What you need to know about the forces reshaping our industry.


May 8, 2017

Why donate a kidney to a stranger? To some, the better question is, 'Why not?'

Daily Briefing

To find out why someone would donate a kidney to a stranger, researchers at Georgetown University examined these "extraordinary altruists" and learned two things: Extraordinary altruists value a stranger's life as much as they do the lives of family and friends—and they're "politely puzzled" as to why others don't do the same.

A surprising strategy to reduce the organ crunch: Use hepatitis C-positive kidneys

Extraordinary altruism meets a pressing need

According to the Washington Post's "To Your Health," it can be difficult to research altruism because most acts of generosity provide some benefit to the giver—such as the tax deduction involved with a charitable donation—or they are determined and reinforced by social norms, such as holding the door open for someone.

So for the latest study, published in Nature Human Behavior, researchers at Georgetown University focused on people who have donated a kidney to a stranger. The donors don't get any tangible benefits from the act, and they face several costs—undergoing major surgery, facing potential pressure from family and friends concerned about their health, and potentially increasing their risk of future health problems.

According to the researchers, this act of generosity is "painful, costly, non-normative, exceedingly rare, and meets the most exacting definitions of costly altruism."

But these extraordinary altruists are helping to meet a pressing need, "To Your Health" reports. As of late April, 97,727 people were waiting for a kidney, and another 20,000 people needed livers, hearts, pancreases, or other organs. Kruti Vekaria—a doctoral student in psychology who worked on the study—said of the 147,000 live kidney donations that occurred over the course of the study, about 2,100 came from individuals opting to donate to strangers. 

Key findings

For the first part of the study, the researchers asked 21 kidney donors and 39 control group members to place avatars representing family, friends, neighbors, and strangers on a computer screen at various distances from an avatar representing themselves. The exercise measured the altruists' view of "social distance," or whether they viewed themselves as closer to strangers than the average person.

Hospitals reconsider kidney donations from older patients

The researchers found no significant difference between how the altruists and the control group completed the initial exercise.

Next, the researchers asked participants to play a money allocation game in which they could keep a larger sum of money for themselves by opting not to share the money with family, friends, or strangers—or give some of the money away to those groups, keeping a smaller amount for themselves. In this exercise, the altruists consistently placed more value on strangers than the control group, giving as much money to "very distant" strangers as control group members allocated to a "good acquaintance."

'Something everybody should do'

In short, according to the researchers, extraordinary altruists "simply don't value strangers less than they value people they are close to," "To Your Health" reports. As Vekaria put it, "They don't tend to view a stranger or even an acquaintance as any less deserving of resources."

Moreover, the extraordinary don't consider their actions heroic or praiseworthy—on the contrary, "they think it's something everybody should do," Vekaria said. Abigail Marsh, lead author on the study and psychologist at Georgetown, added that when asked why they would donate an organ to a stranger, the altruists "just seem politely puzzled."

"They have trouble answering the question," Marsh explained. "They see it as an obvious choice."

'Profoundly lucky' to donate

Just prior to the release of the Georgetown study, Dylan Matthews—a journalist for Vox, who was not involved in the study—shared his own experience donating a kidney to a stranger as part of a kidney donation chain. A kidney donation chain allows hospitals and transplant centers to link up several non-matching pairs of donors and recipients, shuffling around the available kidneys so that every recipient on the chain receives a kidney that's the best match for them—even if the donor is a stranger.

While Matthews wasn't involved in the altruism study, he shares a similar view that it was the "obvious choice," and one that others should also consider. As he puts it, "There were just the raw facts—of how awful it is to need a kidney, how much good it does to receive one, and how little risk donation poses to donors."

But for Matthews, the process wasn't entirely generous.  "I know I'm profoundly lucky to be able to donate at all," he writes. "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" (Bernstein, "To Your Health," Washington Post, 4/28; Matthews, Vox, 4/11).

How six hospitals launched diabetes management programs

In this briefing, we profiled six leading institutions have successfully integrated outpatient diabetes services into their primary care networks. Read it now to learn how an effectively implemented program can benefit PCPs who may otherwise be unable to provide quality diabetes care to their patients and help your organization set itself apart from the competition.

Read the case studies

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.