Squirrels 7 hrs ago

What characterizes the countries with the highest per capita rates of living-donor
kidney donation?
(Should those rates be adjusted for average age? For the probability that a potential
donation will find a recipient? For anything else?)
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r hunter 7 hrs ago
The probability calculation of 1/660 doesn't seem at all correct to me. Every Sievert,
you say, raises your risk of dying of cancer by 5%. But that's raising it from *whatever
the current rate is*, which is... okay, a quick google says that cancer mortality in men is
something like 200/100,000. So 30 milliSieverts would raise your risk by a total of
200/100,000 * 1/660, which is more like 1/330,000. (Or, I guess, raises your cancer risk
by 1/110,000).
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DecipheredStones 6 hrs ago · edited 6 hrs ago
Came here to make a similar point.The linked article says "5% excess risk of death
from cancer" and then has citations I can't reasonably follow; I can't tell whether
that should be understood as (5% excess risk of death)(from cancer) [i.e. the
cancer risk amounts to 5% increase in all-cause mortality] or (5% excess risk of)
(death from cancer).
More glaringly, Scott writes:
"the risk of dying from the screening exam was 1/660. ... I regret to inform you she
might be right. ... a 30 mS dose increases death risk about one part in 660."
Two very different statements! Does the scan have a 0.15% chance of leading to
your death, or does it increase your odds of dying by 0.15%? The former seems
crazily high, but contextually it's being compared to the risk of surgery, where the
figures really are about the risk of the procedure killing you.
Anyway, Scott, if you see this, congratulations and good on you - just want to
make sure you're not unnecessarily making kidney donation sound scarier!
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Liam Scott Writes Flight From Reality 7 hrs ago

Inside of you there is one kidney
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fortenforge 7 hrs ago
> You don’t need to worry about not having a kidney when a friend or family member
needs one. When you donate, you can give the organ bank the names of up to five
friends or family members who you’re worried might end up in this situation. In
exchange for your donation, they will make sure those people get to the top of the list
if they ever need a transplant themselves.
This was certainly news to me, and makes me feel better about the whole thing, but
doesn't the fact remain that your own kidney is much likelier to be a better match for a
family member than some other kidney off the list?
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Scott Alexander 5 hrs ago Author
I don't know. It's true that your kidney (because of genetic relation) is much better
than average. But it might not be better than the best kidney available to the
organ bank with hundreds of kidneys available. (I don't understand how this works
well enough to be sure it works like this). It also seems like in some cases (eg
spouse, relative with different blood type), your kidney wouldn't work at all, and
the bank would be a better alternative (though usually the bank would let you
make some kind of more direct trade).
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Medieval Cat 6 hrs ago
Great post Scott! Lots of love!
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Random Person 6 hrs ago
I found this post somewhere in my newsletter, and i was surprised that anyone would
give precious part of the body to a stranger.
I have kidney disease (they dont work anymore to be honest), located in Europe - and
here i never heard about 'random' donors.
Moreover, i personally never asked (and probably will not ask in the future) my friends
or family for organ donor. Im overwhelmed about idea asking anyone for something
that big and important.
Congrats, you make 30+yrs old man to cry like a baby :)
I really wish you everything best and i admire what you did.
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Eschatron9000 2 hrs ago
You don't mention where in Europe, but depending on country, it might make
sense that you haven't heard of undirected donations — they're illegal in France,
for example. I am duly furious about this.
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 JohanL 1 hr ago
I was just going to say I wouldn’t be the tiniest bit surprised if they were
illegal for no reasonable reason.
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Max More Writes Extropic Thoughts 6 hrs ago
If this estimate of increased risk assumes the linear no-threshold theory (LNT) -- and a
quick look at the cited paper suggests it does -- it's nonsense. Read Jack Devanney's
substack on nuclear power, where you will find demolitions of the LNT theory.
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Scott Alexander 5 hrs ago Author
See my footnote 2 and discussions above.
