As a young adult early in her collegiate career, Abigail Marsh experienced life-altering altruism first-hand. That interaction sparked the question that has fueled much of her research ever since , “why would a stranger risk their life for me like that?” In this episode, host and kidney donor Michael Lollo speaks with world-renowned neuroscientist, psychologist and professor Abigail Marsh to discuss different types of altruism and dive into the connection between altruism and living kidney donation.
As a young adult early in her collegiate career, Abigail Marsh experienced life-altering altruism first-hand. That interaction sparked the question that has fueled much of her research ever since , “why would a stranger risk their life for me like that?” In this episode, host and kidney donor Michael Lollo speaks with world-renowned neuroscientist, psychologist and professor Abigail Marsh to discuss different types of altruism and dive into the connection between altruism and living kidney donation.
Happy New Year and welcome to our first episode of season. Two of One is Enough, the official podcast of the National Kidney Registry. And, in case you guys have forgotten, my name is Michael Lalo, your host, and I am very excited for today's episode for two reasons. One, I cannot believe that we made it to our second season and I want to thank Dan on the train who rides along on a railroad that goes back and forth to New York. I know I have one listener out there because he listens to every episode and he quotes everything. So thank you, dan, for listening to the podcast. And second is, I want to celebrate our new season.
Speaker 1:We have an extraordinary guest and a good friend of the transplant community, and I think I can call her a friend of mine. We're going to have Dr Abigail Marsh. Abigail Marsh holds a PhD in social psychology from Harvard University and conducted postdoctoral work at the National Institute of Mental Health. I did that all at one breath Good breath control. She is currently a professor at Georgetown University, where she also directs the laboratory on social and effective neuroscience. Abigail has released several books and has been a speaker for TED Talks and has been a guest on more podcasts than we have had episodes, so it is a little intimidating because I think you are more of a podcast expert than I am. Abigail first. Is it Dr Marsh? Is it Abigail? Is it Abby? What do you prefer?
Speaker 2:In conversation. Abby is just fine.
Speaker 1:All right. Well, abby, thank you so much for joining us, and welcome to One is Enough.
Speaker 2:Thank you so much for having me. I'm happy to be here.
Speaker 1:We are super excited.
Speaker 2:So you do know that we star in a movie together, right, I do, I do, and we even got to go to one of the various screenings of it together, which was really fun.
Speaker 1:How awesome was that. After the screening, we got to sit on the stage and people got to ask us questions. But when I say we start, I really should say you start in it. And I played a very, very, very small role and I brought my wife and kids to that screening and I told them listen, it's only about like 30 seconds that you're going to see me on the screen, but I think that was pretty cool and I'll do a shameless plug for our good friend Penny Lane, who was the director and star of an amazing documentary called Confessions of a Good Samaritan. That was. It was awesome, right.
Speaker 2:It was fantastic. I mean, I think I've seen it three or four times now and I just love it more every time I see it. It's such a beautiful movie.
Speaker 1:So during the, during the movie, you described a personal experience which I thought was was moving and really telling and kind of like shape your career. Would you mind going over that for the millions of people who are listening on our podcast today?
Speaker 2:Absolutely so. As you said, I do a lot of research on people who I call extraordinary altruists to, who do something you know, both rare and somewhat costly and risky, to save somebody they've never met before, and I can trace my interest in trying to understand this phenomenon to an experience when I was 19, when a stranger took a big chance to rescue me when I was 19 and home for the summer from college, and the, you know reasonably short version of the story is that I was driving south on the Interstate 5 freeway into my hometown of Tacoma when a dog ran in front of my car and I did the wrong thing, which was swerve to try to avoid it and of course, yeah right, I mean and you know I think I mean that was my own little altruistic impulse, my own contribution to the evening.
Speaker 2:Any case, I discovered why it's the wrong thing to do, because I hit the dog anyways and also sent my car into first a fishtail and then actual spinning across the freeway until I came to rest in the fast lane of this Hoover Pass with no shoulders, no way to get out, wow and also in a sort of a blind spot oncoming traffic. So the traffic couldn't see me until they were crossing the bridge and barely had time to get out of the way. And I was. You know, it was definitely the most horrified I've been in my life. I was sure I was going to die.
Speaker 1:Oh my gosh.
Speaker 2:And I had no phone because it was the 90s and out of nowhere. How did we ever survive without our phones?
Speaker 1:But yeah, exactly.
