In our ongoing exploration of life’s profound ethical questions, we tackle another thought-provoking scenario from Gregory Stock’s The Book of Questions.

This week’s question cuts to the heart of sacrifice, obligation, and the boundaries of personal responsibility:

Someone close to you will die in a few months unless you donate one of your kidneys to them. If you knew that your chances of surviving the operation were excellent and that your life expectancy wouldn’t be appreciably reduced, would you give up the organ? What if the operation were risky?

My Answer: A Clear Choice

For me, this question has a straightforward answer: Yes, I would donate my kidney. Even more definitively, my answer wouldn’t change if the operation carried significant risk.

My reasoning is simple and practical: I have two fully functioning kidneys, and medical science has established that humans can live normal, healthy lives with just one. If someone close to me faces death without this organ, why wouldn’t I give up something I technically have in “spare”?

As for the risk factor—what medical procedure doesn’t carry some element of risk? Every time we undergo surgery, there’s a possibility of complications. Yet we accept these risks for far less consequential outcomes than saving a loved one’s life. If I’m willing to accept surgical risks for my own benefit, shouldn’t I be willing to do the same when someone else’s life hangs in the balance?

The relationship specifics don’t particularly influence my decision here. Whether a family member, romantic partner, or close friend, my answer remains the same. The human connection is what matters—not the precise nature of that connection.

The Ethics of Organ Donation: Beyond Personal Choice

While my answer feels intuitive to me, this question opens up fascinating ethical territory worth exploring further. What moral principles underlie the decision to donate—or not donate—an organ?

Altruism vs. Self-Preservation

At its core, organ donation represents a fundamental tension between altruism and self-preservation. These competing impulses have guided human behavior since our earliest days as a species.

From an evolutionary perspective, self-preservation serves as our most basic instinct. Our bodies and minds are hardwired to protect ourselves from harm. Yet humans have also evolved as social creatures, with cooperation and mutual aid being crucial to our collective survival.

This explains why organ donation creates such a compelling ethical dilemma. It pits our individual survival instinct against our social bonding instinct—two powerful forces that have shaped human behavior for millennia.

Bodily Autonomy and Its Limits

One of the most cherished principles in modern medical ethics is bodily autonomy—the idea that individuals have absolute authority over what happens to their bodies. This principle underpins many of our medical and legal frameworks, from informed consent to reproductive rights.

Yet bodily autonomy isn’t typically framed as a moral obligation to others. We generally don’t consider it ethically mandatory to use our bodies to save others, even when doing so might be the compassionate choice.

Consider a parallel example: We don’t legally require people to donate blood, even though the procedure is relatively safe and the donation could save multiple lives. Society has drawn a line that protects individual bodily autonomy, even when exercising that autonomy means others might suffer or die.

So while I personally would choose to donate my kidney, I can understand the ethical framework that defends someone’s right to decline. The philosophical question becomes: At what point, if ever, does one person’s need override another’s bodily autonomy?

The Calculus of Risk

The second part of the question introduces an important variable: risk. How does the calculation change when the donation procedure carries significant danger to the donor?

For me, this doesn’t change my answer. But I recognize that this represents a much more complex ethical calculation for many people. When risk increases substantially, the equation shifts from “giving something I can spare” to “potentially sacrificing my own life.”

At what threshold of risk does self-sacrifice become morally supererogatory—admirable but beyond what moral duty requires? Is there a percentage chance of death or disability at which we can say a person is ethically justified in prioritizing their own survival?

Different ethical frameworks would provide different answers:

• A strict utilitarian might argue that as long as the statistical likelihood of saving one life exceeds the likelihood of losing another, the morally correct action is to proceed with donation.
• A deontological perspective might focus on the inherent rightness of the action regardless of outcomes—either emphasizing the duty to help others or the inviolability of bodily autonomy.
• Virtue ethics might ask what the virtuous person would do in this situation, focusing on character traits like courage, compassion, and prudence.

The Reality of Living Donation

Beyond the philosophical considerations, it’s worth grounding this discussion in medical reality. Living kidney donation has become increasingly common, with over 6,000 such procedures performed annually in the United States alone.