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Mark Writes DOPPELKORN 6 hrs ago · edited 6 hrs ago

My usual admiration for Scott. Even higher than usual if possible. Glad he is alive, was
considering open a manifold market: Is Scott in hospital? - Had hoped for an even
better reason to be there. And feared for worse - The beginning freaked me out: "As I
left the Uber, I saw with horror ..." One of my few wishes left is: May I die before Scott
does.
Cheers for NOTA! To keep up the pressure, I shall keep my organs for now. (From an
MRI I assume the one kidney is not fine enough to donate, and the fine one I intend to
keep.)
Excellent post.
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Dylan Mahoney 6 hrs ago
I wonder whether a policy to give a tax deduction rather than tax credits for kidney
donation could receive less political opposition. Because it seems the main concern
opponents of compensation for kidney donation have is that poor people will donate
kidneys for financial reasons in a way that seems morally icky. Whereas with a
deduction, due to the existence of the standard deduction, the financial incentives
would become active at some level of income while not influencing the behavior of
people poorer than that, right? Does anybody more familiar with US taxation and organ
donation policy know if there's some number at which such a deduction could be set
to alleviate the US kidney shortage while not influencing the behavior of the poorest,
say, 1/3 of Americans toward kidney donation?
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Shivers 6 hrs ago
“It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that
I go to than I have ever known.” --Kidney Carton
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malatela 6 hrs ago · edited 6 hrs ago
I happen to live very near the "castle" and aside from a one week event for college
students when they first bought it, it seems like they haven't actually run any
conferences there yet over the last two years, but have continued to rent other venues
for retreats and so forth since.
Old buildings can be money holes. I suspect, though don't know, that there are either
transportation issues (there's a year+ long road closure on one of the main routes
there) or maintenance issues that have prevented it from being used for any
conferences as of yet. It's kind of a red flag to me that Oxford University owned it but
then sold it as they didn't think it was financially feasible to hold on to. Though to be
honest I'm glad it's back in university-associated hands rather than as a private
building, as the university owns the rest of the adjacent land. It's a lovely area.
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EngineOfCreation 6 hrs ago
Kudos to you. Though I am suspicious your evil voice will learn to adapt to the new
circumstances, perhaps encroaching on your good voice's turf in the right kidney, or, if
the "left" part is important, perhaps claim your left lung?
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Alex 5 hrs ago · edited 5 hrs ago
I looked pretty throughly into kidney donation and even signed up for the first level
screening but I ended up chickening out. However, I heard at one point that a
screening question that’s commonly asked during the kidney donation process is “do
you donate blood?” and I realized it was silly that don’t, given that I was likely eligible
and that it’s a much lower risk but also life saving intervention. So I started donating
blood and I encourage anyone who’s not quite comfortable with donating a kidney to
try donating blood or platelets! The FDA has recently changed screening guidelines so
that some previously deferred groups in the US (including gay men who haven’t had a
new partner recently and people who have lived in the UK) are now eligible to donate.
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Tyler 5 hrs ago
Small note: the article you cite from Tom Ash was actually written by Josh Morrison
and Thomas Kelly, according to the preface of the post.
Thanks for writing this. I donated as well, and found the experience to be a weirdly
effective self-signal. I try to do various altruistic things, from donating money to
choosing high-impact jobs, but good signals are costly, and these just aren’t all that
costly for me.
That’s probably a bit counter intuitive - what could be most costly than my literal time
and resources? That’s all I have! Here’s my thinking: after donations, I still live a life of
extreme wealth and comfort compared to the average human, so the opportunity costs
of donation are kinda trivial (like, maybe if I didn’t donate, I would buy the new VR
headset that just came out, but I don’t suffer greatly because I haven’t done so). As for
my job choices, these have coincidentally (suspiciously I might add, in my moments of
doubt) been things I find challenging and interesting and rewarding in and of
themselves. On top of that, there’s the point you mention that lots of my preferred
ways to do good aren’t actually seen as good at all by plenty of critics (and, like, many
everyday people too). I’m somewhat prone to imposter syndrome, and it’s easy for me
to doubt my own motivations and impact on the world.
