In 2016, Dylan Matthews donated his kidney to a complete stranger.

He didn’t think he was doing anything really extreme or remarkable. He was just trying to do the most good he could.

Dylan was taking part in a movement called effective altruism, a community that tries to maximize the good you do. In our first episode, we’ll explore the idea of effective altruism, why making our charities more effective matters, and what giving a bodily organ looks like in practice.


Further reading:

More on Dylan’s kidney donation

Peter Singer’s case against the Make a Wish Foundation

More of Vox’s effective altruism coverage


Discover more podcasts from Vox here.

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00:00:00So this is ahh letter i got today from hopkins Dear dillon you have been approved as a kidney donor by our multi disciplinary transplant team at the johns hopkins hospital Please notify us Hi i'm dillon matthews I host this podcast and two years ago i gave my kidney
00:00:20away to a complete stranger I matched with someone there's someone who could use my kidney and so that's exciting so i did it The surgery was fine and the recovery was pretty quick but i gave away a major organ and a fair question to ask is why it
00:00:43all connects back to this movement A movement that's only really existed for a couple of years but it's been growing and spreading all across the world It's called effective altruism In its simplest form effective altruism says hey we should be trying to do good in the best most
00:01:02effective ways possible today we'll use kidney donation to flesh out that definition a little bit more kidding donation gets it someone theological arguments that effective altruism makes and some of the sacrifices it suggests that people could make and it's something that a fair number of effective altruists stew
00:01:24Alexander burger is the managing director of the open philanthropy project in san francisco and he's the first person to turn me on to both kidney donation and effective altruism in general So we thought it would be good to bring him on to explain the idea he starts with
00:01:39a thought experiment there's a famous example of a child drowning a pond where if you just bought a new suit and you're walking by a pond where you see a trial of drowning you could save them but it would ruin your expensive new suit Most people will think
00:01:50it's really obvious that you should do that but similarly if you could donate a few thousand dollars to a really effective charity that could save lives in other countries or in other places where it's much cheaper to do so arms you similarly like walking by the drowning child
00:02:03in the world in that pond and so trying to sort of analogize those arguments to get it off the ground Effective altruism is all about cost benefit analysis If the cost is my suit and the benefit is a child's life being saved then the benefit outweighs the cost
00:02:18and i should ruin my suit And the same logic applies for kidney On the cost side the risk of death in surgery is around one in three thousand for like the average doner that's on the order of magnitude of like giving birth or other things like lots of
00:02:30people undergo for everyday reasons in their lives The long term effects aren't totally clear but the current science suggests that you can live pretty well without one of your kidneys So the cost to you is low if but on the benefits side The best evidence i could find
00:02:47suggested that getting a transplant rather than staying on dialysis lead somebody to have ten more years of life on average Ten more years That's a big part of a person's Life also dialysis is really painful and it's exhausted so very few people can work when they're on dialysis
00:03:06It's like costly for the medical system maintain and frankly just they die younger than they would if they could get a transplant And so that was sort of on the benefit side for me so that's one part of effective altruism you're giving mohr especially when the cost of
00:03:20giving is low and the benefits are high But the other part is about making sure that you're giving well making sure that the benefits are as big as they can be Which seems obvious when i talk about affect about tourism with normal people who have not heard of
00:03:35this like one of the first questions is like how does this different for just charities Generally like i think local art nonprofits think they're trying to make the world a better place What is different in how the set of people in effect about tourism think about those questions
00:03:48from how philanthropies have generally thought about it You know a lot of the people in effect of autism community tried to give at least ten percent of their income to charity and the sort of american averages about two percent And so i think there's an idea like we
00:04:02should be maur generous so that's part of it and then the other part of it is that like sort of this peace around using evidence and reason and so trying to think hard and quantitatively about how much value is the local art nonprofit adding to the world compared
00:04:14to how much value could be ad by doing sort of really really basic public health services in low income countries for instance thinking hard and analytically and critically about those questions and not just saying like well you know we're all well intentioned here and so that's enough for
