LW - Don’t Donate A Kidney To A Stranger by George3d6

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Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Don't Donate A Kidney To A Stranger, published by George3d6 on November 12, 2023 on LessWrong.
Donate a kidney to a stranger, is a battle cry picking up some fervor in EA circles. The stem of this seems to be certainty in a flawed understanding of medical research, combined with conviction about a rather acrobatic view of morality.
My argument against donation is split into 3 parts, with the first being by far the most important:
Why kidney donations do great harm to the donor
Why kidney donations are ethically fuzzy and might be a net negative
Why the desire to donate a kidney is likely misplaced
I Health impact
Summary
Kidneys are important, and having fewer of them leads to a severe downgrade in markers associated with health and quality of life. Donating a kidney results in an over 1300% increase in the risk of kidney disease. A risk-averse interpretation of the data puts the increase in year-to-year mortality after donation upwards of 240%.
While through a certain lens, you can claim kidney donation is not that big a deal, this perception stems mainly from comparing a (very healthy) donor population with your average American or European (prediabetic, overweight, almost never exercises, and classifies fruits as cake decoration as opposed to stand-alone food).
Furthermore, when research evidence is mixed due to the difficulty of the studied area, lack of data, and complete lack of open data, we should fall back to our theories about human physiology, as well as common sense, both of which paint a very bleak picture.
You should not donate a kidney if you aren't prepared to live the rest of your life with significantly decreased cognitive and physical capacity.
1.a Limitations of medical research
After more than 5 years of reading medical research as a hobby, the only thing I can conclude about it with certainty is that it's uniquely hard to do well. It sits at the intersection of:
Cutting through a very complicated part of nature that isn't amendable to the kind of experiments that yielded so much success in fields like physics and chemistry.
It is filled with actors that have misplaced motivations, and do not care about "correct" interpretations, nor about data quality (or outright fake data). Not because they are evil, but because getting "the right result" means a payoff in the billions of dollars.
Filled with actors that impinge upon doing science correctly under the guise of ethics and privacy. Often with no real effect on what a normal person would think of as ethical of private… but that's another topic.
The reason Kidney donation is considered "safe" is because. From a limited amount of epidemiological and observational studies, with follow-ups in the 2-30 years, there is, on average, no increase in mortality.
None of these studies were RCTs, and the sample size is quite low.
This amount and type of evidence would not be sufficient to approve a drug. The quality of these claims is about as good as the quality of claims one could make about a relatively niche diet.
There are two big generators of error here
A) Matching Controls
Which is to say, any study that looks at this will pick some controls based on factors like demographics, biomarkers, and, sometimes intent (i.e. people who wanted to donate a kidney to a family member but there wasn't a match). Being the kind of (naively?) good selfish person who would donate a kidney can correlate with a lot of positive outcomes.
B) Researcher and Publication Bias
You rely on the researchers to get the data analysis right, and you rely on whatever gets published being representative as opposed to cherry-picked.
As it stands, the data on which these studies are is usually not public, so you can't double-check the researchers here, you can't pick a different lens through which to analyze the data.
More importantly, t...