Donating a kidney was not only a costly signal of my values (the right balance of costly
- annoying but still worth doing), but it also carried a lot of metaphorical resonance for
me, since I have a typical secular worldview in which I am nothing over and above my
body. Now, when I look at my body in the mirror, I’ll always notice and be reminded that
it has a couple faint scars from the time I literally changed it - changed myself - to try
to help someone else in a small way. It serves as a reminder that I can do annoying
things because I value them, and I can literally change who I am in the process.
This reinforces my identity as someone who wants to do good things for the world, and
serves as a healthy reassurance when self-doubt creeps in. So, for strictly non-
altruistic reasons related to my general self-image and the narratives I want to tell
about my life, I rate kidney donation pretty highly. All the altruism stuff is a great bonus
on top of that 😉
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Athreeren 5 hrs ago
"Also from my spicy [version of the "Effective Altruism As A Tower Of Assumptions"]
essay:
Q: All possible forms of assistance, financial and otherwise, just make recipients worse
off, for extremely complicated reasons. There are literally no exceptions to this. I
promise I’m not just looking for an excuse not to do charity, I would love to do charity,
it’s just that literally every form of charity is counterproductive. Weird, isn’t it?
A: Even kidney donation?"
Now that's what I call putting your kidney where your mouth is! (don't eat your kidney)
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Vadim Writes Rat and Tiger 5 hrs ago
What kind of a technological advance do we need to just start printing out artificial
kidneys for anyone who needs one?
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John R Ramsden 5 hrs ago
Castles need TLC as well, such as repointing stonework as needed, and weeding small
trees and other foliage growing near or on walls, or even retiling roofs assuming the
place isn't a complete roofless wreck. So the group who bought the castle also
deserve some credit for maintaining it, assuming they do so adequately, for the benefit
of future generations.
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Niclas Writes The Paradox Ravens 5 hrs ago
The "In polls" link seems to be wrong or broken?
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savegameimporting 5 hrs ago
> Self-modifying into a person who can act boldly without social permission is a more
general solution and has many other advantages. But the long version involves living a
full life of accumulating moral wisdom, and the short version starts with removing
guardrails that are there for good reasons.
I was vaguely uncomfortable reading part IV - the one about the castles and the
fuzzies and the utilons - and I guess this footnote made it clearer why.
Ten years ago, you wrote that "in all situations, the government of Raikoth will take the
normatively correct action." In those ten years of life, having accumulated the moral
wisdom that you did, would you say you've gotten closer to embodying these words -
not in the sense of *knowing* the correct action, not even in the sense of *actually
doing* it, but in the *knowing that you know* sense?
My impression is that 2023!Scott is, if anything, more reticent about this stuff than
ever. This is a problem when Guardian opinion columnists are constantly whispering
dread outside-view incantations in his ear, demanding that he give up his left kidney,
and generally holding his sense of satisfaction hostage. That seems even worse than
the state of nature, which is getting fuzzies from Meaningful Human Connections™.
Those, at least, are fake in an obvious way.
(not that I'm saying it was wrong to donate the kidney; just that this post is pretty
depressing, like watching someone fill out taxes, except it's not even a morality tax like
the GWWC pledge, it's a tax on *having a morality*.)
(also, there's two part IVs.)
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Jonathan Ray Writes Far-Tentacled Axons 5 hrs ago
Why hasn’t someone already solved the LDNT debate once and for all with a large RCT
on rats? IRBs won’t let them?
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Bhavin Jankharia Writes Man From Matunga 5 hrs ago
Hi. CT scans have been around now since the 80s as well.
The whole brouhaha started with Brenner's paper in the AJR in 2001, which was
modeled on radiation from Hiroshima and Nagasaki, which itself is not a fair modeling
example, because the radiation profile is different and you can't just extapolate the risk
from 1000mSv to 1 mSv (CT scan would be between 1-10 mSv). Until then, no one
talked about diagnostic imaging and radiation risk.
So the burden of proof lies on those who say that radiation from diagnostic imaging (<
50mSv one time dose) increases risk of cancer, not the other way around. There is no
data showing this in adults. Those who believe in the hypothesis have moved to
children, where if at all (and no one has accounted for reverse causation), for every
10,000 CT scans of the brain, there is one increased brain cancer risk, that's it.
