Missing work, recovery time, surgical risk, anesthesia risk, pain, having someone care for you while you recover, medication side effects, nosocomial infection - there are plenty of reasons to hesitate to have major abdominal surgery when you are healthy. Helping others is a generous thing to do, but there is quite a bit of risk to consider. I’ve had abdominal surgery twice and both times it was very painful, and I had a prolonged recovery. I think it’s very normal to consider the impact on your own life.
Not for me and not for others. Enough of humans wanting to extend life beyond normal biological longevity and F the Medical Industrial Complex who sacrifice HEALTH for profit-based endeavours.
I find reason #2 here to be most compelling. All medical interventions represent a balance of risk vs benefit. Indeed, ensuring the patient grasps that balance is at the heart of informed consent. So a medical procedure where there is zero likelihood of benefit to the patient does cast that procedure in an unflattering light.
This and Dr. Satel’s earlier post are excellent examples of presenting both sides of a medical and moral quandary where both authors argue their case without strawmanning the contra position.
First of all, sure I'd give a kidney to a relative. My kids. A stranger? No. So if that's what's being polled is really "25-50% of Americans say they would give a kidney to a friend, relative, or stranger," then you're misusing the poll to ask why more people aren't giving them to strangers. Why haven't I donated mine? Because thank God, my kids don't need it right now.
Also, I think the truth is that you would like to think that you would but when pushed to actually go through with it, you decide not to. I'm sure that back when I was young and naive, I thought I didn't need two kidneys, but in the back of my head, I figured you never know. But here we are at age 50 with bubbles on my pee realizing that maybe I've already got kidney issues. How bad would it have been if I'd already given away one of them? Life lesson learned - I don't assume anymore that I will be healthy enough to get by without some of my organs.
Donating a kidney that you might need requires caring more about that other person than your own life. I truly admire those who can do that for a stranger. But for me, I'm just trying to keep going as long as I can for the sake of those I do know - my family.
"She cites a 2013 poll saying that 25-50% of Americans say they would give a kidney to a friend, relative, or stranger, and compares this to the number who actually do so, which in 2024 was 545."
Several thousand people donate kidneys to friends and family every year. The 545 is just undirected live donations, ie to strangers.
I have pondered that question and others for years. I don't know. For me, it was cowardice. So to make up for this I have decided to donate my body to medical school, postmortem of course.
My daughter just recently received a kidney. The background investigations, getting organs, type and crossmatch over and over again, the race and cajoling to have that kidney in their hospital... To me it looks like a football game sans physical contact. The surgery itself, and then of course recovery, PT, OT.
It is a miracle this can happen and it happened to my daughter. The donor for her we are not aware of at this time. But after going through all of this, tx for HTN, blood work, medication balancing, PD QHS, and then, of course, the waiting for that one call that will change her life forever. It's because of all that I put organ donors high on the list of saints.
I did offer to donate but I'm too old, I have HTN. I asked if that would take mine postmortem, and the answer was still no.
Thank you donors from the bottom of my heart for giving quality of life to others.
I am a recently retired nephrologist and worked in transplantation for almost 40 years. First, her numbers are wrong. There were 6,418 living donor kidneys transplanted in the US in 2024
To understand the problem, step back and look at all the kidney transplant centers and compare deceased donor kidneys transplanted to living donor transplants. You will see a broad range. Some centers do many more LD transplants than others. Why? Vigorous LD programs have a culture to promote living donation. To increase LD numbers, under performing centers could study and emulate high performing centers. This culture change can have a much greater impact on LD’s done than rewarding donors.
When evaluating LD’s the physician needs an honest history to accurately assess donor risk. If the donor has their eye on the reward it may very well impact their transparency.
In short, change the culture of transplant centers and the number of LD transplants will increase.
Great information - thanks for that perspective. With all the pontification about what might help shift these numbers, it is nice to hear from an expert who sees a rather obvious solution that has not been mentioned. And your suggestion seems to have little downside, will be the quickest way to move forward. Hope this is going on at the various transplant centers.
One wonders whether Margaret and Adam and all the others wringing their hands over this have themselves donated kidneys.
Here's the thing about the polls: Many people like to think of themselves as good, altruistic people. And they are, to the extent that altruism doesn't cost them too much. But giving up an internal organ, particularly if it's to someone you don't have a close personal relationship with, is a big ask. It shouldn't be surprising that people don't actually go through with it.