00:04:30a long time alexander worked for an organization called give well they're a nonprofit that tries to figure out how much value different charities add to the world He now works for open philanthropy A connected group That's made nearly six hundred million dollars in grants to what it considers
00:04:46effective charities activists and researchers at universities But i wanted to know how alexander got interested in this work to begin with I came across give well isin college Andi i took a term off from school when i went and lived in india i volunteered to school every day
00:05:04on the way to school I'd walk by these kids who are begging in the street and i really want to do something to help the kids that they looked like they were sort of desperate need up But i also knew that if i just give that money that
00:05:14would be an incentive for the parents to keep him out of school And so i thought like okay when i get back to us i'll just find the best cherry that i can and donate like a few hundred dollars to it I think i literally googled best charity
00:05:29and i found the give well vlog and they were asking these questions about like how do we know different programs work What is the evidence How cost effective are different charities How much does it cost to save a life in a sort of real analytical way Not to
00:05:42have a slow anyway And i thought that was totally awesome If you could have the give well site you can see exactly how they evaluate charities They have studies randomized Controlled trials all kinds of research and they can tell you which charities are doing a good job of
00:06:00achieving their goal girls But they also ask you to consider what goals matter to you Do you want to save lives Do you want to lift people out of poverty Do you want to help them escape some diseases that won't kill them but we'll make them miserable Give
00:06:15all has a fancy spreadsheet that helps you make those decisions My producer bird and i decided to pull it up and go through the process So we got this very colorful document This looks like most spreadsheets that i opened for work There are sections that are bold id
00:06:36and then there's a whole bunch of tabs Lotta tabs There is a very ominous tab called moral weights Let's open that tab Oh yeah So it's Kind of like the world's most depressing buzzfeed quiz Instead of asking you do you prefer pizza or tour ingeles It's like do
00:06:59you prefer to save someone's life or doubled their salary for a year Then instead of telling you the end this is what harry potter character you are It gives you kind of a measure of what you care about the most So it looks like you kind of value
00:07:14different charities compared to each other So dylan compared to saving a life do you think de worming Someone is like a i got one a ten out of one hundred Well okay so there's a lot of controversy over whether the de worming studies air true So i'm going
00:07:35to put in a point zero zero one eight there So this is like would you rather save the life of someone Who's We ended up having a long conversation about each one of these because it's hard to figure out how valuable it is to save someone's life versus
00:07:49doubling their salary Eventually we had the whole thing filled out so so we've we've filled out the buzzfeed quiz and we're now at the part where we find out which does new princess jeff dullness right So i'm the disney princess that says over five year old is worth
00:08:08eighty percent as much as an under five year old this's such a like overwhelming list of just values and choices but i don't know there's a lot of money here and a lot of it is going to charities like this I kind of feel like you have a
00:08:25duty to try toe work through this stuff to figure out why it should be going to this organization or not this other organization but i don't know that i'm qualified to make that judgment I mean you make decisions like that all the time I make decisions like that
00:08:42all the time like you pay for life insurance and for property insurance there's lots of little decisions we make in life about how much we value money versus life They're just really laid out this explicitly So first you take a cold hard look at your values and then
00:09:06once you've decided like i think saving a three year old's life is more valuable than doubling the thirty year old salary for a year You can look very specifically a charities that save children's lives and focused most of your donations there But there are lots of ways to
00:09:24try to save children's lives and so you need to pick an efficient one The research on a site like give well suggests that one way to get the most bang for your buck the most children's lives saved is by giving malaria bed nets to people and that's Because
00:09:41there's a lot of good research done to show that there's a return on that donation The same process applies with donating a kidney You can donate to a person you love and that's Fantastic But there are ways to donate that generate even bigger returns That's where don't eat
00:09:57into a stranger comes that Because if you don't need to a stranger you can create a chain You ended up donating to start a chain too right So for the folks at home who have spent their time in the in the kidney donation larger So what do we