Modeling is just that, modeling. All of the references below say "There is no evidence
that low-level radiation from medical imaging causes harm and below 50-100 mSv of
exposure, the risks are too small to be observed or non-existent".
1. Amis Stephen. Radiology 2011: 261: 5
2. Position Statement of the Health Physics Society, Jan 2020
3. American Association of Physicists in Medicine – position statement Oct 2018 -
https://www.aapm.org/org/policies/details.asp?type=PP&id=439
4. Hendee William R. Radiology 2012: 264: 312
Unlike with so many other medical interventions, where our follow-up data is in the
range of a few years (statins is now 35 years), with X-rays we have good solid long
term data. Remember that from the 20s till almost the 90s, patients were also exposed
to barium studies, IVU studies, where the radiation was in the same range sometimes
as CT scans. Some observational study from the NHS or from the Scandinavian
countries that track all their patients would have shown some causation. But there is
nothing.
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Jonathan Ray Writes Far-Tentacled Axons 5 hrs ago
Casually bringing up your disdain for journalists in the absence of an occasion to
criticize them creates more heat than light and annoys my NYT-reading fiancée
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Leo Abstract 2 hrs ago
Being annoyed is a sad waste of an opportunity to reflect on bias.
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Kronopath 4 hrs ago

This still gets my hackles up. Let me fumblingly try to articulate and explore why I feel
this way, in a way that hopefully sounds valid.
-----
Let's imagine for a second that this was written by someone other than Scott,
someone who I haven't spent years reading, and whose thoughts I don't understand as
well.
The text of this article is "I donated my kidney". The message, partly stated but mostly
implied, is "You should do so too." (With caveats of "I'm not telling you to do this, just
giving you social permission to do it if you were already inclined.")
Most people trying to get you to do something this drastic and unusual don't have your
best interests at heart. They stand to benefit in some way or another. That in and of
itself is a pretty big barrier to convincing people.
How can someone benefit from kidney donation to a random stranger? They don't
have to benefit directly. If they have a value system that thinks your actions improve
(their conception of) the world, they'll usually try to argue you into it anyway.
Does this actually improve the world? Probably, at least to some extent. Does that
extent justify the health risks?
Scott's a doctor, I'm not. With my limited knowledge, my heuristics are, generally
speaking, "Keep things related to body, health, and diet as close to natural as possible,
doing medical interventions only when necessary, or where the problems are
accumulating enough to justify it." I assume that the redundancy in my kidneys is there
for a good
Expand reason and am inclined to keep it.
full comment
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Shabby Tigers 1 hr ago
While I don’t agree, I think this is a beautifully written and valuable comment.
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pozorvlak 4 hrs ago
I applaud your donation, but as for making one myself I have a deep sense of DO NOT
WANT.
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Anish Pimpley 4 hrs ago
Welcome back !
Seeing you gone for so long had me turning into a conspiracy theorist.
I'm just glad this wasn't a case of "OpenAI had invented AGI, and brought Scott in for 1
month long NDA access."
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demost_ 3 hrs ago
That's pretty close to my partner's guess, that Scott was currently "in the boss
fight with the AGI".
Great to hear about the different kind of fight. Scott's success in winning is that
he picks the right battles. Literally.
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Nuño Sempere Writes Forecasting 4 hrs ago
> as low as an 0.5 - 1% ...
Not sure which way the utilitarian calculation goes. The additional ACX time, either now
or 25 hence, is probably still fairly valuable, e.g., David Friedman is still cranking out
interesting stuff while old. But not sure how to quickly compare intellectual output to
additional QALYs now.
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avalancheGenesis 4 hrs ago
Huh, and here I wasn't sure if I was just imagining "haven't seemed to get many SSC
emails lately, what's up with that?" Worth the wait - always really enjoy posts about
your own life. Skin in the game and all that, now you've Got The Receipts in a very
concrete way. Someday if we get excellent generative AI for shows, it'd be cool to
dramatize this essay as The Alexander Kidney. Or I'll try to recast you as the hero in
Angel Beats!