Speaker 2:Well, we survived because of each other at least I did. Out of nowhere, a man appeared next to my car who I'd never seen before. I later figured out that what he must have done is, as soon as he crashed at that bridge and saw my stranded car, he had to have pulled over into the off-ramp, sort of opposite, where I was immediately.
Speaker 1:Sure.
Speaker 2:And then run across the freeway in the dark. It was around midnight to get to me and then he stood on the you know passenger side which, because I was facing it, into oncoming traffic at that point it was sort of by the little tiny shoulder and said you know, you look like you could use some help. And I remember being just like sort of floored at the both. I mean, you just had that. All I remember really really well about him is his voice. It was very calming and warm and deep, but I just had the sense of like, okay, I think this guy's going to make this all be okay.
Speaker 2:Right, I trusted him, Anyways, and so he, you know, said okay, well, can I get in the driver's seat? And so he ran around the car again into traffic, got into the driver's seat, I scooched into the passenger seat, he got my car running again because the engine had died, and then waited for a break and the you know freeway traffic and got us back to the other side of the road and then looked at me and I was sweating and shaking and gray and he's like you don't look so good. Do you need me to follow you to make sure you go home? Okay?
Speaker 2:So he was willing to do even more.
Speaker 1:Wow.
Speaker 2:And I was so out of it that I didn't properly thank him. I said something like no, no, it'll be okay, it'll be okay. And he's like okay, well, you take care of yourself very kindly. And then hopped out of my car and off he drove into the night.
Speaker 1:Wow as.
Speaker 2:I ever heard from him haunts me. To this day I never asked his name, I don't know anything about him and I don't think I said thank you.
Speaker 1:But crazy, and I'm sure you've retold the story many, many times and people probably could Google you and find you would be amazing, right? If he said hey, abigail, I'm the, the dark silhouette guy that saved your life when you were 19.
Speaker 2:I still hope. I hope to this day that that could happen. And I, you know, I was 19,. You know everybody over the age of 25. When you're 19 looks a million years old.
Speaker 2:So I haven't absolutely no idea how old he was, but I hope he's out there someday and I hold, I hope I'm like it's a medium. But it stuck with me, you know what he did and the gun, the just sort of awe inspiring nature of his actions and it. I think it just stuck with me like a little you know bug in my brain like how is it possible that somebody would make a decision like that? So that's the focus of a lot of my research now.
Speaker 1:So at 19, did you already know that you were going to go into this field?
Speaker 2:Not directly, you know. I think your decisions make a lot more sense in retrospect when you can see the long trajectory, that at the time I had already started taking psychology classes and I loved them. I had no, you know, no intention of studying psychology, but my very first class I was totally hooked.
Speaker 1:I remember reading the facts back. Yeah, why did why? Why were you hooked? Why did it like?
Speaker 2:You know I remember loving everything about it. We had the class at Dartmouth, had four different faculty teaching it, different sections of it, and each one was better than the last. You know, the one who was the rat researcher brought some like rats in a tub to the front of the class and we got to, you know, put a camera on them when we got to watch, like Matt, rat mating behavior. This is so weird but like that's what psychologists do. This is fascinating. And there, you know, I did a like. I had to participate in a research study on like language comprehension and I remember reading in the book about psychologists teaching sign language to apes. I remember thinking that's what psychologists do, that that's the most fascinating thing in the world I would do that for free.
Speaker 1:I didn't know you could do that for a job, yeah, so. That's awesome, but during your story you mentioned the term extraordinary altruism and I know you described there are several different types of altru altruism, so I was hoping that you can go through each one of them briefly, I guess.
Speaker 2:Yeah, certainly. So what I call extraordinary altruism is, you know, quite literally altruism that's out of the ordinary. So it's something that's very rare, although it doesn't have to be rare forever, but at least at this point.
Speaker 2:For example, giving a kidney to a stranger is very rare and usually is rare in part because it's very costly and risky and it's done for a stranger, which is unusual. Most people are altruistic preferentially for people that they know well or who they're related to, and that's because evolution has built us with lots of different systems that promote altruism for different reasons and in different situations. Maybe the best well known is what's called kinselected altruism, so that's altruism to help people you're related to because that helps your own genes make it into the next generation and you can see that kind of altruism in ants.
Speaker 2:You can see it in lots of different species and it, you know, helps all of us be greater than the sum of our parts. There's also reciprocal altruism, which is also somewhat widespread in the animal kingdom and it's very common in humans, which is helping somebody who's helped you in the past and who may well help you again in the future if you help them and you're now cooperating. So that's a really cool kind of altruism, but helping somebody who you don't even know who they are, at a significant cost and risk to yourself, but no objective benefit rather than being really glad you did.