00:10:14mean by chain And what does it mean for six people to be on that So the vicinity is that often people want to donate a kidney to a love one but they're not a good match Let's say I'm willing to give to my girlfriend and i'm not a
00:10:26match But alexander is i would give to your girlfriend but i would still donate a kidney I just wouldn't give it directly to my girlfriend I'd give it to someone living in illinois or somewhere and then that person's friend or loved one would give to the next person
00:10:46And these could sort of go on indefinitely long They usually end with a person who's extremely hard to match because if they aren't getting something from the end of the chain that person is pretty unlikely to ever find a matching cannon Most people are more willing to give
00:11:00to someone they love But if there's one person like me or alexander who's willing to just give a kidney to a stranger we can kick off a chain of four or six or eight kidney donations The longest chain so far is more than eighty donations long Have you
00:11:20ever met your recipient I've never met her in person but we've corresponded she's a math teacher in rural pennsylvania she has like teenage sons they were teenage sons we usually send each other quick email around the anniversary i should i should do that more i've said like three
00:11:37emails of my recipient but i have to be in better touch I kind of like the one you think is it's like it's nice to be reminded this person sort of exists and is out there doing well in the world but i also she was like a sort
00:11:47of random stranger assigned to my kidney I don't i don't feel like a super deep personal connection I never thought my kidneys like walking around in pennsylvania you know this kind of separation from the emotional side of things it's both the strength and away weakness of effect of
00:12:03altruism On the one hand emotional giving doesn't always lead to the most effective outcomes but on the other hand we're all humans and it could be really hard not to go with our emotions especially when things like kidney donation get riel my parents weren't like super ecstatic about
00:12:20me donating and people don't walk around knowing how safe it is and so i think they thought i was like a really weird kind of risky thing to undertake a twenty one year old right We forgot to mention alexander was only twenty one when he donated his kidney
00:12:34during the psychiatric evaluation They kind of want to be in doubt for you The psychiatrist told me that like assumed she got on the phone with my mom and i was like birthday to tears because i think she was like oh my my son is going to go
00:12:44do this like risky dangerous thing and like all support him because it's something that's important to him but i'm like not super excited about it The idea of like your kid's making sort of voluntary the risks for other people who they're never going to meet doesn't necessarily seem
00:12:58like a great trade as a parent So i think this is emblematic of dylan in many ways it's not just alexander's family My girlfriend hannah was kind of nervous about my donation too We interviewed her on the train on the way to my surgery He has a moral
00:13:16certainty that a lot of us lack Where he's really able tio collect the information available and you know decide that something is a moral good So in philosophy there's this thought experiment where there's a train coming and the train will go in one of two directions and you
00:13:36control which stretching the train present and one track There are ten people and if the train goes towards that they won't On the other track there is just one person train goes four sons they will die And so most people agree that what you should do is move
00:13:56the train So it just kills one person and you see ten lines right like that seems pretty straightforward But then imagine that the one person on that track alone is your child's or your mother or sister someone you love someone you really closed tio and the ten people
00:14:16are strangers What you did I think the logical thing is to do exactly the same right you kill one person you save ten lines right Like the moral maths hasn't changed just because you happened to know and love one of the people involved but i think most people
00:14:39would struggle with that and it's What second decision i would save the first pilot dylan what kill diversity levels without a doubt he's just has that like clear vision about what the right thing to do is beyond just what the haps selfish thing that he ruins It could
00:15:03be why he and i sometimes disagree about saying just like donating a major organs stranger because i'm focused on the person i know the person i care about and he's focused on the street there on the chain and all the lives that are going to save it She's
00:15:22Right I definitely would kill one person even a person I love to save ten and i don't think that's a bad thing It feels pretty rational but after the break i'll talkto alexander about how rational altruism really has to be Zack beecham you were one of my real
00:15:42life best friends I go to pass over your parent's house every year That is true You have a podcast that i love listening to called worldly worldly is vox's foreign affairs podcast We talk about the most important stories that are going on in the world right now and