...which segues into, I can't really imagine spontaneously donating a kidney to a
__complete__ stranger? Maybe a family member, probably a friend, definitely a SO,
some sort of handwavey Inner Ring calculus involved. Bad experiences with involuntary
donations make me react really poorly to bodily-autonomy-integrity violations, no
matter the utils involved. (And that was just for hair!) OTOH, being on the standard
organ-donor registry that everyone signs up for with their driver's license - yes, of
course, it's not like I'll be around to miss them at that point. I think I read somewhere
on your old blog that such organ donations went down as cars got safer, actually, and
It's A Problem...?
Description of the actual process and surgery...retroactively reassures me I made a
correct decision to cancel [other elective surgery], even if in theory there's financial
reimbursement available. I do think there's definitely some above-replacement Happy
Price which would change my mind - $100k is several years of wages for me, that's
Not Nothing, money is fungible - but other illegible costs like time and logistical hassle
can't be "repaid". Wonder if there's any potential in streamlining the approval process -
does it actually need to be several months? (I also don't understand why homeopathic
levels of mental illness would be disqualifying, unless it was of a variety particularly
prone to driving rash decisions?)
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Jeremiah Johnson Writes Infinite Scroll 4 hrs ago
Scott, as a kidney donor
A: Welcome to the club!
B: Thank you so much for writing this. This piece is going to reach a ton of people,
make waves, cause a bunch of new donations, and probably save far more people's
lives than your actual donation did.
I've chatted with Dylan Matthews about this, but there's an *extra* massive reason for
public influencers to donate their kidneys. Dylan has probably, no joke, caused
hundreds or thousands of extra donations via his articles and advocacy. The actual
impact of his specific kidney is a rounding error to the attention he's drawn. I suspect
that with your platform, the impact your donation will make is at least 100x the typical
donation.
So thank you for donating, and thanks for being vocal about it. And thanks for
supporting the Modify NOTA campaign!
If anyone is interested, I wrote about my decision to donate here:
https://www.infinitescroll.us/p/infinite-scroll-special-edition-kidney. I'm happy to
answer any questions anyone may have.
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Turtle 3 hrs ago
First off: congratulations Scott! A tremendous thing to do, and I admire your speaking
openly about it and encouraging others to do the same.
The CT scan/risk of cancer struck me as unbelievable! I do try to avoid CT scans on
patients younger than 40, but I always put the risk as closer to 0.05% - 0.1% per scan
rather than nearly 0.5% as your girlfriend calculated. I did a deep dive into this once for
pregnant women and I remember the 5% per Sievert thing coming up there (risk to the
fetus of childhood cancers, if Mum gets a CT.) Are we definitely sure this is for adults? I
did a quick Google just now and clicked on the usual suspects - Scientific American
says "a single CT scan increases the average patient's risk of developing a fatal tumor
from 20 to 20.05 percent." WebMD: "the chance of getting a fatal cancer from any one
CT scan is about 1 in 2,000." Memorial Sloan Kettering: "0.05 percent, or less than one
in 2,000 — of possibly developing a future cancer."
Obviously I would love to see a deep dive into this topic!
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Scott Alexander 3 hrs ago · edited 3 hrs ago Author
A multiphase abdominal CT is 30 mSv, compared to 7 for a standard chest CT, so
if the upper end of your number is right for the average CT, my number is
approximately right for the multiphase abdominal that I was considering.
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Turtle 1 hr ago
Interesting. Multiphase is getting you up to whole body combined CT/PET
scan levels.
 Even if it’s 1/500 (0.2%) this is overwhelming the operative risk and should
probably be emphasised much more in the consent process.
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Jia Yinglei Writes Jia’s Newsletter 3 hrs ago
1. Kudos on the Vox journalist line, made me genuinely giggle uncontrollably at work.
2. Kind of strange, I've been involved with EA for awhile, donated a lot of my (meager)
income to charity, and, given the opportunity, would happily take some risks for
altruistic purposes. But I still haven't got past kidney donation to a stranger sounding
absolutely ridiculous. You can do something just bloody horrible, slightly dangerous
(possibly including a bunch of risks you're not taking into account), not at all fun/
exciting, with lower altruistic cost-effectiveness than working and donating to an
effective charity... If the effectiveness calculations looked incredible, I would be at least
persuaded that it's a morally good idea, but as it is, it feels more like the kind of
socially contagious masochism that EA should be trying to avoid.
