Dan Coyne was at his local grocery store in Chicago one day buying beer, when he looked up and noticed that his favorite cashier didn’t seem like herself. She didn’t greet him in her usual cheerful way. Her face was ashen. She seemed thinner. Coyne, who was 52 years old, knew her first name, Myra (from her name tag), but not her last name (de la Vega) or where she was from (the Philippines). “It was just her personality,” he says. “No matter what I was buying, I always went through the beer line to get my self-esteem pumped.”
Just as he was leaving, Coyne stopped and asked de la Vega if everything was all right. Her eyes teared up. She told him she had kidney disease. Each night at home, she sat hooked up to a dialysis machine and tried to sleep. For eight hours, her blood was pumped out, cleaned, and then pumped back in—the job that functioning kidneys handle. Dialysis keeps you alive, but you don’t enjoy life. Some people become sicker and sicker until they’re no longer healthy enough for a transplant. Some just stop dialysis and wait to die.
“It’s very hard,” de la Vega told Coyne, “to live and work in this condition.”
The words tumbled out of his mouth: “Can I do something? Anything? Maybe I can be a donor?”
Coyne had had a troubled youth. He’d spent time in jail for burglary and at the Indiana Boys’ School. But people had helped him along the way, so now he always tried to give back. That’s how he came to be a school social worker on Chicago’s South Side. Now he had a wife and two kids of his own. He donated blood whenever he could, so he thought, Why not this? Why not an organ?
De la Vega looked at him like he was crazy. “No, no,” she said. “This is a family matter. My sister will be coming when her paperwork goes through. She can donate her kidney.”
Coyne went home and hoped for the best.
But a few months later, he was back and de la Vega looked worse than ever. As it turned out, her sister had a heart condition and wasn’t a viable donor. So de la Vega made arrangements for her children to be cared for. Her weight dropped to 80 pounds. She kept up her dialysis so she could be with them as long as possible. She bided her time.
Again the words came to Coyne. Again de la Vega was suspicious. What did this man want? Was he crazy? That night they talked on the phone, and she gave him her doctor’s number. If he was really serious, he could call.
He did. Then he went through the battery of physical and psychological tests all donors must undergo. It was a few months before he received word: He was a match. Coyne and his family decided to surprise de la Vega at the store. When they told her, she collapsed in tears.
But the question remains: What did he want?
When people give away pieces of themselves, most receive nothing tangible in return. Sure, starving college students may go to clinics and make a little money from their plasma, or find a fertility clinic and sell sperm. But each year, 9 million people show up at blood drives and donation centers, ready to roll up their sleeves and give a pint of blood and an hour of time in exchange for some OJ, a few cookies, and the vague satisfaction of helping an unknown person. Then there are the roughly 44 percent of us who check the DMV box for “organ donor” so that desperate strangers can have our parts when we no longer have use for them.
Living organ donors, however, are in a different category. They offer up a piece of one of their lungs and spend weeks recovering. They have their livers cut in half and sewn into another person. Some—often referred to as “altruistic” or “nondirected” donors—don’t even know the recipient; they just know that someone needs an organ and that they have a spare.
Not long ago—as late as the 1990s—this kind of extreme sacrifice was rarely seen, since the medical establishment viewed such donors with as much suspicion as Myra de la Vega first viewed Dan Coyne. After all, who would want one of their organs cut out for a total stranger? It was assumed they must be unstable—or insane.
It was a relatively new dilemma for doctors, since the first successful living kidney transplant didn’t even happen until 1954. This became easier in the 1960s, when medications were developed that could help suppress the recipient’s immune system so it wouldn’t react to the donor organ as if it were some kind of giant invading virus. As these drugs improved, the circle of potential donors widened and altruistic individuals started coming forward, resulting in a small number of operations in the late 1960s. But the success rate was poor, so doctors stopped performing transplants between unrelated people. Besides, kidney donation at the time was an arduous procedure to undergo—in addition to a long hospital stay, donors ended up with a huge torso scar and quite possibly a missing rib.
But around 1995, researchers found a way to remove a person’s kidney employing laparoscopic surgery—that is, using a few small holes and a camera. Suddenly the procedure was less painful and the recovery easier. This, plus still better medications to reduce the risk of organ rejection, made altruistic donation much more viable.
As word got out, donors began calling hospitals again. A 2003 University of British Columbia study found that “without solicitation, 93 individuals contacted our center over 18 months expressing an interest in becoming an LAD [living anonymous donor] … Some called our center persistently over several years in their efforts to become a donor. Indeed, we did not need to find individuals who would be willing to be LADs. They found us.” And not only that, but many of them were remarkably sane.