I would give a kidney to someone I loved, with a few caveats: There has to be a reasonable rate of return on quality and quantity of life. As much as I love my 82-year-old father, he's not getting my kidney.
The second caveat, and this is a factor the author doesn't consider, is whether the organ failure is a result of poor life choices that are likely to continue. This is admittedly more of a factor in something like liver failure, but the last thing I want to do is slice myself open and give a precious body part to someone who isn't likely to take care of it.
As for a random stranger, no. A kidney donation should be a gift, given out of love and not obligation. While I wouldn't say I have no concern for strangers, it is not the same level of care and affection I feel toward my friends and family. There's no shame in that—it's simply how our bodies and brains work. There will always be death and suffering; it's hubristic to think we're going to end all of it.
As for paying kidney donors...this is likely to end up like surrogacy, creating a market where the wealthy pay for the bodies of the desperately poor, creating even more of an imbalance in the distribution of health and wellness.
Thank you Rebekah. It reminds me of the times I've been asked why I give money to the homeless on the street. People say that the person will use it to go buy a bottle, or a small pack of the "white stuff". I say, so what. What if getting that bottle with my money saves him/her from going through the DTs. What if my money bought that packet of cocaine saved that person from detoxing. When something is given it is not our place to think of how that receiver will use it. A gift is not a gift if it comes with strings.
Interesting perspective, obviously (and reasonably) shared by many. But I don't typically think of giving a homeless person a "gift". "gift" is a bit more intimate and generally implies some sort of relationship or at least some affection between two people.
A handout seems a better term - also given without strings or expectation, but not with a sense of relationship or connection.
Donating a kidney doesn't fit either label perfectly. Too big to just be a "gift" and definitely more meaningful than a "handout". Sacrifice is a reasonable word. Probably other aspects to form a comprehensive definition.
With most of these things, considering broader aspects (especially when not "in the moment") can be helpful. I've occasionally given money to a homeless person - when coming face to face with human suffering or downtrodden state it is good to feel compassion, which I do. But it helps to consider aspects of "gifts" or handouts - what if you just enable and prolong an ineffective way to get through life as opposed to helping them avoid problems. I don't want to be someone who enables ongoing suffering either - so generally try to avoid the urge to "help" in the moment.
We can (and often should) absolutely consider how the person will "use our gift" - the decisions best made ahead of time. Consider parents who fall into a trap of being unable to stop "gifting" money to their adult children, enabling them to avoid responsibilities that come with adulthood. Not a good "gift".
I believe that anything I give to another person is an intimate gesture, if not on both sides than just me.
I agree with DocH when giving to an adult child who is able and won't is enabling.
And, lastly, I truly despise semantics. I grew up in a culture where people blurted out what they wanted to say. If they used the word, "crazy", I don't sit and ponder what exactly were they trying to say. Things like any number of diagnoses and conditions in the DSM-5. If the person expounds - great, if not - great.
Now, having said all of that I do enjoy digging deeper for a word that matches exactly what I'm thinking. But that time is few and far between anymore.
I hear you. Was trying to avoid true semantics debate. I guess my bottom line is we generally consider bigger picture before giving a gift or handout and then make decision it is a good thing to do. Reasonable from a variety of perspectives to both give and for others to decide not giving is more humane thing to do.
I agree with your thoughts that "cowardice' plays a role - but probably a fair and human desire to avoid unnecessary pain/discomfort/hassle. I put off my own elective surgery - I just don't want to go through it all until I can't avoid.
I agree that we do look at the bigger picture-I said as much in my reply to Linda—and while I think the nature of “gift” vs handout or whatever is semantics, but agree that there’s a difference between giving someone money (in the case of a homeless person, usually a small amount) and giving a large amount of money or a kidney, which may require increasing degrees of sacrifice.
Of course, when it’s a big gift (or donation or whatever) like that you should consider how it’s going to be used and whether that’s something you want to contribute to. That was the point I was making in my original comment. But once you give, the healthiest thing to do, for your own peace of mind, is let go of expectations and sense of feeling the recipient owes you. Otherwise it’s a dishonest transaction, not a donation or gift.
I agree. I have absolutely given money to the homeless with this attitude before. And I agree that giving should be done without strings or obligations. That said, I can’t say that I never think about how my gift might be used. As I said, I don’t want to give a kidney to someone who won’t take care of it. I only give when I can do so freely, with no demands or expectations. And if it doesn’t feel right or wholehearted to give, I don’t give, and I don’t beat myself up over it.
Seems to me it is much easier to answer the question “why don’t more people become living donors” than “why can’t we pay people for their kidneys”.