3. When I was travelling in Northeast China near the Korea border, I spoke to a cleaner
in a cheap hotel. He asked me: "Where are you from?" "The UK", "Ah, can you sell
kidneys in the UK?", "No, there might be a black market, but it's illegal", "Ah". Then the
conversation ended.
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Deiseach 3 hrs ago
Well, first of all, congratulations! There's kidney disease in my family, and yes my
cousin died several years down the line after a transplant, so it doesn't mean you can
live your normal lifespan. But without it you'd probably be dead, so better a few more
years of life than nothing, right?
"They found 34 extra cases of ESRD (end-stage renal disease, the most severe form of
kidney disease) per 10,000 donors who were related to their recipients, compared to
15 cases per 10,000 for donors who weren’t (the difference wasn’t statistically
significant, but I think it’s still correct for unrelated donors to use the unrelated donor
number)."
I imagine if you're donating to a relative, that means there's already a higher risk of
kidney disease in the family, so the risk would be increased. As for the risk for donors
overall, that may well be because if you have two working kidneys, and then down the
line one of them conks out, the other can pick up the slack. But if you only have one
working kidney and it starts to fail, then you develop the problems faster and worse.
But it truly was a charitable deed so well done!
I'll only take this one little pop at the Brits, so the castle was the cheapest option?
Perhaps, but did they factor in (1) the bad visuals this would produce, so hampering
their efficacy because this will turn off the public from donating to them and (2) how
do other organisations manage? Are they all out there renting/buying castles, or do
they somehow manage to find some kind of conference centre that won't rip them off?
I have a feeling that the British EAs had too high an expectation for what they would
find acceptable in a conference centre, and coming across a castle they may have
found ways to justify "wouldn't it be really cool if we had our own castle?" Boring,
bland, beige big room in a hotel may not be anywhere near as glamorous, but I find it
difficult to believe it would be that hugely more expensive. I do feel there has been
some creative accounting of the "sure, it *seems* like a huge expenditure, but if you
take it that over the next twenty years we'll be hiring conference centres at a cost of
£X,000 each time, and you multiply £X,000 times Y conferences to get a total cost of
£Z00,000 then by comparison, a one-time purchase comes off cheaper".
Yes, you're not paying £X,000 a go for each conference, but now you have a castle to
maintain and upkeep, and that's gonna cost.
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Deiseach 3 hrs ago
"I thought I was going to be able to do a good deed that I’d been fantasizing about for
years, and some jerk administrator torpedoed my dreams because I had once, long
ago, had mild mental health issues."
That's hard. But on the other hand, you live in America. The most litigious nation in the
world. Where cities sue car manufacturers because their cars are too easy to steal
(Chicago, Baltimore and New York bringing lawsuits against Kia and Hyundai). I'm
tempted to say "well in a sane country, you'd blame the criminals for stealing, instead
of blaming people for not making their products too difficult to steal" but that would be
unkind?
You could swear up, down and sideways that you really want to do this and you're a
grown and sane adult and you are doing this of your own free will, but they have no
guarantee that five weeks after the operation they won't get a solicitor's letter looking
for zillions in damages because they took advantage of a mentally vulnerable
individual. Hence, the magic therapy requirement: it's covering their backsides in case
of legal action so they can point to "we required him to go to therapy to make sure he
wasn't crazy", not for your or any other potential donors' welfare.
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K. Liam Smith Writes Data Taboo 1 hr ago
> I'm tempted to say "well in a sane country, you'd blame the criminals for
stealing, instead of blaming people for not making their products too difficult to
steal" but that would be unkind?
 I friend of mine blew up at me for saying almost exactly this. I could see this
getting generalized in very weird ways.