00:15:55by we i mean it's me senior writer at box alongside john williams the foreign under and alex work who is a foreign reporter and we talk about the big stuff in the world So why should future perfect listeners listen to worldly Because if you're interested in the problems
00:16:09facing humanity you need to understand the politics behind these problems but you need to understand why extreme poverty has been falling in china You need to understand why it's so hard to open up the borders in developed countries thes issues thes things that future perfect listeners really care
00:16:25about or exactly the subject matter that we tackle Think what's your favorite thing about doing worldly mostly bantering with the other hosts Honestly john williams and alex ward we talk about these really dark depressing often very difficult news and policy Issues but we try to make it you
00:16:42know not as horrible illicit seems like it is That sounds like a good time too You listen to a worldly every thursday it's on apple podcasts or wherever you get your podcasts The city needs you This is police chief greg suhr I only hope if you go on
00:17:04youtube and type in back kid you can pull the video from the make a wish foundation in it You see this five year old leukemia survivor he has to be the back kid for a day way bringing back You got to run around san francisco completing missions walking
00:17:25in a parade dynamic duo i'm afraid your old nemesis the riddler finding riddler with enough dynamite this's wonderful and sweet but it also costs thousands of dollars for some people in the effect of altruism movement Maybe even for me this feels inefficient You could spend thousands of dollars
00:17:49to give one kid one good day or you could use that same money to save several kids lives Alexander berger understands that perspective but he doesn't necessarily agree with how hard some effective al tress khun beyonce stuff like make a wish The reason that i don't love to
00:18:06think in this way is because i think it's better to think about sort of growing the pie in some sense and so that point i made earlier about how the average american gives about two percent of their income to charity and effective all truths aimed to give at
00:18:16least ten percent I think it's a really useful idea is not to say that you need to stop doing those other things like if that makes you feel good or warm or like you like to support those organizations I'm not here to tell you not to do that
00:18:29I'm here to tell you that also you can achieve really huge benefits for the poorest people in the world by giving mohr and taking it a little bit more seriously and thinking hard about how to do it in the way that's going to have the best impact an
00:18:43example i sometimes use with this is that so i think most of my terrible giving i give tio against malaria which gives bed nets to prevent malaria and teo give directly which just gives cash to people in sub saharan africa But i also give like maybe one hundred
00:19:00bucks a year to the animal shelter that i got my cat from and it's not that i think that's super effective i think even if i just like wanted to help animals i would like give to another charity but like i want my cat and like it makes
00:19:14me feel good to support the place but like i just think of those is different buckets Yeah exactly I don't think like there's lots of civic institutions that could buy and philanthropy and effective altruists and some of the proponents wanted like sort of set them up as the
00:19:26opponents of effective philanthropy And i'm more just like yeah we should mostly be drawing the pi and getting a lot of people to give Mohr And i think when you think about it is coming out of a different bucket It's My main arguments like this fuck it of
00:19:37like really helping the world should be a lot bigger than this There are a lot of ways to grow the bucket You can move from thinking just about charitable donations to thinking about ways you can volunteer your time Or in my case a bodily organs Donating a kidney
00:19:57cost me next to nothing and it's Probably the single most valuable thing i've done in my life not least because i'm lucky enough to be a journalist who has a platform i can use to encourage other people to donate to Maybe even some of you listening to this
00:20:13right now we'll think about giving a kidney that be fantastic But growing the bucket takes other forms as well like changing government policy or changing your career On this podcast we'll talk about everything from climate change to prison reform to immigration and how effective altruism khun re shape
00:20:35How we think about and tackle some of the hardest problems in our society No i know i'm excited I hope you are too That was the first episode of future perfect We have a bunch more coming your way every wednesday for the next few weeks so let us
00:20:59know what you think are wonderfully talented Producer is bird pinkerton Our editor was amy droz dot ska We owe many things to julian weinberger for a lot of things Our engineer is jared floyd The tape from when i donated my kidney was collected by josh fawn She also
00:21:16made a whole video about it It's fantastic you khun checked about on our youtube channel The music was by krista brisky and paddington bear Future perfect is made possible through a grant from the rockefeller foundation Trade More of our reporting on effective altruism check out fox dot com
00:21:30slash future perfect No

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