Speaker 2:it is a really different thing and you can't explain it through either those kinds of well established evolutionary mechanism.
Speaker 1:So the people listening to this podcast may say, well, all this sounds very interesting, but what's the connection of altruism to living kidney donation? So can you share how kidney donors have been a part of your research and altruism?
Speaker 2:Absolutely so.
Speaker 2:You know, partly inspired by what happened to me and partly because I had been doing research with populations who were very low in empathy and compassion and it had got me interested in trying to understand compassion and caring about other people in general, I set out when I first got to Georgetown to try to find a group of sort of real people in the world who had done something that would be, you know, as close to unambiguously altruistic as you could imagine, to try to learn more about altruism in the real world.
Speaker 2:So not altruism in the lab, where you're like giving somebody a dollar or not, you know that's not, it's not an unuseful thing to do. But I felt like to really understand altruism. You have to understand it in the real world, and so that was in about 2009. And that was just about the time I think the average person was starting to understand that there were people in the world who were volunteering to give their own kidneys to strangers. Larissa McFarquhar had had that fantastic book, an article out, called Strangers Drowning, and it was just getting to be common enough that I think most people had heard of it. A lot of transplant centers still didn't allow it.
Speaker 2:You still weren't allowed to give a kidney to a stranger in many places, but it was 2009. Yeah, yeah so you're not talking about like 1970 something.
Speaker 1:We're talking 2009.
Speaker 2:Yeah, I mean the first truly non-directed donation, as far as we know, was in about 1999. And the first one that was in DC, I think, was in 2000 or 2001. Anyways, and I thought you know, like if anything counts as altruism it has to be altruistic condemnation, because you know it's so difficult to do. You know the transplant centers, you know make sure that you can't possibly be getting paid for it and that you know they. You know long psychological exams to make sure that you know what you're doing. You know it can't be that there's a misunderstanding about what's happening.
Speaker 2:And I thought, yeah, if I want to understand altruism, this is exactly the right group of people that I should work with. And luckily there had been a really nice article about altruistic kidney donation published recently at that point by a bioethicist named Robert Beach, who was sometimes called the father of modern bioethics, and he was a Georgetown professor, and so you know I wandered over to his office with his article and I said, professor Beach, can you help me find altruistic kidney donors that I could maybe work with for this research program I have planned? And he very kindly did, and that was the beginning of this line of research.
Speaker 1:But you ended up getting to this research by starting with the opposite right. You studied people who maybe aren't so altruistic.
Speaker 2:Yes, exactly. So you know, by the time I finished my undergrad and then started working as a graduate student, my interest in doing psychology research had really started to focus on what causes people to care about others. But I was doing research in the social psychology department and lab, where almost all of the research that we conducted was within the lab.
Speaker 2:You, know, you have to try to simulate altruism in the tiny room between two strangers you know who were there for half an hour getting paid $5.
Speaker 2:And you know, I just wasn't satisfied with any of the answers that I was getting.
Speaker 2:I mean it was useful and it was informative, but I felt like this is not ever going to help me understand, like, why people really care about other people. And so a pretty classic approach to trying to understand basic psychological phenomenon is to find groups of people in the world who are missing the thing you're interested in, and then bring them into the lab and study their behavior and their cognitive functioning in their brains and see, okay, for example, if you're interested in memory, memory research owes so much to work with people who have amnesia or who have damage to a structure called the hippocampus which causes amnesia, and we learned so much more about memory than we could have without those special populations. Same with recognizing or same with understanding. You know face recognition. Or you know a thousand intelligence, a thousand different psychological phenomena. So I was like, okay, if you're interested in studying empathy and compassion, we should find a group of people who don't have any and see what's different about them and maybe then you can understand-.
Speaker 1:There's a couple of them in the United States. We got a couple of us.
Speaker 2:There's a couple of them, yeah, no everybody.
Speaker 2:You know, when I describe with somebody who is psychopathic is like almost everybody is like oh, I see, yeah, now I understand.