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Curious mathematician 3 hrs ago
Typo: "have still" -> "still have"
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traumtaenzer 2 hrs ago
Dear Scott,
it was interesting to read about the low risks of kidney donation as well as the thought
process you went through. What I am sceptical about is wether paying people for
kidney donations would actually be the best systemic solution for dealing with kidney
failure. I don’t have numbers on the following and you are probably much better at
doing the research on that, but as far as I know most kidney failure is related to other
diseases (like diabetes II or hypertension) the genesis if which is closely related to
lifestyle/ living conditions and can well be prevented. Do wouldn’t the best systemic
intervention be to create living conditions that allow people of all classes to make
healthy choices without additional expenses? (like modifying taxes on certain foods or
forbidding them once they have been proven to be harmful - like high fructose corn
syrup - or reorganising supermarkets and advertisement in a way that doesn’t ruin
lives for the profit of certain industries…) Or even investing more money on alternative
treatments for infectious diseases that would allow to use nephrotoxic antibiotics less
often?
Those are just some naïve thoughts of a European, but I would be curious your
prognosis on those interventions vs. paid kidney donations.
Kind regards!
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Shabby Tigers 51 mins ago
Slow chronic kidney function decline is almost universal with aging, as is true of
other chronic cardiometabolic problems. How bad it gets, and how early it gets
bad, is highly multifactorial and can’t be cleanly ascribed to lifestyle. There is a
complex interplay among different aspects of the metabolic syndrome, as well as
their best-practice treatments, such that the causality arrows don’t always fall in
the places and orientations you might assume. The subset of severe kidney
failures that occurs in young people with really obvious lifestyle risk factors
certainly exists, and is very visible and salient if you are looking for it. I question
whether health policymaking should treat it as the conceptual starting point for
thinking about kidney failure management.
 I think from the examples you suggest that you aren’t yourself very prone to a
punitive gatekeeping mindset, and I don’t want to impute one to you, but I don’t
trust broad policy strategy to be developed without one if pursued along these
lines. Rather than little tax nudges or occasional judicious ingredient regulations, I
foresee non-judicious ingredient regulations (ie, proliferating sweeping bans: as
an American who is now German, food and drug regulation strikes me as already
overzealous here; the 180 degree opposite of wrong is not always right) as well as
draconian treatment eligibility crackdowns, which to your credit you don’t
recommend but which seem to me fairly likely results of a broad shift toward this
kind of approach. I don’t even think you’re wrong. I just worry about it.
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Reginald K. 2 hrs ago
As someone who started looking into thuisbankier reading Mathews’ article and was
then beset by akrasia, I want to give this another go. Does Waitlist Zero have
counterparts in Europe (specifically the Netherlands)? Their contact form asks for a US
address.
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Jigs Gaton Writes Herojig Cartooning and Ballooni… 2 hrs ago
Wow, amazed at the quality of writing here. that one blew me away. i had no idea, but
have known many in my life who both donated and received kidneys... and i think i
knew one whose left one was stolen. But as a non-Dr, and with a RN Nurse sister, I can
say this for others, "We don't trust u." Flat out. No trust. Nada. Not for giving blood
anymore and not for anything while alive. Sure, harvest everything you can once I am
brain-dead, but stay the F away from me until then. Yes, it's that bad. I've been here
almost 70 years, and seen shit I still can't believe happen in field hospitals to the best
America the world can offer. And now ya got your AI to cut with, so I'm out just from
that point alone. You should be really aware about what goes on in the medical-device
industrial-complex before you let one of those things tear into ya. FDA? ha. They have
better inspections here in Nepal, even with our ragtag group of clipboards and ink
stamps. Hate to break ur bubble, but great writing, nonetheless!
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Yug Gnirob 2 hrs ago
Reading this reminds me of Shamus Young's blood pressure/kidney problem posts,
which he died from last year.
https://www.shamusyoung.com/twentysidedtale/?p=52745
These are the recipients.
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Mark P Xu Neyer (apxhard) Writes apxhard 1 hr ago
> No matter how contrarian you pretend to be, deep down it’s hard to make your
emotions track what you know is right and not what the rest of the world is telling you.
This sounds to me like it was written by someone with an very different internal
experience than me.
Do you actually feel like you “know what’s right”?
