A Response to an Interesting New Yorker Article About People Who Donate a Kidney to a Stranger

(“The Kindest Cut” by Larissa MacFarquhar in the July 27, 2009, issue of The New Yorker.)

New Yorker: The opening paragraphs describe (in typical New Yorker style) a 40-year-old man with strong convictions about giving back. “He believed that if his needs were met and he found himself in possession of a surplus… he was obliged to share it” (p. 39)

The other donors the reporter describes have similar spiritual values. One guy is kind of a fuck-up who can’t make child support payments, but realizes that he could actually do another human being a great deal of good. Two other donors profiled are women whose lives have been more explicitly devoted to giving back—one is a missionary and pastor, the other decides to donate a kidney in honor of her grandmother, a Korean immigrant who has always helped those less fortunate.

TD: I can relate to their urges to give back and to do something that has concrete value in terms of committing myself to the Human Body Project. For me, the project came as an inspiration, a calling. These people describe similar feelings of rightness, of deep knowing that they are doing something that has to be done.

New Yorker: The parameters of MacFarquhar’s discussion are American. It is illegal in the US to pay for a kidney. The people in this article registered on a five-year-old controversial website MatchingDonors.com to offer a kidney. None of them were paid, although at first the child support guy was looking for that possibility. (She also talks about stranger donor evidence more generally in ways that indicate that many of the donors are like these specific ones).

The article deals with the emotionality of this kind of kidney donation. Turns out there are incredibly strong reactions. MacFarquhar describes the different emotional processes of each donor-donee relationship, but first I want to discuss some of the outside reactions she describes and some of the questions she asks.

TD: While my project certainly doesn’t have the reach or impact of directly saving a life, I believe that because I use my body and because I act “against” self-interest, the reactions I get and go through are quite similar and related to the reactions reported here. I also believe that in some ways I’m working on the same principle, I do what I do because it is the right thing to do and because I am able to do it. It’s in the world’s interest and whatever is in the world’s interest is in my interest. These people are doing it because of the rightness and because doing something good makes them feel good.

New Yorker: Her questions: “Do you find the idea of donating a kidney to a stranger noble? Or freakish? If the latter, is it the extremity of the act that baffles you? Does it seem crazy, giving something that precious to someone for whom you have no feeling, and whom, if you knew him, you might actually dislike?” (p.40)

TD: Is standing around naked and vulnerable a noble thing to do? Is it freakish? Is it extreme? Why do it for all the fuckheads who are out there?

Many people think I’m noble and way more think I’m an extreme freak. I find both reactions difficult. I would like people to understand that I’m modeling something that I hope we can all do in our own ways to move humanity forward/make the world a better place/create world peace. In a way, it’s really not a big deal, but many people make it so.

New Yorker: MacFarquhar explains that for the donor, the operation is pretty easy and recovery is relatively swift. The main worry about only having one kidney left in your body is the possibility of losing one in an accident. If a person gets kidney disease later in life, it would affect both kidneys anyway.

TD: The idea of donating a kidney to a stranger does not call to me. I am still too afraid to even donate blood. It’s not rational, but there it is. But I don’t find the idea of someone else doing it repellent. It’s amazing how much projection and difficulty people have with it, though. See left column for reactions.
p.s. Since writing this yesterday, I made an appointment to donate blood tomorrow.
New Yorker: -Paul Wagner: reads about a lady on the website decides to give a kidney to her; his partner, sister and father don’t want him to do it (p. 39)
-Rob Smitty: loser/child support fuckup guy, first hoped for pay but after finding out it was illegal still wanted to donate; the recipient’s (Bob Hickey) surgeon refuses to do operation when he reads about the fact that the kidney was found online; Hickey intends to file suit and it becomes a news story; 2 days later operation happens; 8 days later Smitty is jailed for nonpayment and is disappointed that the judge didn’t show more lenience; a man reads about his case and helps him out with money; many media stories vilify him as an opportunist, though the man helped him out after the deed (p. 42-43)
-Bob Hickey becomes a kidney transplant activist; he believes that UNOS (Untied Network for Organ Sharing) which manages the cadaver kidney waiting list “intimidates transplant centers into rejecting Internet donors” (p. 42); UNOS position is that MatchingDonors.com ‘exploits vulnerable populations and undermines public trust in the equitable allocation of organs’ (p. 42)
-MacFarquhar reports at length about studies regarding living donors who were suspect even though they were family members; the medical/psychiatric establishment reactions are summed up in these sentences: the “surgeons and psychiatrists went to heroic lengths to draw out the conflicts and ambivalence that lay hidden beneath donors’ supposed willingness to undergo surgery. If the potential donor’s motivation appeared inadequately healthy, they turned him down.” (p. 43)