Speaker 2:And so I left the social psychology lab after I graduated with my PhD and went to the National Institute of Mental Health for my postdoc, where I started working in the lab of James Blair, who was one of the very few people in the world doing brain imaging research with people who were psychopathic At the time, both adults and adolescents, and then I ended up mostly studying adolescence and you know we brought kids into the lab who, you know, as close as we could tell, lacked any empathy or compassion for other people, based on other people's interviews with their parents, for example, based on interviews with them, standard measures and then we did brain scans with them and found that they pretty consistently had differences in the structure well, many differences, but one that kept popping up was differences in the structure called the amygdala, which, in people who were psychopathic, tends to be smaller than average and also underactive to certain kinds of information, including threats but also the sight of other people who are being threatened, so people who look afraid, and this might help explain why people who were psychopathic make threats is because they don't have a strong emotional response to the sight or sound or even idea of another person in danger, and so that seemed pretty suggestive that, like maybe something happening in the amygdala is really important for understanding, empathy and compassion.
Speaker 1:So if you take the psychopath and you take the extraordinary altruistic person, it's not something that can be learned right. It's you rather are or aren't. Is that a good understanding of it? Like you can't, can an extraordinary altruist become a psychopath, and can a psychopath become an extraordinary altruist?
Speaker 2:Well, this is not something we have any data on. However, we do know that there's pretty good stability in psychopathic trades across the lifespan not perfect stability, and especially if you first measure somebody when they're really little, when there's still a lot of room for change and improvement in somebody who's very young and psychopathic. But once you hit adulthood, you know again, you can get better in terms of your behavior and lots of people who are psychopathic have gone through effective psychotherapy and they learn to behave better. But you're not going to ever become the sort of person who feels the strong sense of empathy and care for other people. And this is partly due to what we think is the pretty strong heritability of both of these trades, where, well, I think of it as two ends of a single continuum, to be honest. But yeah, there's some evidence that these trades are moderately heritable.
Speaker 2:So about half of the variation in the population is due to genetic factors. So you know, I think the way I think of it is that we each probably do to our genes and other things that happen while we're developing in the uterus. We each have sort of a window of possible outcomes for almost anything for how tall we might end up being for how good at playing piano we might end up being, and life experiences will help dictate kind of where in that window we end up and none of us knows. You know from the beginning how where our window is for any given outcome and so most people can absolutely become more caring and compassionate and altruistic. But I think most altruistic kidney donors started with something about them that was different, that gave them the possibility to become even more altruistic and caring. But life experiences helped also contribute to the way that people become.
Speaker 1:So in your research, when you did the brain scans for people who were extraordinary altruistic donors or good Samaritan donors, did some of them have normal sized amygdala or slightly not as large as some of the others? And then what would you attribute that person being this, you know, good Samaritan donor. Is it like you just explained, because of the life experiences? So the amygdala is not the only factor. Right, you could have an average amygdala and still be a non-directed donor.
Speaker 2:Absolutely yes. I should emphasize that strongly which is that there's no brain scan in the world that can diagnose any psychological outcome yet. So I couldn't ever take a brain scan of somebody and measure the size of their amygdala and be like look at you. You're a psychopath, or look at you.
Speaker 1:You're very altruistic. That would be awesome, because I would want brain scan stations set up everywhere and then, as the people who walk by are like, whoa, you got a big amygdala, come over here, maybe you could be a kidney donor. That would be awesome, wouldn't that be anything? Oh my gosh, that would be great.
Speaker 2:And that was the original thinking was that we would be able to do that with brain scans, and I think, you know, maybe someday the technology will be there, but it's not there now.
Speaker 2:And part of the problem is that the amygdala is a really complicated structure. Even though it's pretty small, it has so much stuff happening within it, most of which is probably irrelevant to altruism, and so what we're picking up on when we measure the size of the entire amygdala is a bunch of irrelevant stuff and then something happening within a couple of the nuclei that must contribute to altruism. Is it more receptors for critical hormones like oxytocin? Is it just better connections with other critical parts of the brain? We don't know. And so I do think that people who are very altruistic there must be some common thread there, but our MRIs just can't pick it up yet. And so, yes, there are plenty of people who are very altruistic, whose amygdala are very average or even smaller than average, but they still might have something special happening within it. It's just, you know, we don't have the sensitivity to pick up on them. And plenty of people who are psychopathic have, you know, very ordinary size amygdala.
Speaker 1:So we're just not there yet. I am very curious about the size of my amygdala so I may have to when you open up the scans again. If you're going to do that, I may apply for the study to see. I'd be really upset if I think I might be upset if you said you're just an average amygdala.
Speaker 2:Oh yeah, no, if you know, I've had a couple of times where I've brought people in to do scans for you know, not research purposes. For you know, for Penny's movie or for episode of 60 Minutes.
Speaker 1:Sure.
Speaker 2:I'm like I'm going to feel so bad if I have to tell them that like, oh, things don't look so good, or at least we're not like you know.