The medical consensus indicates that living with one kidney typically doesn’t significantly impact life expectancy or quality of life for most donors. The human body adapts remarkably well to this change, with the remaining kidney often increasing in size and function to compensate for its missing partner.

However, donation isn’t without consequences. Donors face a recovery period of 4-6 weeks, potential complications from surgery, and the psychological impact of undergoing a major medical procedure. They must also adjust to living with a single kidney, which may require lifestyle modifications and vigilant health monitoring.

Living donation also occurs within a complex social and emotional context. Donors often report feeling subtle or explicit pressure from family members, medical professionals, or their own sense of obligation. Others describe complex emotions after donation—ranging from profound satisfaction to unexpected grief or identity disruption.

Alternative Perspectives: The Case for Saying No

While my personal answer is a clear “yes,” I think it’s valuable to consider thoughtful arguments for declining to donate:

The Ripple Effect Argument

One could argue that personal health decisions don’t occur in isolation. If I have dependents—children, elderly parents, or others who rely on me—my decision to undertake a risky procedure affects them as well. If something were to happen to me during or after donation, those dependent on me would suffer consequences they never consented to.

From this perspective, declining organ donation might not reflect selfishness but rather a careful weighing of all one’s responsibilities and obligations.

The Coercion Concern

Another legitimate hesitation centers on the psychological pressure inherent in this scenario. When someone’s life hangs in the balance, can any decision truly be free from coercion? The emotional weight of potentially being responsible for another’s death creates a decision-making environment that’s far from neutral.

Some ethicists argue that truly ethical organ donation must occur in contexts where donors feel genuinely free to decline—a condition that may be impossible when a loved one’s life is at stake.

The Precedent Problem

A more abstract but philosophically interesting objection concerns the precedent set by normalizing significant bodily sacrifice. If we establish that people have a moral obligation to undergo surgery for others’ benefit, where does this obligation end?

Today it might be a kidney, but what about tomorrow? As medical technology advances, we may develop ways to transfer or share other organs and tissues. Would we then be obligated to share parts of our livers, lungs, or bone marrow? Would we be justified in refusing to donate these if doing so could save a life?

Finding Your Own Answer

What makes questions like this so powerful is that they force us to confront our deepest values and priorities. There is no universal “correct” answer—only the answer that aligns with your personal ethical framework.

In considering your response, you might ask yourself:

• What value do I place on my own bodily integrity versus another’s survival?
• How do my various relationships create different levels of obligation?
• What level of risk am I willing to accept to benefit someone else?
• What other responsibilities and commitments might be affected by my decision?

For me, the calculus is clear. The temporary discomfort and manageable risk of donation pale in comparison to the alternative—standing by while someone I care about dies from a condition I could have remedied. I’ve always believed that organs I no longer need after death should go to those who can use them. Extending this principle to living donation, especially when medical science confirms I can thrive with one kidney, feels like a natural extension of this belief.

However, I respect that others might reach different conclusions based on their unique circumstances, values, and ethical frameworks. The beauty of these profound ethical questions lies not in finding universal agreement, but in the self-discovery that comes from wrestling with them.

Your Turn

Now I turn the question to you, readers. Would you donate your kidney to someone close to you? Would your answer change if the procedure carried significant risk? What factors would influence your decision?

Share your thoughts in the comments below, and join us next week for another Question of the Week.

---

This series explores thought-provoking ethical questions from Gregory Stock’s The Book of Questions. Each week, we examine a new moral dilemma and invite readers to reflect on their own values and perspectives.

---

I Published a Book!

In 2007, the American Film Institute released its definitive list of the 100 greatest American movies of all time — a sweeping celebration of the art of cinema. But do these classics still resonate today? Are they as timeless, powerful, or entertaining as AFI claims?

In this book, I take you film by film through the AFI’s iconic list — from Citizen Kane to The Godfather, from Star Wars to The Graduate. Trying to maintain a refreshingly personal tone, you’ll get film summaries as I share what they meant (or didn’t mean) to me. I’ll challenge the hype, celebrate the underrated, or call out the overrated.

Whether you’re a film buff, a casual moviegoer, or someone looking to deepen your appreciation for American cinema, this book is your ticket to a thoughtful — and sometimes funny — journey through Hollywood history.

Available in Paperback or Kindle