TD: She provides specific instances that are heartbreaking in the invasive psychological diagnoses by the outsider physicians and the outsider physicians’ arrogant ability to project motivations on the donors.

MacFarquhar brings up the emotional messiness of kidney donation, whether it be from a family member, a person found on the Internet, or an anonymous donor. The medical/psychiatric establishment clearly sees itself as some kind of proper arbiter of that mess. But I find it interesting that a profession known for the gigantic egos of its members mirrors their own egotism in their judgment of donors and, not only that, sees themselves as the people who can best decide about emotional consequences.

One reaction I often get from people is that I am doing the Human Body Project for attention. I find this really fucking irritating. One of my art teachers said, “You must have felt a lot of power.” Like that was my point!!! I am embarrassed, not so much by being naked, but my passion about it and commitment. It’s so “uncool.” When I send out press releases and put up posters, I feel I’m doing due diligence. Others see it as self-promotion. Holy fucking projection! It’s like they can’t get around their own twisted egos to see that there might be a sincere reason for me to do something fairly extreme and risky. I see this as mirroring the medical establishment’s reaction and the easy vilification in the media of the nonpayment dad.

New Yorker: MacFarquhar’s article reveals many examples of the difficulties of the donor-donee relationship. One young woman (the one with the Korean grandmother) hoped she would meet rock stars and become famous after donating to a rock musician. When she found out he didn’t really know Mick Jagger and he basically didn’t stay in touch, she was very offended (p. 46-47). MacFarquhar cites some examples of doctors not allowing certain relatives to donate: because a wife of a man who wanted to donate to his brother didn’t like the idea and the doctors thought the man was doing it to get away from her; or a mother wishing to donate to her daughter got severe nervous symptom during testing (p. 43).

TD: So fucking what?!!! This idea that the doctors know best about how people should lead their lives is very disturbing to me, especially this idea that messiness can simply be avoided. The young woman was still proud of what she did. We don’t know what happened to the brother and the mother; presumably if their loved one died, that couldn’t have been better than not donating!

New Yorker: I am particularly inspired by the last donor MacFarquhar describes, Kimberley Brown-Whale, a missionary who donates a kidney without needing to know for whom it is intended: “Most people who donate their kidneys to strangers say it’s not for everyone, but Kimberley Brown-Whale disagrees, ‘I don’t see why not,’ she says. ‘People used to say the same thing about the mission field: ‘I could never do what you do.’ Well, why not? You pack up some stuff and you go. Give it a try. We can do more than we think we can. If you’re sitting around with a good kidney you’re not using, why can’t someone else have it? For a couple of days of discomfort, someone else is going to be freed from dialysis and be able to live a full life. Gosh, I’ve had flus that made me feel worse.’” (p. 52).

TD: I’m kind of saying the same thing, we can all let ourselves be more vulnerable than we presently allow ourselves and by doing so, make the world a more peaceful place. It’s kind of matter of fact and not actually that hard. Reading this piece has solidified more for me the need for teaching actual ways of thinking about how we can use ourselves and our abilities to intentionally create a better world. Many people say, well there never has been world peace and there never will be. We have to at the very least teach the possibility of peace rather than that stagnant stance of cynicism.