Speaker 1:You're just average. I'm sorry You're amygdala is.
Speaker 2:But of course they're not. I mean, the behavior is still the behavior. What you did is there's nothing that I can see on a brain scan ever could take away from what would actually happen.
Speaker 1:It just means that you don't understand, I know, but I want a big amygdala.
Speaker 2:Of course, yes, I you know. It just means we don't understand any of this as well as we wish we did. We're really we're in the early, early stages of trying to. We're trying to understand it.
Speaker 1:So we have. You might be familiar with a program called micro sites. It's for patients who are looking for a living kiddie donor, and we do this champion training. And there's, you know, we have this. It almost looks like a bullseye, right, you know. We tell them that they should reach out to their immediate family, and then you know friends and you know other relatives, and then you know, the last part of the circle is, you know strangers. So friends and relatives that come forward to potentially donate either to or on behalf of this, this person, would that? What kind of altruism would that be? Is that reciprocal altruism? Or how would you quantify? You know someone that knows the person you know, but they're not necessarily, like you know, blood related.
Speaker 2:Well, you know, as I'm sure you know and lots of people listening might know, you know many people don't like the term altruistic kidney donor to refer to non directed donors, because it suggests that if you donate to a friend or family member, you're not altruistic, and so I agree, I usually correct people.
Speaker 1:Yeah, I think all donors are altruistic. You know, that is exactly what I think too. Yeah.
Speaker 2:No, I think to give a kidney to anybody you know, give up your own, you know internal organ, go through a lot of inconvenience and medical testing and discomfort and then a surgery that is not a zero risk. Surgery, as you know, is like that's a really big deal and I don't think it should be discounted if it happens to be somebody that you love and care about and I know you know many directed kidney donors as well and directed liver donors and I think it's a pretty magnificent thing. Regardless, I do think there's something a little extra about donating to somebody that you never met before. I mean, most people would not ever consider doing that. However, a striking number of people don't want to donate to anybody.
Speaker 2:I mean, you know, one of the more, one of the stories I've heard that's really stuck with me is one of the first donors we met and worked with here at Georgetown was the first ever non-directed donor in DC and he donated here at Georgetown. His name's Harold Mence. Many of you know him or are familiar with this story. He's been just a wonderful friend now for many years. He's he.
Speaker 1:I spoke to him a lot.
Speaker 2:Yeah, I've learned a lot from him and you know, one of the really amazing stories he told is that his the initial person that was selected for him to donate to off the list in DC was a 17-year-old boy, but it was eventually decided that Harold could not donate to him as a stranger because the boy's mother was also a match for him.
Speaker 1:Wow.
Speaker 2:And had said she was not going to donate a kidney to her son until he brought his grades up. No kidding, that's the story.
Speaker 1:Really yeah.
Speaker 2:And so my sense is that that was not the reason. The reason was that she didn't want to donate her kidney. She was frightened, probably, of the surgery, or maybe there was something else going on, and so you know that is. The reality is that there are people who refuse to donate to people who are close to them for reasons that are hard to understand as an outsider, and so I think it's a really big deal for anybody to donate.
Speaker 1:So I did speak to Harold, unrelated to this podcast episode, and he said he's had many conversations with you about your work, of course, which he appreciates and stuff. But he said that you guys have debated the fact that one of his theories is the brain's a muscle and you're studying these altruistic donors or non-direct-to-kiddy donors, I should say after the fact, and so I don't really know a lot about the brain. I don't have my brain, it's probably really small, but I don't really know about a lot of it. Is it a muscle like my bicep that if I work it enough I'm going to have these like huge on the shoulder muscles or short-sleeved muscles? So I don't want to say that he doesn't buy into it, but he does question. You know, could the brain, could the amygdala grow? Because you did this act and usually kidney donors afterwards feel this sense of wanting to do more and stuff. So I don't know if I hate to put you on the spot, but I did tell Harold if I ever spoke to Abby I said I would ask you that question.
Speaker 2:Of course. Of course, though I think it's a perfectly good and thought-provoking question that he's asked, and it's an important question, and it is true that we ask in people's brains it's after they have donated. It would be almost impossible to do it any other way. I mean, you can't sample the population and hope some of them go on to donate kidneys. You'd have to scan millions of people's brains in the hopes of that, and then obviously, I would never ask anybody to like work in a brain scan after they've already you know, when they're in the lead-up to the donation.
Speaker 1:It seems almost impossible.
