Organ donation: some heroes wear no uniform, only a scar

On empathy, the sum that always ends in the red…

Picture two people walking into the same hospital on the same morning.

One of them is ill. They know why they have come.

The other is perfectly healthy. No symptom, no pain, no diagnosis. And still they walk into the operating theatre. Part of their body will be taken out, not to make them better, but to give someone else a future.

No superpowers. Just a person who woke up healthy one morning, perhaps still held someone’s hand, spoke words no one else heard, and then quietly decided: ‘I’ll do it.’

Why would anyone do that?

That is the question of this piece. And I’ll say it now: it stays partly open at the end.

The operation where the benefit lies with someone else

The great majority of operations in medicine are meant to make the person on the table better. We operate because something is wrong, and the benefit falls to that same person. Most of the profession rests on it.

With living donation, that is not how it works.

The donor isn’t ill. On the contrary: after strict screening they have been found healthy enough to be allowed to give. And then they go under anaesthetic, and something is taken out. The direct physical benefit of that operation does not fall to them. It falls to someone else.

I could write here about the liver. Or the kidney. About which vessels, which margins. But that isn’t what this story is about.

It is about the person who said yes.

Why do we help one another at all?

That question has been studied seriously for decades. Not with fine words, but with experiments.

In the early 1980s the American psychologist C. Daniel Batson asked an uncomfortable question. When we help another person, do we truly do it for them? Or mainly to rid ourselves of our own discomfort at watching them suffer? He called his answer the empathy-altruism hypothesis.¹

Put simply. Batson kept giving his participants an easy way out. You could simply walk away. Nobody would see it, nobody would mind. Anyone who only wants to soothe their own unease takes that exit at once. Leaving works perfectly well for that.

But they didn’t. It was precisely the people who truly felt for the other who stayed. Even when leaving was easiest.¹

That unsettles a stubborn misconception. We often assume that every good deed is secretly a trade, a bargain we don’t dare admit to ourselves. Batson’s participants showed something else. Helping really can grow out of feeling for another person, even when walking away would cost nothing.

And there is something else. The psychologist Jonathan Haidt described how moral choices often don’t begin in the head, but in feeling. We feel first what is right. Only afterwards does the mind look for words and arguments. Feeling leads the way; reason walks behind it and explains.²

That may be why, for many people, a choice like this doesn’t begin with a list of pros and cons. It begins with something that was already there. With connection. With a yes that came before the reasons.

And here the nuance belongs straight away. However valuable those insights are, no model explains a single human being completely. Science shows us patterns. It doesn’t show us souls. One person gives out of love for a child. Another for a brother or a sister. Another out of faith. Another simply because they feel: I can help, so I will. None of those reasons is interchangeable.

And when you ask donors themselves, a choice like this turns out to rest on more than one pure motive. A synthesis of 26 studies involving 478 kidney donors found a mixture: love, a sense of responsibility, the deliberate acceptance of risk, expectations within the family, personal meaning and faith. Those same studies also describe how heavily the status of hero can weigh when you never asked for it.³

The sum that always ends in the red

Try calculating goodness, the way you check a receipt.

On the left you write what the donor loses. Part of an organ. Weeks of recovery. A scar. A risk that isn’t zero.

On the right you write what the donor gains physically. Nothing goes there. Not one health benefit.

So the bottom line of giving always ends in the red. That is what a cold cost-benefit analysis does: it counts only what disappears from your own life. What is added to someone else’s life never appears on your receipt. On paper, giving shouldn’t really exist at all.

And yet people give. Every day, all over the world.

That is exactly where the gap in our knowledge sits. Batson shows that people can choose purely for another. Haidt shows that such a choice is felt before it is reasoned. But neither can explain why this person, on this morning, says yes. That is where measurable explanation stops. Not everything that is true can be calculated.

What a donor gives away is therefore more than tissue. More than a piece of liver, one of two kidneys, a bag of blood or cells from the marrow. It is also the willingness to walk into an operating theatre while perfectly healthy. The composure to say yes to something that isn’t required at all. To be healthy and still entrust yourself to an operation asks a kind of courage most people never have to summon from themselves.

They wear no uniform. They wear a scar.

Not a mark of loss. A quiet badge of honour for what they gave.

The margin nature built in

Look at a page of the book lying next to you. Around the text there is white space. A margin. You can pencil something into it without losing a single word.

Our bodies have a margin like that.

Take the liver. That organ can repair itself. Give away a part, and the remaining tissue grows back to roughly the amount the body needs. In the donor and in the recipient. It is one of the best-studied forms of regeneration we know.⁴

And the liver isn’t the only one. We have two kidneys, while one healthy kidney is enough to live a healthy life. Blood replenishes itself. So does the marrow, where the stem cells come from.

