Since reading about Zell Kravinsky several years ago, I have toyed with the idea of donating one of my kidneys to help someone else in need. After finally devoting some time to think about the issue more carefully, I have concluded that the kidney should be sold rather than donated, since the proceeds of the sale could be given to a cost-effective charity, which would do much more good with the money than the recipient would with the organ.

I have corresponded with many people who have either participated in non-directed kidney donations (such as Alexander Berger) or studied the issue of markets in organs (such as Alex Tabarrok). Here are some relevant quotes, edited for brevity and clarity:

Just technically speaking, I don't think the right call is to go with the fixed-price donation. I think you'd want to set up an auction mechanism, which would garner a larger amount of money and also be better for getting attention to the issue (something that I regard as crucial). On the conditionality side, one idea for how to execute it would be to get them to make a donation to a donor-advised fund for which the "donor" is registered as some third party that you believe would allocate the funds optimally, such as GiveWell, GWWC, etc. Could also just make it a direct donation to one of those orgs, I suppose.

I don't know anything about the regulations in the EU, but in the U.S. the law says that it's illegal to receive any "valuable consideration" in exchange for a kidney. I've talked to some smart, engaged, people about this and they seem to think that a charitable contribution, even to a charity that you're not affiliated with in any way, would likely qualify as "valuable consideration," especially if it were a quid pro quo (which it would be).

The bigger problem than the law is the doctors. Getting a transplant team to sign off on this arrangement seems to be virtually impossible, because they'd be worried about being prosecuted as accessories. You'd basically need some special decision for the justice department saying that this arrangement is in the free and clear. That seems to be far off.

Unfortunately, I think this plan would be illegal in the U.S. What I would suggest, if you want to do a great deal of good, however, is to start a kidney chain. The way it works is that a husband say would like to give a kidney to his sick wife but cannot because they are incompatible. An altruist donor agrees to donate to the wife if the husband agrees to donate to some other person in need who in turn has their loved one donate to someone else. Recently a 30 kidney chain involving 60 people was created because of one donor who began it all. Contact the National Kidney Registry if you decide to follow this route.

I became very discouraged upon learning that my plan was not feasible, and dropped the idea for a while. However, it now seems to me that I should at least make my findings public and post them to this forum, to spark discussion.

So, what do you think of the whole idea? And do you see any way of circumventing the existing legal obstacles? If not, can you think of an alternative that would produce comparable good? Any feedback will be much appreciated.

It is also worth bearing in mind that, since the idea of selling one's kidney as a morally preferable alternative to donating it has never, to my knowledge, been considered before, this thread will remain for some time the only site where interested parties could learn about the topic.

Hi Pablo, thanks for the post, it's a very interesting perspective on the issue of selling/donating organs.
I have been thinking about it in different occasions, and I had the same concerns about the possibility of ending up doing something (overall) bad while intending to do something good. Apart from the omnivorous case, one could think of different categories of people you would not like, in general, to help. I am thinking, for instance, of extremely violent people. Would I like to give up my kidney for someone who I know is going to go around harming other sentient beings? I don't think I would.
So, if it is not possible (because of legal restrictions) to sell organs and give money to cost effective charities, it should at least be possible to select categories of people you would like (or would not like) your kidney (or other organs, if we think of post-mortem organ donation) to go to. One could choose to give her own organs to vegetarians, someone else could choose not to give their organs to atheist or utilitarians, and so on, according to their own moral approach. This option would maybe solve the first issue you identified.
francesca

Thanks, Francesca. Making one's donation conditional on the recipient's being a vegetarian is an interesting idea. One may combine it with the suggestion, quoted above, to create a kidney chain, and restrict it to vegetarians. That would probably also get some publicity--though I'm not sure the effects of it would be positive overall. (Kravinsky himself required that the beneficiary of his donation should be female and African American, if I recall correctly.)

And do you see any way of circumventing the existing legal obstacles?

Go to Iran, where it's legal.

I think donating a kidney to only a vegetarian would be harmful activity. Such an act would be regarded as unequitable, discriminatory, distasteful, etc etc. It would bring publicity, but I can hardly think of a less useful kind of publicity.

Hi Ryan

it would probably be perceived as bad if you' only give the opportunity to choose a group of recipients to someone and not to others. But I would be fine, for instance, with religious people donating organs just to other religious people, or atheists just donating to other atheists etc. It is just applying the same principles we apply to donation within a certain family to a bigger group. It would make perfectly sense to some people to prefer to donate their organs to someone who is closer to them (as for ideas, principles, etc) than their own family members. If we can choose to donate to family and not to people who are not members of our family, why can't we choose to donate to people who share our same ideas about life?

I agree with Francesca that it would make no sense to regard such a conditional donation as "discriminatory". On the other hand, people often do things that don't make sense, so I also agree with Ryan that we should take seriously the possible negative consequences of a scheme of this sort.

Right, Pablo. My intention is to prescribe an action (though my prescription is highly uncertain) for the real world that considers the consequences of widespread irrationality.

So, I believe that donating a kidney only to vegetarians would be:
1. mostly condemned
2. probably harmful in most contexts

If I lived only in a community of members of Felicifia, Lesswrong, GWWC and 80,000 Hours, then this kind of organ donation would be very beneficial!

edit: actually, Francesca, I think you're right. I think the part that would be controversial to the general public is the idea that donating a kidney to a carnivore would be overall harmful. I think, as you say, that just donating a kidney to someone vegetarian because they have 'similar values' to you would be widely accepted. Especially considering that there are already available databases for selecting a recipient who is young, with a good life expectancy, etc. Donating a kidney could still be very useful for a career in influencing.

Donating a kidney could still be very useful for a career in influencing.

Great point. It would be worth studying the reactions to Zell Kravinsky's case (as well as other cases) to present the donation in such a way as to maximize the expected positive reactions to it. As I recall, many people were reacting negatively because Kravinsky's wife was adamantly opposed to it, to the point that Kravinsky lied to her about the whole operation until it was already a fait accompli. In light of this, I think it would be crucial to obtain the support of close family members.

*If the main goal is PR then it seems crucial to investigate this thoroughly before doing it. I'm myself unsure whether the PR/influencing effects would be positive or negative.

*If there is not high excpected PR utility or much money to be gained I expected you donating a kidney to a stranger would have a negative expected value, since there is a small risk of death.

Jesper Östman wrote:If the main goal is PR then it seems crucial to investigate this thoroughly before doing it. I'm myself unsure whether the PR/influencing effects would be positive or negative.

Yes, I agree.

Jesper Östman wrote:f there is not high expected PR utility or much money to be gained I expected you donating a kidney to a stranger would have a negative expected value, since there is a small risk of death.

There is a lot of money to be gained. Something in the order of USD 100,000.

RyanCarey wrote:If I lived only in a community of members of Felicifia, Lesswrong, GWWC and 80,000 Hours, then this kind of organ donation would be very beneficial!

In a weak sense you have this option - you might retain your kidneys even having decided that selling them is net good, all else being equal, if you think there's a sufficient chance another EA who's physiogically compatible with you will require one in your lifetime. I'm not sure how likely this is - anyone know what the odds of having a relevant affliction are?