Speaker 2:So to me, the sum total of the evidence is that it's pretty consistent that wherever you are on the caring continuum, there is some relationship between amygdala size and your behavior. And so the fact that we see both people who are psychopathic have smaller amygdalas and people who are more altruistic have relatively larger amygdalas, you know, and the heroic rescuers that we scanned for the 60 Minutes episode was the same. And so after the fact, and so to me it makes more sense that this difference in brain structure and function is leading to differences in behavior. However, I really do think of altruism as and certainly altruistic kidney donation, oftentimes as the result of a long process of people's brains changing and developing as they become more and more altruistic over time, and so most people I've worked with who are altruistic kidney donors also are longtime blood donors.
Speaker 2:Many have donated marrow or platelets or plasma or done many other helpful things, and the idea is that you know every time you do something that helps another person, it's reinforcing If you're an altruistic person. Right, people who are altruistic find it particularly joyful to help other people, and that makes it more likely you'll do the next thing, and the next thing, and the next thing.
Speaker 1:And so you're doing double donors, right, you did kidney first and doing liver, or vice versa.
Speaker 2:Yeah, apparently there was a men's health article where they interviewed what they called a triple donor, which is kidney, liver and marrow.
Speaker 1:Right.
Speaker 2:Or stem cells. Yeah, yeah, no, it's amazing. It's amazing and so and that's great, I mean, it's great that that helping other people, if you are an intrinsically altruistic person, feels good and makes you more likely to do it again. So I fully agree that I am capturing a moment in time in a long trajectory of somebody's personality and behavior. However, I also think that you know those brain changes are why you are more likely to then help the person the next time. You know.
Speaker 1:I don't.
Speaker 2:Actually I don't see there being a contradiction between Harold's question and the way I think of things.
Speaker 1:So let me ask you a question, not my words, these are, these are yours. You would consider me to be extraordinary. I'm an extraordinary altruistic person because I donated as a good Samaritan donor and I think you know my wife donated a portion of her liver last December. Actually, it'll be a year in a few days of the taping of this podcast. So if I'm so extraordinary, right, and even you know, my wife donated to. You know, I think you know, although she knew of the person, it was a work acquaintance. You know, I wouldn't even consider the person of friends, it was a. She got an email that someone within the DA's office needed a, you know, a liver and you know she stepped forward and ultimately donated to him. So I, personally, I consider her to be the same as me, right, it's just, you know it's. She's a good Samaritan, although she saw the guy occasionally in the courtroom.
Speaker 1:But my question is you know I've been. I donated my kidney back in 2018. And you know, my wife only decided to donate a portion of her liver last December. My wife donated a portion of her liver last December and I, I know people personally who are double donors and I don't have any desire, I don't have the same feeling to do a liver donation that I did for the kidney donation. So if I'm so extraordinary Abby, why do? Why am I not moved to to start the process and donate a portion of my liver to somebody which I know? There's many people out there that that need it?
Speaker 2:That's a great question and I mean, you know what you're talking about I think gets a really deep sort of questions about. You know, in theory was your wife. She was the same person before she donated her liver and before she even decided to donate her liver that person was there all along, right, and maybe that she was sort of changing personality wise to become even more likely to do something like that. But you know, the altruistic personality is there, regardless of whether it manifests as a particular behavior or not.
Speaker 2:I also think that, and you know, what I find very lovely is that all the altruistic kidney donors that I've had the opportunity to talk to throughout my research has, I think, been sort of very clear that there's lots of different ways that altruism can manifest. It's not just one way. So there can be a really altruistic person who's never donated kidney but has, you know, worked for doctors that borders and offer for years and years, and that's, you know, it doesn't make them less altruistic that they didn't do this one particular thing. I think there's some complicated soup that makes one particular way of helping others more just feel like a more I don't know sort of reachable option, and you know you could answer better than me.
Speaker 2:You know what is it about the potential of donating a piece of your liver that you're just like? I don't think that's me, you know, and what feels different about that from deciding to donate a kidney?
Speaker 1:I've thought a lot about it because you know she had an amazing and actually because of her liver donation it brought it back up and in my mind because I'm like, wow, you know, it was a major surgery, much more difficult than a kidney donation, much more risky. And I said, you know, I watched her go through the process and for the most part it went exactly as planned and it was fairly I don't want to say easy, but you know what I mean. It was. It was, it went exactly what was supposed to go. And I said, gosh, why, like? Why aren't I doing this? You know, and there's a gentleman named Mark Scotch who donated a portion of his liver after kidney.