Giving wears more than one face

So far this has mostly been about donation during life. But giving wears more faces, and each of them deserves a place here.

There are the bereaved. In the Netherlands the doctor first looks at what the person who died recorded themselves. But there are people who deliberately left that decision with their family. And then, on perhaps the hardest day of their lives, someone sits in a small room and has to choose, while the news itself has not even landed yet. And they still say yes. In the middle of their own grief they grant a stranger a future. I know few gestures more generous than that.

And even where the choice was already recorded, there is still a conversation. A doctor who tells them. A family who, at the heaviest moment of all, has to hear their own person’s yes, and carry it.

There are the blood donors. On an ordinary evening they walk into a small hall, roll up a sleeve, and are home again half an hour later. Somewhere after that, their blood runs through someone else. They never hear who. They don’t know whether it was a mother, a four-year-old, or someone knocked off their bike. And many of them simply come back. Year after year. Without anyone noticing. Without anyone thanking them.

There are the stem cell donors. They once put themselves on a register for someone who wasn’t even ill yet, and whom they will probably never meet. Sometimes, years later, the phone rings. Sometimes it never does. And still they stay on that register, all those years. Just in case.

Different people, different gestures. But one movement underneath: someone makes themselves a little smaller, so that another can go on.

The vine of Marcus Aurelius

With stories like these we catch ourselves in a reassuring thought: such people are simply different from me. Heroes, made of other material.

But is that really so?

Almost two thousand years ago the Roman emperor and philosopher Marcus Aurelius wrote something down about people who do good. He distinguished three kinds. The first helps and keeps the account. The second says nothing, but in his own mind knows exactly what he is owed. And then there is a third.

A third in a manner does not even know what he has done, but he is like a vine which has produced grapes, and seeks for nothing more after it has once produced its proper fruit.

Marcus Aurelius

A vine does not show off its grapes. It asks for no thanks. It does what it was made for, and carries on.

Perhaps that is the bravest thing there is: goodness that doesn’t consider itself special.

And it raises a question I don’t want to take out of your hands. Not the big one straight away, would I give up an organ? That is a heavy, deeply personal decision for a few. The smaller version you can ask yourself today. Blood. Recording your choice on the donor register. An hour of your time. Attention for someone who is struggling.

You don’t have to be a hero. You don’t have to prove anything either. You can simply consider, calmly, which choice genuinely fits you. No is also an answer that deserves respect.

As a tribute

This piece exists in honour of everyone who was given a second chance, and of the people who made that chance possible.

On behalf of the people who came home again. Who saw another birthday. Who simply woke up in the morning, the way it should be.

Because behind every transplant stand at least two stories. The story of someone who receives a second chance. And the story of someone who freely gave a piece of themselves, so that this second chance existed at all.

To every donor. In life, after death, of blood, of cells: I look with deep awe at what you did. You didn’t have to. And you did it anyway.

Perhaps that is the heart of this whole story. Not to solve the mystery of human goodness. But to look at it with wonder, and, where we can, to follow it a little ourselves.

To you who gave a part of yourself to someone you may never meet: you are, in the most beautiful sense of the word, unforgettable. Somewhere a person lives on with something of you inside them. For as long as that person lives, that piece of you lives too. There is no monument that comes close.

What do you have to give? And when did you last give it, without expecting anything back?

This article provides general information and is not medical or psychological advice. If you have questions about organ donation, about living donation, or about registering as a blood or stem cell donor, please speak with your GP or a treating specialist.

Related reading

• Why one child moves us, and a thousand leave us cold
• The liver: the organ the ancients revered and we forget
• Fear and control: the smoke detector in your head

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Sources

The numbers in the text refer to this list.

1. Batson, C. D., Duncan, B. D., Ackerman, P., Buckley, T., & Birch, K. (1981). Is empathic emotion a source of altruistic motivation? Journal of Personality and Social Psychology, 40(2), 290–302. https://doi.org/10.1037/0022-3514.40.2.290
2. Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review, 108(4), 814–834. https://doi.org/10.1037/0033-295X.108.4.814
3. Tong, A., Chapman, J. R., Wong, G., Kanellis, J., McCarthy, G., & Craig, J. C. (2012). The motivations and experiences of living kidney donors: A thematic synthesis. American Journal of Kidney Diseases, 60(1), 15–26. https://doi.org/10.1053/j.ajkd.2011.11.043
4. Michalopoulos, G. K., & Bhushan, B. (2021). Liver regeneration: Biological and pathological mechanisms and implications. Nature Reviews Gastroenterology & Hepatology, 18(1), 40–55. https://doi.org/10.1038/s41575-020-0342-4
5. Marcus Aurelius. (n.d.). Meditations (G. Long, Trans.). The Internet Classics Archive. https://classics.mit.edu/Antoninus/meditations.5.five.html (Original work written ca. 170–180 CE)

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