Today, some transplant doctors dislike the term “altruistic donor,” since anyone who’s not being paid for an organ, such as a family member, is arguably acting altruistically. But most donors don’t think too much about these labels. They don’t see themselves as heroes. And most don’t even consider what they’ve done to be a big deal. The University of British Columbia study concluded: “For [living anonymous donors], donation was a natural extension of giving, in lives already rich with philanthropy,” which “dispels the notion that psychological health is irreconcilable with altruism.”
That study’s title is “The Living Anonymous Kidney Donor: Lunatic or Saint?” “And the truth is that they’re neither,” says Gabriel Danovitch, M.D., the medical director for the kidney and pancreas transplant program at UCLA. He has worked with many altruistic donors over the years and feels that there’s something very ordinary about them, despite their extraordinary act. “They’re just decent people, normal people, healthy people who find that donating is something they want to do,” says Dr. Danovitch. “It gives them gratification and fulfills a tremendous societal need.
Back when Todd Musgraves worked as a cop, the job initially seemed to satisfy his abiding desire to help people, to have a positive impact on their lives. But after seven years on the force, the 38-year-old resident of Texarkana, Arkansas, felt he needed to do more, which led to a second career as a grade school teacher. This was closer but still not enough. Then he remembered an article he’d read about altruistic kidney donation.
For several months, the idea of donating a kidney to someone rattled around in his mind. After all, he was healthy, and the need was there—100,000 people were waiting for transplants. Finally something clicked into place. He knew what he had to do. “I just thought, ‘If there’s somebody who’s hurting, and I can help them, why not?’ ” he says.
After doing some research, Musgraves found a hospital he felt comfortable with—the University of Maryland Medical Center—and reached out. He told his family about his plan. They weren’t very keen on it, but they could see it was something he had to do and agreed to help.
After he’d passed all the necessary tests, Musgraves flew to Baltimore. Once at the medical center, he was put under anesthesia and one of his kidneys was cut out. The organ was placed in a cooler with a GPS tracker and transported by car to Pennsylvania, where at the Penn State Milton S. Hershey Medical Center 34-year-old Melissa Masse was waiting. Just as she was wheeled into the operating room, she saw a doctor holding Musgraves’s kidney. He was cleaning it, measuring it. It looked big and full and healthy, especially compared with her own shriveled organs she’d seen on an ultrasound.
When Masse woke from the anesthesia, Musgraves’s gift was already pumping away inside her body, cleaning her blood like magic. Immediately, her kidney function shot up from just 7 percent to 68 percent. Immediately, her husband and her 7-year-old daughter were given an unknown number of additional years with her.
Musgraves and Masse were the first links in what’s known as a “kidney chain,” a coordinated effort to match donors who are unsuitable for their intended recipients with people in need who also have incompatible but willing donors. On his last day of testing, Masse’s husband discovered that his kidney wasn’t compatible with her. He felt like he’d let her down. He was devastated.
So he readily agreed to give his kidney to someone he did match: A man in Philadelphia he had never met who was also married with kids. The man had been on dialysis for seven years, with a mere 12 percent chance of finding a compatible donor because his antibodies were too high.
That man, in turn, had a donor lined up who gave a kidney to someone else, and then one more kidney was donated after that; so four lives were saved thanks to Musgraves’s act of altruism.
“He’s very rare,” says Masse. “But I think it’s just the kind of person he is. He likes to help people. And he certainly helped me. Todd literally gave me a second chance at life by making the selfless decision to donate to a stranger.”
People have many reasons for giving pieces of themselves to others. According to the American Red Cross, the top three motivations cited for donating blood are as follows: “I like to help others,” “I feel it is my responsibility,” and “I enjoy the feeling of gratification after donating.”
Some donors, like Ben Schollmeier, a 33-year-old mechanic from Minnesota who gave part of his liver to his ailing sister, do so because they don’t want to lose a loved one. But others, such as 24-year-old David McVeigh, who recently took several days off work so he could donate bone marrow to a person he doesn’t know, have reasons that are more complex.
“The way I see it,” McVeigh says, “if I’m not willing to donate for someone else, then why should someone be willing to do that for me or my family members?”
When George Taniwaki decided to sacrifice a kidney, he had a similar reasoning. Twice in his lifetime he’d seen people give away a kidney. In college, a guy he carpooled with took time off from work to donate to his brother. Some years later, a coworker suddenly had to go in for emergency dialysis. A guy in the office next to Taniwaki’s stepped up to be the man’s donor.