Speaker 1:Lin Boldek is another liver donor, excuse me, started out as a kidney donor and became a liver donor, right? So I've spoken to probably at least half a dozen people who've donated and I'm like, why? So what? I actually? I actually said like, so what's wrong with me? Like what? I know you're laughing, but I like, really like, what's like, what's wrong with me? The only thing I could really say is, I mean, I'm not old, but you know, I'm 51 now and I don't know.
Speaker 1:I feel like, you know, we have a mutual friend, ned Brooks, right, and I spoke to earlier today about something unrelated to this, and I remember when I told Ned that I was thinking about it and this is probably about a year or two after I donated my kidney, and he said hopefully I'm not gonna get a man.
Speaker 1:But he said what he's like, michael, you know he almost was insinuating that there there could, like I could be crazy, right, like, like there could be this, you know, like this need you know to, to want to like do something again and and he I'm sure now he's probably pro double donation, but at the time he he's like you're, like you've done enough, right, you did it once and you put yourself through this potential risk and to do it again. Really, he wondered about it and and again, it did give me pause at that time. But now it came, like this resurgence has happened and with my wife's liver donation and I'm like I really I'm not kidding you. I said to myself what, like, what's wrong with me? Like, what do you? Why you, why are you wimping out? Like, just like you know, there's plenty of great hospitals here in New York that might take me, because not every transplant center will allow you to be a double donor.
Speaker 1:Totally I usually prefer you to do liver first if you are going to do to oh interesting, I didn't know that yeah, yeah, yeah. I was having a conversation with Dr Sandy Kapoor over Cornell and he said if you are going to due to you know, organs, you should start with the liver. It regenerates. You know there's more risk because you only have the one kidney you know, and all the stuff that you have to go through, you know, for that procedure.
Speaker 1:So so there isn't anything wrong with me that I don't want to do anybody, that I don't feel this same desire that I did when I, you know, decided to be a good smerag of the life.
Speaker 2:You know, to me it feels like you know one of the ways you're continuing to contribute is by all the work that you're doing with the National Kidney Registry. I mean, you are, you are continuing to do so much that other people aren't doing and there's nothing wrong with them that they donated their kidney and they're like you know what I feel. They're really good about that, but I don't feel the need to, like you know, work and you know, devote my working hours to trying to promote the cause of kidney donation.
Speaker 2:So I think it really is the case that you know, we're all contributing in our own ways and there's not anything wrong with somebody who's not choosing to contribute in one particular way.
Speaker 1:Yeah, it is fascinating because I think about tons of things. Right, like you know, you walk down the streets of New York City and there's a lot of people who are, you know, homeless and you know, who are asking for money. So, if I'm that altruistic, why don't I have, like a lot of dollars or you know cash on me and I'm handing every single person, you know so. So I'm walking or choosing to walk past by this person who's asking for help, yet in 2018, I, you know, chose not to and decided to, you know, to help someone. So, I don't know, I think about that stuff when I'm walking around and like it is amazing.
Speaker 2:It's amazing to me how many donors I've talked to have, you know, wondered and felt frustrated that they were not even better. You know, I wish I could do more. I really I don't think I'm that great a person, because look at how much more I could be doing, how much more I could be and less altruistic. People don't seem to have those conversations with themselves as much In your research.
Speaker 1:do extraordinary altruists have any kind of instinct or belief that they would be capable of doing something so selfless before they actually did it?
Speaker 2:My, at least in the interviews that I've done. I think it's mixed. I think there's a number of people who say, yes, I'm old. I've always been the kind of person who, when I saw somebody need, when I saw the animal suffering, when I saw the way that somebody needed help, I just jumped in to do it. And so when I heard that you could donate a kidney to a stranger, this was a really natural extension of that. Others of them I think it was not that way. They, you know, sometimes people who were very altruistic will say I don't really think there's anything different about me. But then if I ask, well, the other people who know you say they think there's something different about you. And sometimes you're like well, yeah, other people do describe me that way, I'm sure there's a lot of people who think there's something different about me.
Speaker 2:Yeah, and you know, and it's all sorts of different things Not in an altruistic way.
Speaker 2:Well, and this is the incredibly important detail from a recent study that we did that I think is so important is that when we ask the average person what they think an altruistic kidney donor will be like, they just, they say just better in every way, you know, like, give them a trait, they're like, they'll be better in that way too. They'll be more conscientious, they'll be more agreeable, they'll be more open to new experiences, more like, less neurotic. And we find that there's no difference between altruists and everybody else on any of those metrics, because they're not that closely related to altruism. The only difference is that altruists are higher in this trait called honesty, humility.