Each person who goes through living donation seems to me has a very special set of characteristics. Tremendous altruism with or without special circumstances (donating to your offspring).
Anyone know what is the number of living donors NOT donating to a friend or loved one?
We don't donate because we can't afford to. Not enough time off given in the US, threat of losing the job if we do. No savings, no safety net, only downsides to the living donor. The reasons given in the article are written from the perspective a a white collar worker who can afford to. Really lopsided opinion piece.
I am intrigued by some of the vitriol in the comments. A lot of anger can cloud sensible thinking, although I completely understand much of where it comes from. As I read, sadly an old phrase came to mind that my gruff old Marine father used to say, “I ain’t cheap but I can be had…” Sadly in these times that might be the only solution.
I don't want to be an organ donor because they can take your organs when you're still alive.
It's been done quite often —and I'm not interested in that. Am I really dead? Maybe not. Oh well, harvest organs. Organs aren't valuable from a dead person.
And:
If they just paid people for their organs, there wouldn’t be a problem.
Why doesn’t the free market work in the case of organ donation?
Of course it works—
I don’t see anything wrong with people being able to sell their organs when they’re dying...
The issue with lack of donors is that it is not a free market.
The article is about living-donor donations—healthy people donating an organ that they theoretically can spare. That has nothing to do with the donation of organs at death or with the definition of death.
My unvaccinated family took our names off. We refuse to support a system that actively forced us to take invasive tests and kept us from activities because we aren’t vaccinated. Let all the mRNA vaccinated die. We don’t care.
Excellent discussion. A good friend of mine was, through a miraculous sequence of events, able to qualify and donate her kidney to a brother-in-law. Both were in their sixties, and the recipient died less than a year after the donation. Of course, the health of the recipient had everything to do with the subsequent demise. The care of both patients was exceptional, and the donor will receive ongoing care as usual for donation. There is everything right about this scenario, and yet in medicine, the outcome is not always guaranteed. Tyranny, yes, and yet medical progress has always been about failure as much as success.
Missing work, recovery time, surgical risk, anesthesia risk, pain, having someone care for you while you recover, medication side effects, nosocomial infection - there are plenty of reasons to hesitate to have major abdominal surgery when you are healthy. Helping others is a generous thing to do, but there is quite a bit of risk to consider. I’ve had abdominal surgery twice and both times it was very painful, and I had a prolonged recovery. I think it’s very normal to consider the impact on your own life.
Not for me and not for others. Enough of humans wanting to extend life beyond normal biological longevity and F the Medical Industrial Complex who sacrifice HEALTH for profit-based endeavours.
I find reason #2 here to be most compelling. All medical interventions represent a balance of risk vs benefit. Indeed, ensuring the patient grasps that balance is at the heart of informed consent. So a medical procedure where there is zero likelihood of benefit to the patient does cast that procedure in an unflattering light.
This and Dr. Satel’s earlier post are excellent examples of presenting both sides of a medical and moral quandary where both authors argue their case without strawmanning the contra position.
First of all, sure I'd give a kidney to a relative. My kids. A stranger? No. So if that's what's being polled is really "25-50% of Americans say they would give a kidney to a friend, relative, or stranger," then you're misusing the poll to ask why more people aren't giving them to strangers. Why haven't I donated mine? Because thank God, my kids don't need it right now.
Also, I think the truth is that you would like to think that you would but when pushed to actually go through with it, you decide not to. I'm sure that back when I was young and naive, I thought I didn't need two kidneys, but in the back of my head, I figured you never know. But here we are at age 50 with bubbles on my pee realizing that maybe I've already got kidney issues. How bad would it have been if I'd already given away one of them? Life lesson learned - I don't assume anymore that I will be healthy enough to get by without some of my organs.
Donating a kidney that you might need requires caring more about that other person than your own life. I truly admire those who can do that for a stranger. But for me, I'm just trying to keep going as long as I can for the sake of those I do know - my family.
There might be another reason more don't donate; they're not asked.
"She cites a 2013 poll saying that 25-50% of Americans say they would give a kidney to a friend, relative, or stranger, and compares this to the number who actually do so, which in 2024 was 545."
Several thousand people donate kidneys to friends and family every year. The 545 is just undirected live donations, ie to strangers.
I have pondered that question and others for years. I don't know. For me, it was cowardice. So to make up for this I have decided to donate my body to medical school, postmortem of course.
