I have a colleague who would not be alive today if it were not for a complete stranger, who volunteered to give her a kidney. Her kidneys were failing, and she would not have survived for long. Now she is healthy, and has been for some years. So I understand in a personal way that living kidney donation is an extraordinary gift, a far-too-rare act of pure altruism.
Yet I have not offered to make the same gift of my kidney. I have a friend who did, who donated one of her kidneys to a stranger, just out of the goodness of her heart. I admired her, but it made me nervous when she did it, for the same reason that it makes me nervous now. What if something goes wrong? What if my remaining kidney should fail? What if a loved one needs a kidney somewhere down the line?
Making a living kidney donation is not risk-free, which is why it's called extraordinary altruism. Very little is known about the origins of such unusual generosity, in part because it's so rare. Fewer than one in 10,000 people take such a step, so it's been almost impossible to study the social and psychological precursors of this action.
Until now. Two Georgetown University psychological scientists recently figured out a way to explore the roots of unambiguous altruism, using aggregate data from states and national surveys. Kristin Brethel-Haurwitz and Abigail Marsh wanted to test an idea -- called the "engine model" of well-being -- which basically says that people become kind and generous when their own lives are going well. More specifically, the model predicts that objective measures of well-being -- like income and good health -- lead to positive emotions and a greater sense of meaning and purpose, which in turn promote genuine beneficence.
The two scientists had observed that living kidney donation is not uniform across the country. It varies significantly from region to region. They also knew that subjective well-being varies greatly from region to region in the U.S., and is linked to lesser forms of altruism, like volunteer work and charitable giving. Brethel-Haurwitz and Marsh wondered if there might be a connection between regional well-being and the prevalence of unusual altruism -- a strong enough connection to support their model.
To test this idea, they turned to the Organ Procurement and Transplant Network, which has maintained records of all altruistic kidney donations since 1999. To fit the OPTN definition, a donation must be made to an anonymous stranger -- eliminating any possibility of self-serving motivation. The scientists also tapped into a recently available, region-by-region assessment of subjective well-being, called the Gallup-Healthways Well-Being Index. This extensive sampling has been going on since 2008, and is more thorough and dimensional than any previous well-being survey. They examined the relationship between state well-being and state rates of altruistic donation, controlling for age, gender, education and race.
Here's what they found, and report in an article to appear in the journal Psychological Science: There were only 955 altruistic kidney donations during the decade they studied, and these varied widely by state. Delaware and Mississippi recorded zero donations during this period, and Utah had the highest rate of donation, by far. Well-being also varied fairly widely state-by-state, from a low in West Virginia to a high in Hawaii. When the scientists crunched these data together, they found a clear connection between state well-being and state levels of altruistic donation. This pattern held up when they collapsed the state data into nine broad geographical regions, and it also held true for a single year and for a decade. What's more, the data clearly support the engine model: That is, increases in objective well-being -- like income -- do lead to a greater subjective sense of well-being, which in turn promotes acts of kindness to strangers.
There is growing interest in public policies that boost well-being. These findings point to a possible concrete benefit of such policies -- an increase in life-saving acts of altruism. It's well known that altruism itself promotes a sense of well-being, so such policies could -- the scientists believe -- create a "virtuous circle," with well-being boosting altruism, which then boosts well-being, and on and on.
Meanwhile, more than 5,000 Americans are dying every year while awaiting a kidney transplant. If the national rate of altruistic donation matched that of Utah, the most altruistic state, it could yield more than 900 additional, life-saving donations every year. Intriguingly, between 11 and 54 percent of people say they would consider making an altruistic donation, but actual donations are far below that. Other factors must be nudging potential donors to actually act on that impulse, and well-being may be one of those factors.