Would you give up a kidney to save the life of an anonymous stranger? Me neither. (I’m too squeamish even to donate blood.) But some people would. In fact, nearly 1,000 people in the UK have given up theirs, not because they’ve been moved to act by an individual’s appeal for help, but as “non-directed altruistic kidney donors”, where the donation is made to the national transplant list. In some cases, donations do lead to donor and beneficiary meeting and even becoming friends, but often the two never cross paths. It is perhaps as close to altruism – that is, selfless concern for the wellbeing of others – as you can get.

Most of us will find it very hard to imagine taking that step. To others – given that a healthy person can live perfectly well with just one kidney – it seems crazy not to do it. 

Zell Kravinsky, an American kidney donor interviewed at length about his decision, explained his logic. For him there was a risk of one in 4,000 of dying during the operation, while the recipient faced “certain death” without a donation, he told The New Yorker in 2004. He added: “I’d be valuing my life at four thousand times hers if I let consideration of mortality sway me”. (UK sources now quote a one in 3,000 risk, similar to the risk of death during appendix removal.) In another interview, Kravinsky argued that, just as no one should have a holiday home until everyone has a place to live, no one should have two kidneys until everyone has one.

He had already given away much of his wealth – not unheard of, particularly within the effective altruism movement, a utilitarian approach that argues we should do the most good we can. But Kravinsky took that to a pretty extreme level. He described kidney donation as a necessity, not a choice. He went ahead with it despite his wife’s opposition, sneaking out to the hospital one morning and only telling her after the operation. Later, he even talked of giving away his other kidney and living on dialysis, if the life he could save was of more value than his own.

His arguments make for uncomfortable reading. But the underlying logic is hard to dispute. In the UK, around 250 people in need of a kidney die every year, and more than 5,500 are on the NHS waiting list for a transplant, according to the charity Give a Kidney. And one donation could actually save several lives, by triggering a chain of transplants. For example, you’d donate to a person in need whose relative was willing to donate but incompatible; that relative would then agree to donate to another person in need with whom they are compatible, whose incompatible relative would donate to another, and so on. The sharing scheme can also happen by matching up incompatible pairs: this is a fascinating story about how it all comes together. 

So what motivates some people to go through with a procedure that is at best painful and disruptive, and where they may not even be thanked at the end of it? ‘Warm-glow giving’ is one theory to explain why we help others – we give because it feels good. That’s a different motivation to pure altruism. But maybe highly altruistic acts also create something like warm glow. As Kravinsky put it: “However I screw up morally in the future, this is something nobody can take away”. He even began to think of his donation as “a treat” for himself, “something pleasurable”, according to The New Yorker. Research on ‘super-altruists’ echoes this. Those who go to extreme lengths to help others do not see this as a sacrifice but as a price worth paying – which is “personally satisfying” to them, as social psychologist Tom Farsides writes. 

But altruism is not an unambiguously and universally good thing, Farsides explains. For example, those who risked their lives to rescue Jews from Nazi persecution are often considered “exemplars of super-altruism”. This was not the view of one mother of a rescuer: she said her daughter was selfish and irresponsible for risking the safety of her own children. And in some forms, it can encourage bias and even animosity. “Social campaigners can neglect their families; heroes can risk leaving their children orphaned to save strangers’ lives; champions of freedom and justice can be willing to kill for their cause,” writes Farsides. “The more extreme the altruism, the more likely it is that extreme risks and costs will be accepted in pursuit of the welfare of those who altruists care most about.” 

The super-altruists are fascinating, and their actions challenge the rest of us to think a little differently. But altruism without responsibility, including towards oneself, might not work out so well.

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