My daughter just recently received a kidney. The background investigations, getting organs, type and crossmatch over and over again, the race and cajoling to have that kidney in their hospital... To me it looks like a football game sans physical contact. The surgery itself, and then of course recovery, PT, OT.
It is a miracle this can happen and it happened to my daughter. The donor for her we are not aware of at this time. But after going through all of this, tx for HTN, blood work, medication balancing, PD QHS, and then, of course, the waiting for that one call that will change her life forever. It's because of all that I put organ donors high on the list of saints.
I did offer to donate but I'm too old, I have HTN. I asked if that would take mine postmortem, and the answer was still no.
Thank you donors from the bottom of my heart for giving quality of life to others.
I am a recently retired nephrologist and worked in transplantation for almost 40 years. First, her numbers are wrong. There were 6,418 living donor kidneys transplanted in the US in 2024
To understand the problem, step back and look at all the kidney transplant centers and compare deceased donor kidneys transplanted to living donor transplants. You will see a broad range. Some centers do many more LD transplants than others. Why? Vigorous LD programs have a culture to promote living donation. To increase LD numbers, under performing centers could study and emulate high performing centers. This culture change can have a much greater impact on LD’s done than rewarding donors.
When evaluating LD’s the physician needs an honest history to accurately assess donor risk. If the donor has their eye on the reward it may very well impact their transparency.
In short, change the culture of transplant centers and the number of LD transplants will increase.
Charles Wright MD
Tampa FL
Yes, but how many of those donations at high-LD centers are to strangers? I suspect it's a small number compared to relatives and friends.
Great information - thanks for that perspective. With all the pontification about what might help shift these numbers, it is nice to hear from an expert who sees a rather obvious solution that has not been mentioned. And your suggestion seems to have little downside, will be the quickest way to move forward. Hope this is going on at the various transplant centers.
One wonders whether Margaret and Adam and all the others wringing their hands over this have themselves donated kidneys.
Here's the thing about the polls: Many people like to think of themselves as good, altruistic people. And they are, to the extent that altruism doesn't cost them too much. But giving up an internal organ, particularly if it's to someone you don't have a close personal relationship with, is a big ask. It shouldn't be surprising that people don't actually go through with it.
I would give a kidney to someone I loved, with a few caveats: There has to be a reasonable rate of return on quality and quantity of life. As much as I love my 82-year-old father, he's not getting my kidney.
The second caveat, and this is a factor the author doesn't consider, is whether the organ failure is a result of poor life choices that are likely to continue. This is admittedly more of a factor in something like liver failure, but the last thing I want to do is slice myself open and give a precious body part to someone who isn't likely to take care of it.
As for a random stranger, no. A kidney donation should be a gift, given out of love and not obligation. While I wouldn't say I have no concern for strangers, it is not the same level of care and affection I feel toward my friends and family. There's no shame in that—it's simply how our bodies and brains work. There will always be death and suffering; it's hubristic to think we're going to end all of it.
As for paying kidney donors...this is likely to end up like surrogacy, creating a market where the wealthy pay for the bodies of the desperately poor, creating even more of an imbalance in the distribution of health and wellness.
Thank you Rebekah. It reminds me of the times I've been asked why I give money to the homeless on the street. People say that the person will use it to go buy a bottle, or a small pack of the "white stuff". I say, so what. What if getting that bottle with my money saves him/her from going through the DTs. What if my money bought that packet of cocaine saved that person from detoxing. When something is given it is not our place to think of how that receiver will use it. A gift is not a gift if it comes with strings.
Interesting perspective, obviously (and reasonably) shared by many. But I don't typically think of giving a homeless person a "gift". "gift" is a bit more intimate and generally implies some sort of relationship or at least some affection between two people.
A handout seems a better term - also given without strings or expectation, but not with a sense of relationship or connection.
Donating a kidney doesn't fit either label perfectly. Too big to just be a "gift" and definitely more meaningful than a "handout". Sacrifice is a reasonable word. Probably other aspects to form a comprehensive definition.
With most of these things, considering broader aspects (especially when not "in the moment") can be helpful. I've occasionally given money to a homeless person - when coming face to face with human suffering or downtrodden state it is good to feel compassion, which I do. But it helps to consider aspects of "gifts" or handouts - what if you just enable and prolong an ineffective way to get through life as opposed to helping them avoid problems. I don't want to be someone who enables ongoing suffering either - so generally try to avoid the urge to "help" in the moment.
