The Kindness of Strangers

The Kindness of Strangers

By DANIEL AKST

The Wall Street Journal
July 25, 2008; Page W11

Lots of well-intentioned individuals want to give something of themselves, but few take the project as far as my friend Anthony DeGiulio, a 36-year-old securities trader who yesterday donated a kidney. The really unusual thing is that he gave it to a perfect stranger.

Anthony's been a nice guy for as long as I've known him. We met in the spring of 2006 when he advertised some free mulch on Craigslist. I drove over, and before I knew it he was filling his own trailer, using his own front-end loader and then driving the whole mess over to my place with his own truck. Subsequently, after clearing some land, he gave away thousands of dollars of firewood to all comers. He's also a big supporter of a couple of charitable organizations.

But when he first told me about the kidney, I wondered about his sanity. Anthony has had this response from lots of people, including relatives; after all, only 533 others in this country have ever given a kidney away without a recipient in mind, according to the Organ Procurement and Transplantation Network created by Congress in 1984. In other words, Anthony didn't just choose a stranger; he gave a kidney to someone whose identity he didn't even know (although they were scheduled to meet sometime after the surgery).

Anthony isn't religious, but he knows instinctively what sages and (lately) scientists have been insisting, which is that, by giving, we get. Study after study shows a strong correlation between altruism, happiness, health and longevity. What Anthony's story demonstrates is that almost any of us can do something truly great -- that in addition to making a living, obeying the law and caring for our families, we have the power to achieve transcendence by giving.

Unfortunately, making a "nondirected" kidney donation requires clawing through walls of skepticism on all sides. Despite a waiting list of nearly 77,000 kidney patients nationwide, about 40% of transplant centers won't even work with donors like Anthony. The fear is that such donors might be irrational, unstable or might back out at the last minute. The writer Virginia Postrel, who donated a kidney to an acquaintance in 2006, reports that "you have to be incredibly pushy to make a live donation to anyone but a close relative."

That's a shame, both for the patients and for potential donors who may be deterred from saving a life -- and reaping the kind of satisfaction hard to get by any other means. "The idea that I can help someone in such a profound way is very compelling to me," Anthony wrote on his blog (http://giveakidney.blogspot.com). "We chase the ridiculous goals, like wealth, beauty, and power, without realizing what is really important. Money, as I know all too well, is fleeting. Beauty fades. Power corrupts. There is no downside to helping someone live a healthy life."

Anthony's adventure began about two years ago, when he saw a "60 Minutes" segment on organ donation. "I've always wanted to save somebody's life," he told me just days before the surgery. But a burning building never seemed to present itself -- until that evening. "I said to my wife, I'm doing it."

In delving into the subject, he soon discovered how little guidance was available for a kidney-bearing altruist. So he decided to call New York Presbyterian, in New York City, where he discovered there was a lot more to donating a kidney than taking off his shirt. For example, donors who insist on giving to a stranger must undergo psychological evaluation, and Anthony reports that his visit with a derisive-seeming hospital psychiatrist was unpleasant in the extreme. He also had to meet with a social worker.

His ultimate success in this endeavor may have been helped by his refusal to select a recipient. Anthony didn't want to be in the position of making such a life-and-death choice, especially from Web sites that host the pleas of desperate kidney patients. "To me," he says, "it seemed like a popularity contest." Hospitals are wary of donors who designate strangers as recipients because they fear that money might change hands, and organ sales are illegal. Besides, transplant surgeons don't like people jumping the line.

Once Anthony got past the psychological hurdles, he was embraced by the hospital staff -- only to confront the medical issues. First and foremost, donors must be healthy. But while Anthony is a big, strong, youthful guy, medical testing uncovered a few problems that took months to resolve. But resolved they were, with the ironic result that giving a kidney markedly improved his health -- probably enough to outweigh the small risk associated with donation.

The main hazard is the surgery. The National Kidney Registry (whose mission is to increase living-donor transplants) acknowledges this risk but says the mortality rate is only three in 10,000, making it much safer than withstanding the first year of life. Plus nowadays the surgery can often be performed laparoscopically, through one or more small incisions. Afterward, the remaining organ easily takes over full kidney function. A hospital spokeswoman says that if Anthony's remaining kidney failed for some reason, he would get a four-year credit on the national waiting list -- now about three years, meaning he'd shoot to the top.

Anthony hasn't had to worry about medical expenses, either, since these are covered by the recipient's insurance. He doesn't mind that he's had to pay for repeated trips to the hospital, and for nondirected donors who can't afford even this expense, the National Kidney Registry says it has funding available. "There's very little downside to donating a kidney," Anthony says.

His act of altruism turned out to help a lot of people. A number of patients have willing donors lined up but can't accept the offered kidney because medically it's a poor match. So the hospital arranges cross-donations, mixing and matching donors and recipients in life-saving kidney exchanges. The spokeswoman said earlier this week that Anthony's kidney would make it possible, using the exchange system, to do four simultaneous transplants.

Society is seriously short of kidney donors, and organs from living donors lead to better outcomes than organs from cadavers. To help the many patients waiting for kidneys, we need to stop discouraging healthy, sane people like Anthony from stepping up to save a life. We might even offer financial incentives via a properly regulated marketplace for organs, one in which, like most other marketplaces, everyone can benefit (including, in this case, those who can't afford to pay). Until then, why not encourage more people to step out of their everyday lives and do something really great -- by saving a life?

Then again, in Anthony's view, donors already get paid far more richly than they might in any marketplace. "It's a selfish act for me," he says. "The satisfaction is so profound. This is all for me."

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Mr. Akst is a writer in Tivoli, N.Y.

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