My experience is I often have conflicting notions of what is or isn’t right, and “the rest
of the world” isn’t telling me one thing or another - it’s a confusing mass of shouting
from different groups of loud, confident, intelligent sounding people all explaining why
the other groups are stupid and evil.
Sometimes, I’ll see someone do a thing, or be a certain way, and think, wow, that
seems right and good and noble, and I want to imitate that way of being. But to me this
is like a non deterministic Turing machine that cannot find the truth (it takes too long!)
but is sometimes capaable of recognizing specific instances of it.
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Christopher Moss 1 hr ago
If you want to save multiple lives and not discover that falling GFR in older age is twice
as bad with one kidney (it is, obviously!), donate blood and get on the bone marrow
database. You really can make a huge difference. I'm alive today because a delightful
young man in Germany gave me some bone marrow stem cells. Yes, that makes me
biased, but it's a no-brainer! I used to be a blood donor back in the UK, but here in
Canada they didn't want my blood as I'd lived in the UK in the early 1980s - risk of mad
cow disease. Moo! They wouldn't take it anyway, now, having leukemia.
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Bob Frank Writes Forewarned Is Forearmed 1 hr ago
> (obviously saints can do good things without needing psychological permission first,
but not everyone has to be in that category, and I found it easier to get the
psychological permission than to self-modify into a saint.)
“Assume a virtue, if you have it not.
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery
That aptly is put on. Refrain tonight,
And that shall lend a kind of easiness
To the next abstinence; the next more easy;
For use almost can change the stamp of nature.”
― Hamlet, William Shakespeare

Having said that, there's one thing that the article never went into that you'd kind of
think would be front and center in any talk about transplants: rejection and
management thereof. If you give someone a new kidney but at the same time condemn
them to a lifetime of immunocompromise, how much have you really improved their
quality of life? The more you look at transplants, the more they look like a really terrible
thing that we only do because it's the least-bad option available at the moment, the
kind of thing that Dr. McCoy would scoff at and accuse us of being barbarians living in
the Dark Ages for practicing.
Out of curiosity, (I genuinely don't know and would be interested in finding out if
anyone's looked at this,) has there been any research done on questions along the
lines of "would it be more effective to donate a kidney and help one recipient, but we
know it works, or to fund stem cell research into own-organ cloning which could end
up solving the problem for everyone but is currently hypothetical?"
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Metacelsus Writes De Novo 59 mins ago
1. Everyone knows we need a systemic solution, and everyone knows what that
solution will eventually have to be: financial compensation for kidney donors.
Over the longer term, I'm highly optimistic about bioengineered human-compatible
kidneys grown in pigs.
2. I was getting worried when Scott didn't post much over the last few weeks. Now I
know why! And it's a very commendable reason. Thank you Scott for donating!
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Mr. Doolittle 54 mins ago
For what it's worth, I know two people who have recently gone through the process.
One dropped out late in the process, and the other successfully donated their kidney.
This is in the last ~6 months.
The one that dropped out felt very pressured by friends and family, and realized they
were not in a good life place to take the time off of work. I think they were scared as
well.
The one who donated seemed to have a fine time and was back at work well before
expected.
Both reported that a charity was going to pay their expenses, including lost wages. For
the one that went through with it, that seems to have worked exactly as advertised.
 REPLY SHARE
Paula Amato 44 mins ago
Kind of related. I’ve always thought that “opt-out” (instead of opt-in) organ donation
on driver’s licenses for example, would help increase the supply of organs including
kidneys. But when I’ve talked to healthcare economists about it, they say it’s a bad idea
because it would bankrupt the health care system given the high cost of these
surgeries and the aftercare. Thoughts?
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averagethinker 14 mins ago
Obviously the castle people could have found cheaper, drabber options, and guests
would've been fine with it. I doubt there's a warehouse shortage. It seems EA folks
haven't learned much from FTX.
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averagethinker 12 mins ago
There's an implicit Peter Singer argument in here somewhere. I only have one kidney to
give, so by giving it to a stranger, I can no longer give it to a family member.
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Blowtorch Writes Blowtorch's Public Service Anno… 10 mins ago
Very honest post. I hope you get the likes from people you were looking for by
donating your kidney!
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