We can (and often should) absolutely consider how the person will "use our gift" - the decisions best made ahead of time. Consider parents who fall into a trap of being unable to stop "gifting" money to their adult children, enabling them to avoid responsibilities that come with adulthood. Not a good "gift".
I tend to lean more on how Rebekah views things.
I believe that anything I give to another person is an intimate gesture, if not on both sides than just me.
I agree with DocH when giving to an adult child who is able and won't is enabling.
And, lastly, I truly despise semantics. I grew up in a culture where people blurted out what they wanted to say. If they used the word, "crazy", I don't sit and ponder what exactly were they trying to say. Things like any number of diagnoses and conditions in the DSM-5. If the person expounds - great, if not - great.
Now, having said all of that I do enjoy digging deeper for a word that matches exactly what I'm thinking. But that time is few and far between anymore.
I hear you. Was trying to avoid true semantics debate. I guess my bottom line is we generally consider bigger picture before giving a gift or handout and then make decision it is a good thing to do. Reasonable from a variety of perspectives to both give and for others to decide not giving is more humane thing to do.
I agree with your thoughts that "cowardice' plays a role - but probably a fair and human desire to avoid unnecessary pain/discomfort/hassle. I put off my own elective surgery - I just don't want to go through it all until I can't avoid.
Appreciate your perspective!
I agree that we do look at the bigger picture-I said as much in my reply to Linda—and while I think the nature of “gift” vs handout or whatever is semantics, but agree that there’s a difference between giving someone money (in the case of a homeless person, usually a small amount) and giving a large amount of money or a kidney, which may require increasing degrees of sacrifice.
Of course, when it’s a big gift (or donation or whatever) like that you should consider how it’s going to be used and whether that’s something you want to contribute to. That was the point I was making in my original comment. But once you give, the healthiest thing to do, for your own peace of mind, is let go of expectations and sense of feeling the recipient owes you. Otherwise it’s a dishonest transaction, not a donation or gift.
yes, agree.
Thanks Doc
I agree. I have absolutely given money to the homeless with this attitude before. And I agree that giving should be done without strings or obligations. That said, I can’t say that I never think about how my gift might be used. As I said, I don’t want to give a kidney to someone who won’t take care of it. I only give when I can do so freely, with no demands or expectations. And if it doesn’t feel right or wholehearted to give, I don’t give, and I don’t beat myself up over it.
Seems to me it is much easier to answer the question “why don’t more people become living donors” than “why can’t we pay people for their kidneys”.
Each person who goes through living donation seems to me has a very special set of characteristics. Tremendous altruism with or without special circumstances (donating to your offspring).
Anyone know what is the number of living donors NOT donating to a friend or loved one?
We don't donate because we can't afford to. Not enough time off given in the US, threat of losing the job if we do. No savings, no safety net, only downsides to the living donor. The reasons given in the article are written from the perspective a a white collar worker who can afford to. Really lopsided opinion piece.
I am intrigued by some of the vitriol in the comments. A lot of anger can cloud sensible thinking, although I completely understand much of where it comes from. As I read, sadly an old phrase came to mind that my gruff old Marine father used to say, “I ain’t cheap but I can be had…” Sadly in these times that might be the only solution.
Maybe I misread something, but about 7000 kidneys were donated by live donors last year. So what is the 545 number?
I don't want to be an organ donor because they can take your organs when you're still alive.
It's been done quite often —and I'm not interested in that. Am I really dead? Maybe not. Oh well, harvest organs. Organs aren't valuable from a dead person.
And:
If they just paid people for their organs, there wouldn’t be a problem.
Why doesn’t the free market work in the case of organ donation?
Of course it works—
I don’t see anything wrong with people being able to sell their organs when they’re dying...
The issue with lack of donors is that it is not a free market.
The article is about living-donor donations—healthy people donating an organ that they theoretically can spare. That has nothing to do with the donation of organs at death or with the definition of death.
My unvaccinated family took our names off. We refuse to support a system that actively forced us to take invasive tests and kept us from activities because we aren’t vaccinated. Let all the mRNA vaccinated die. We don’t care.
Excellent discussion. A good friend of mine was, through a miraculous sequence of events, able to qualify and donate her kidney to a brother-in-law. Both were in their sixties, and the recipient died less than a year after the donation. Of course, the health of the recipient had everything to do with the subsequent demise. The care of both patients was exceptional, and the donor will receive ongoing care as usual for donation. There is everything right about this scenario, and yet in medicine, the outcome is not always guaranteed. Tyranny, yes, and yet medical progress has always been about failure as much as success.