I know a few people who have donated kidneys (both to friends and strangers), and I find it admirable (and supererogatory).
At the same time, I think this post demonstrates a kind of selective unawareness that I’ve seen members of the EA community demonstrate. A significantly less charitable summary of Scott’s situation is “our prospective kidney donor is newly-married high-stress professional with a history of SSRI usage who has recently experienced significant negative public attention and belongs to an actively-imploding community/cult.” This is almost certainly what the UCSF administrators perceived, and his latent hostility to them almost certainly didn’t help.
This doesn’t necessarily justify their decision (maybe they are just bureaucrats), but it’s a framing that’s roughly as plausible as the bucolic EA one that’s presented. A community that has a self-stated mission in rationality should be able to see that.
We have a long waiting list for recipients, and we don't have an excess of donors to be picky with.
Why are you assuming Scott was not "able to see" the explanation you laid out, when in all likelyhood that thought has crossed his mind (he's thought about this far more than you, a commenter who speculated that in 5 minutes)?
Perhaps he thought of it, and decided saying it would be even meaner to the hospital... which frankly, I think that framing is far crueler to the hospital. Like, if they rejected him from bureaucratic incompetence as they tried to filter out people who can't consent to surgery? Fine, incompetence is bad, but fine.
If they rejected him because they could give someone with kidney failure 10 more years of good life, they thought he had a healthy kidney and could consent, but they had a personal grudge or moral judgement... That's a much more repugnant way to operate a hospital than simple incompetence. Reducing the quality of life of a potential kidney recipient for any of those reasons intentionally is far crueler than mere incompetence.
I also suspect saying anything other than the hospital's purported reason would be grounds for libel.
> Like, if they rejected him from bureaucratic incompetence as they tried to filter out people who can't consent to surgery? Fine, incompetence is bad, but fine.
I'd be even more charitable to them: it's not incompetency, but waste inherent in a bureaucratic process, which is a consequence of scale. Sure, it would be better if Scott was interviewed with someone dedicated and empowered, who could hear and verify the full story, understand the context. But there are only so many people able to do this and willing to accept responsibility for making a bad call - and healthcare system can't afford them anyway. The bureaucratic process focused on effectively minimizing false positives will introduce a lot of false negatives - but it's also much more streamlined and cheaper to run at scale. And sure, it sucks to be the one rejected by an effectively automated process[0], but it's better for everyone than not having any process at all.
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[0] - I maintain that bureaucracy is software running on a distributed system made of meat instead of networked silicon. It has the same dumb failure modes because it's the same thing.
> And sure, it sucks to be the one rejected by an effectively automated process[0], but it's better for everyone than not having any process at all.
You could have a much lighter weight process, that leaves more of the decision making powers with individuals and families. That would be cheaper and overall suck less.
Placing the responsibility with families results in compelled donations (“you love your Dad, don’t you?”). Our medical system is (imperfectly) built around consent; that consent needs to be in evidence.
Yeah. When my dad had a kidney failure I had a lot of fun proving to the doctors that I did not in fact love my dad, and that's why I was giving him a kidney.
Really though, the definition of "compelled" is fuzzy, and mostly for medical stuff we take "consent" to mean "sound of mind" and "not overtly coerced, i.e. by threats of violence or such".
Is someone able to "consent" if they're only donating blood or a kidney because their religion tells them to do good? That sounds like a cult, huh. What about because they love someone? What about because the local blood drive literally gives you 10 bucks and a candy for donating blood?
Like, you can argue around enough and say everyone is always compelled at all times by "society" or "their upbringing", but that's an obviously useless definition.
What we have now, you getting a private meeting with a nurse or such who asks "are you really sure? Is anyone making you do this?"... that, plus doing basic mental health checks of "does not have dementia or mental retardation", that seems like it should be enough for any real situation.
Trying to say "No, someone who's famous might be doing this to write a blog post about it, that's not okay" is an interpretation of consent that simply is too far gone to be useful.
> Trying to say "No, someone who's famous might be doing this to write a blog post about it, that's not okay" is an interpretation of consent that simply is too far gone to be useful.
Nobody has said this, as far as I can tell. My claim was that there were other things about his situation that might suggest to the bureaucrats in question that he was a risky donor. I don’t think Scott gave a kidney so that he could write a blog post about it.
There are two people in surgery and two families involved in this transaction. The recipient side is relying on the healthcare system to make the transplant work out well, and it's the medical staff that will be blamed and held responsible if the recipient suffers or dies due to an avoidable mistake. Because of that, there's only so much decision making powers that can be granted to the donating side.
> We have a long waiting list for recipients, and we don't have an excess of donors to be picky with.
That’s not how this works. Organ donation is inherently picky and fallible: without that pickiness, you get coerced organ donation and people undergoing mental crises seeking a form of salvation.
I don’t understand where the moral judgement or grudge determination came from: everything I’ve said is a prima facie plausible reason to reject a donation candidate on basic medical ethics grounds.
That international organ trade still operates as a black market. So it's hard to compare that with being less picky about organ donors.
The very pdf you linked to even mentions 'Reducing U.S. Demand for Trafficked Organs' as one of the policy avenues to pursue to help combat trafficking of organs. Being less picky about donors in the US seems exactly like what you'd need to do to reduce that kind of demand.
You might also want to look into the situation in Iran, where financial compensation for organ donors is legal.