Then one day in 2007, he read about altruistic donation. It was the first time he realized you didn’t need to know someone with kidney failure to be a donor. Taniwaki was struck by the urge to donate. He was 48 years old, married, healthy, with a good career at a software company and no children. His wife was opposed, but he says, “Over time I was able to convince her that this was something that I wanted to do; that it would have an impact on the patient who received it, obviously, but would also be an improvement to society as a whole; and that overall the benefits outweighed the risks.”
In a sense, McVeigh and Taniwaki were trying to create the kind of world they wanted to live in. This is perfectly reasonable, even wise. But why don’t we all want to do it? It’s a question that puzzles most altruistic types. If we did, the wait would be over for people in need of organs. We would probably live in a much more humane society. As Dr. Danovitch notes, an altruistic donor’s response to “Why would you donate a kidney to a stranger?” is often “Why wouldn’t you?”
For hundreds of years, altruistic behavior was seen as an anomaly because humans were presumed to be purely self-interested. Religion was supposedly the only check on our selfishness. By the mid-20th century, however, there was plenty of evidence to the contrary; and in the 1970s, the theory of “reciprocal altruism” showed that selflessness could evolve as a force of nature. By helping each other, we could all benefit. Cooperation could be a competitive survival advantage.
Evolutionary hardwiring may help explain the findings of Georgetown University psychology professor Abigail Marsh, Ph.D. She and her colleagues recently completed a study of altruistic kidney donors that turned the focus to the organ behind their donation: the brain.
The researchers used brain imaging to examine the size and responsiveness of 19 donors’ amygdalae. The amygdala is a region that plays a key role in our emotional processing and social cognition. It’s also known to be smaller and deformed in psychopathic people. What Marsh found was that the amygdalae of altruistic donors were significantly larger and more responsive than average.
“They have these Cadillac amygdalae that might make them more attuned to distress than the average person,” says Marsh. “This may be one reason they go so far to help someone in need.”
That’s not to suggest that extreme altruism can be entirely explained by anatomical differences. In the 1960s, the psychologist Erik Erikson noted that we spend the first few stages of our lives constructing our identity, finding our place in society, and looking for love. Then as we arrive at what he called “middle adulthood,” we become more concerned about what we are contributing to the next generation. He called this “generativity,” and the more generative we feel our life is, the more we have what’s known as “eudaimonic” (meaningful) well-being, as opposed to hedonic (pleasurable) well-being. Could there be a more generative act than donating an organ to a stranger? And the resulting sense of eudaimonic well-being? Perhaps it’s more reward than many of us can imagine.
There’s also a paradoxical fringe benefit to putting one’s own health at risk for another person: A study in Psychological Science found that people who felt “more purpose in life” had a 15 percent lower risk of dying over a 14-year period than those who “wander aimlessly through life.” This carries through to the cellular level, where people with higher eudaimonic well-being have less gene expression related to inflammation than those higher in hedonic well-being.
Being good to others, in other words, is good for you, says Marsh. “A lot of research shows that people with higher levels of well-being tend to be more prosocial, and that being prosocial—doing things for others—gives you more well-being. So they’re reciprocally related,” she says.
Marsh and a colleague recently published a paper exploring the geographic link between well-being and altruistic kidney donation. They found that states with higher levels of reported well-being, such as Hawaii and Minnesota, also have higher rates of altruistic kidney donation.
This doesn’t mean Minnesotans have more-altruistic brains than people in Mississippi or Delaware, the two states tied for last. But it does mean that where social connections are strong and where people are healthy and find purpose and satisfaction in their lives, folks may be more likely to be altruistic toward those around them—and create even stronger social ties in their lives.
There’s little doubt about the ties that bind Todd Musgraves and Melissa Masse. When Todd sent his kidney off to Pennsylvania, he made sure the doctors put a card with it that said, “I just want to tell you from my heart, I hope your life is amazing from this point on.” The two, once strangers, now e-mail or talk several times a week.
“Since my donation,” Musgraves says, “I find myself enjoying life more rather than waiting till the weekend to enjoy it. My whole outlook has gotten better. And from other donors I’ve talked to, none of them have complained about donating their kidneys. It’s a life-changing thing to help somebody in this way.”
As for Dan Coyne and Myra de la Vega, the surgery went well on both sides. She was finally unchained from the dialysis machine, and Coyne was released from the hospital after just 24 hours. These days, their two families often have dinner together, and Coyne has been to both of the de la Vega children’s graduations.
“To be able to go and see Myra alive and living fully, as her children do the same,” Coyne says, “is so much a gift back to me.”
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