Speaker 2:That basically indexes the degree to which you subjectively value other people's welfare Like you really do, like the way that other people are doing matters to you. Fundamentally, you don't view other people as just things to be exploited to benefit yourself. That's very psychopathic. Like other people are just instrumental, they're just there for me to use to benefit myself. And people who are altruistic are the opposite, and that's really the, that's the core quality, as far as I can tell, and that leads you to be more likely to empathize with suffering of even people that you don't know they you know they have no connection to you, but you're just like well, if a person is a person, they matter, whoever they are, and if I can do something that I know will, you know, have a strong chance of making their life better. That's good enough.
Speaker 1:Right. So the next question is is pretty interesting and we wanted, I wanted, your take on it. So, even after donation, did most of your research subjects play down their act of giving a kidney to a stranger?
Speaker 2:Absolutely.
Speaker 1:Yeah, can you? Can you describe that a little bit, because I want to dive into a little bit of a conversation about this.
Speaker 2:Well, it comes back to this trait. So this trait and most people have heard of the big five personality traits again conscientiousness, agreeableness, extroversion, neuroticism or negative emotionality, and is that all of them? Was that five? Anyways, the big five.
Speaker 2:However, interestingly, the people who created the initial personality measures that are supposed to capture sort of all major differences in human personality deliberately left off items that seem to be related to morality, because they didn't think that morality was really the domain of psychology. You know, back in the day it was more kind of the domain of religion and so, but more recently, this new personality scale that has all the same five factors, plus this honesty, humility factor, seems to do a much better job of capturing variation in people in terms of antisocial and pro-social tendencies and the humility element of it. I was really surprising to me that people who were very altruistic are very humble about what they've done. They universally I mean, I'll tell you actually, nugget is that when I wrote my book, my publisher wanted to call it Saints and Psychopaths and I remember thinking like that's a great title, like it's so catchy People would have loved it and I was like I can't do it.
Speaker 2:Like altruistic people hate being called saints, they just hate it.
Speaker 1:Saints heroes. Yeah, we, yeah, yeah.
Speaker 2:Guardian angels, all that stuff, because it's just like super human, like better than anybody else, sort of traits, and you know they were like, yeah, but you could say that in the book, and I'm like I just I can't do it, like I just think that all the altruists that I've worked with over the years would feel betrayed if I refer to the saints, so that's my book People picking outside Georgetown going yeah, I'll never work with you again.
Speaker 2:You're dead to me. No, but, and it's too bad because it was. It was a really great title and I thank you to that person who suggested it. But I and I was so puzzled by this at first, when I started working with people who were very altruistic, that so universally there was a sense of like I'm not special, there's nothing different about me. I did what anybody would have done in the same situation. You also hear the same thing from people who rescue strangers and like heroic rescue situations. But again, the more I thought about it and gathered data, the more it felt like this was actually essential to being altruistic. Right Is to think that you're not any more special than anybody else, because if you think you're more special, why should you give a kidney to somebody else? The special person should have all the kidneys and the less special people should not.
Speaker 2:But if you really think that, like everybody is just as good as everybody else, then it makes much more sense to be like well, why should I have all the kidneys? There's nothing special about me. And so then it makes sense that you would think like, well, just because I gave a kidney to a stranger, that's not, you know, it's not crazy, it's not extraordinary, it's just I just did. I just did what seemed obvious to me. And this is the other thing that I think is interesting and I've really really learned from this line of research is that you know, everybody's doing what seems reasonable and obvious to them, with the information that they have right. And so for people who donated a kidney to a stranger, when they hear about the need and they hear that the risks are relatively low and you can live just fine with one kidney, one is enough.
Speaker 1:One is enough, thank you for that.
Speaker 2:They're like well, I mean, that's the most common response I get in interviews with people being like it just felt like the obvious thing to do, like I don't even understand, like why it needs an explanation, right, and so that's.
Speaker 2:What's so interesting is that most people can get all that exact same information and it does not seem obvious to them that they would donate a kidney, and so that's where the difference is is the way that you do to, whatever your internal traits are, take that information and respond to it in terms of your decision.
Speaker 1:So I think that's a good segue to my next question is the response from people that kidney donors get, because it's typically not a positive one. We have so much more to cover with Dr Abigail Marsh, so stay tuned for part two of this episode, where we will dive further into extraordinary altruism and Dr Marsh's groundbreaking research on the practice.