Your summary literally doesn't even sound more stressful than the median American adult life. He has a job? He got married? He has taken psychiatric drugs before? Some people don't like him? There exists social drama sort of nearby him? So what? These are incredibly superficial assessments.
Why is the standard for donating a kidney that your life has to be, in the opinion of some bureaucrats who just met you, super chill? Nobody applies this standard to any other similarly-risky (i.e. not very risky) decision. The standard should be whether you are a person in sound mind who wants to donate it and is physically fit to donate it.
The average American isn’t donating half of their kidneys, as the post points out. It’s entirely possible that the average American isn’t psychologically suited to do so without an extensive (and fallible) filtration process.
But beyond that: the author is not an average American, and we both know that. Most Americans don’t find themselves in the NYT, or somewhat central to a large, wealthy controversial community that’s actively imploding.
Why does being a minor celebrity mean you shouldn't donate your kidney?
You don't think most Americans are "psychologically suited" to donate a kidney? Again, I don't think you would apply this level of paternalism to other situations. Would you tell the median person that they aren't "psychologically suited" to have a kid and therefore aren't allowed to? That's a dramatically more impactful and psychologically stressful decision, but we admit that the person best suited to make it is the person living it.
I think you are just trying to justify a dumb bureaucratic decision that doesn't respect the suffering of people who actually need kidneys.
I didn’t say that. I think anybody should be able to donate their kidneys, provided that they are deemed competent to do so. Famous people and controversial people can be competent, and Scott almost certainly is.
As a society, we treat organ donation differently because it comes with significant opportunity for abuse and regret.
The sole point of my comment was to highlight how prominent EA writers can demonstrate a hypocritical blindness in a way that dispassionate observation can reveal. I’m not especially interested in UCSF’s actual decision.
I know at least for directed organ donation transplant teams will frequently lie - for instance, if a donor backs out, the clinic will default to telling the recipient it isn't a match rather than them backing out. I wonder if there's similar things going on here.
The not PC version of my thoughts is you have to be nuts to want to give away a perfectly good kidney to a random stranger. The system doesn't agree with me and has criteria for who can "reasonably" do that.
My experience is that insanity is essentially rooted in "buying the BS" and actual reality is the best antidote for it.
If they really are concerned for the mental health of donors whose reasoning worries them, they should find a means to effectively express that to them.
The policy you describe is likely a factor here. It's also a form of gaslighting which is an effective means to drive someone insane.
It's not gaslighting or headfuckery to come up with polite explanations for someone changing their mind. It's just a practical matter. But telling someone repeatedly "Get therapy" if* you have misrepresented what you see as mentally wrong is pointless.
* Granted, as someone else pointed out, we are only hearing his version of events and it may not be "The truth, the whole truth and nothing but the truth."
I agree. But we also only have Scott’s telling; it’s entirely possible that they expressed other concerns to him and only concluded with a final point.
I’m absolutely positive they don’t. That’s why they don’t get to choose other peoples’ organs, and why we don’t let the families of victims determine the suitable punishment for the criminal.
Effective altruism, which is both a general (and not especially objectionable) variant of act utilitarianism, and also a specific community that has (fairly, to my eye) been accused of diverting money towards a particular set of reactionary worldviews held by its leadership.
EA isn't a form of act utilitarianism. Though EA certainly has a consequentialist flavor, it isn't the case that all (or even most?) EAs endorse utilitarianism (utilitarians aren't the only ones who care about scale). For example, Holden Karnofsky is explicitly non-utilitarian and Will MacAskill advocates making decisions based on considering (fundamentally, not just for optics) non-utilitarian ethical systems, though he is more utilitarian than someone like Karnofsky.
The main recipients of EA political funding (what little there is: the majority of money goes to global health and development, with AI safety as a distant second) are centrist Democrats. They're too right-wing for my taste too, but calling them "reactionaries" dilutes the word into meaninglessness.
I'm not sure woodruffw necessarily talked about donations to US politicians when they mentioned 'diverting money towards a particular set of reactionary worldviews held by its leadership.'
I meant more the accelerationist and AI derisking contingents, not political donations. Both are explicitly reactionary in the most basic sense (and accelerationism is also reactionary in the far-right sense).
> Both are explicitly reactionary in the most basic sense
In the most basic sense, as a reaction? Are weapons regulations "reactionary?" I think it's well established what using the term "reactionary" is, and it doesn't apply to X-risk concerns. Also Eliezer Yudkowsky has been "reacting" against AI X-risk since you were a toddler, in case you thought this was some recent phenomena...
The idea that we should plow charitable donations into various low-value and ill-conceived projects because the moral calculus of doing so versus a malicious general AI strikes me as reactionary.
That’s independent of (but connected to) Yudkowsky’s whole thing, which to my understanding never really attempted to apply the logical extreme here.
At the same time, I think this post demonstrates a kind of selective unawareness that I’ve seen members of the EA community demonstrate. A significantly less charitable summary of Scott’s situation is “our prospective kidney donor is newly-married high-stress professional with a history of SSRI usage who has recently experienced significant negative public attention and belongs to an actively-imploding community/cult.” This is almost certainly what the UCSF administrators perceived, and his latent hostility to them almost certainly didn’t help.
This doesn’t necessarily justify their decision (maybe they are just bureaucrats), but it’s a framing that’s roughly as plausible as the bucolic EA one that’s presented. A community that has a self-stated mission in rationality should be able to see that.