Ethical equivalents: donating a kidney, taking part in a Covid-19 trial

A few months ago, one of us (S.B.) found himself staring up into the bright lights of an operating room. He wasn’t sick or injured — far from it. Instead, he was about to undergo surgery to donate a kidney to a stranger.

Why? He knew it could save the life of someone who would otherwise die. He recognized his choice carried the risks and costs, including a 3 in 10,000 risk of dying and slightly increased long-term odds of developing kidney disease.

In the last decade, nearly 2,000 other Americans have made the same choice, believing these risks are worth the benefits.

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Now recovered, Sam has volunteered to take another risk for the benefit of strangers by participating in a Covid-19 human challenge trial. In such a trial, he and other volunteers would be given an experimental vaccine and then deliberately exposed to the coronavirus. That would allow researchers to quickly gauge the vaccine’s efficacy.

Challenge trials like this have made important contributions to developing vaccines for cholera, typhus, and other diseases. In July, Oxford University’s Jenner Institute announced it is preparing to begin challenge trials for its Covid-19 vaccine candidate by the end of this year.

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Some scientists are pushing back against trials like these, arguing that they are not ethically justified because volunteers do not stand to gain personally from participating in them. Gary S. Firestein, director of the Clinical and Translational Research Institute at the University of California San Diego, believes these trials would not pass ethical scrutiny because “there probably is no benefit to the participant.” Davey Smith, director of infectious diseases and global public health at the same university, agreed, stating, “there is no potential clinical benefit for participating in the study. The participant has nothing to gain except altruism.”

For some people, that may be enough.

One of us (A.M.) has spent the last decade conducting research with people who have undergone the medical risks of kidney donation for purely altruistic gains. As recently as 25 years ago, this research would have been impossible because these donations were actively discouraged. Not for medical or technical reasons, as kidney transplants between unrelated individuals had been performed successfully since the 1960s, but because most transplant professionals believed altruistic donations were not ethically justified — that anyone seeking to give a kidney to a stranger was by default hoping for illegal compensation or was uninformed, irrational, or, in the words of one clinician, “pathologic by psychiatric criteria.”

Research from the Marsh lab confirms such fears are unfounded. Brain imaging and laboratory tests have shown that kidney donors are unusually good at detecting when others are in distress, skilled at empathizing with them, and genuinely place more value than most people do on the welfare of others — even strangers. This suggests that kidney donors’ informed decisions to sacrifice for others are compatible with their values and preferences — and are thus ethical.

The same is likely to be true for who want to participate in Covid-19 challenge trials. According to data collected by 1DaySooner, these volunteers overwhelmingly cite a desire to help others as their reason for signing on.

Although there is much we still don’t know about the novel coronavirus, the available evidence suggests that the risk of death from Covid-19 infections among 20- to 29-year-olds is comparable to that of donating a kidney. If it is ethically justifiable for healthy, informed adults to take a risk of this magnitude to benefit a stranger through kidney donation, we should not deny a similar choice to healthy, informed adults who wish to benefit strangers by volunteering for a challenge trial.

Thousands of patients in kidney failure died needlessly because transplant professionals refused to consider the possibility that rational, mentally healthy people who genuinely value helping others were willing to take on some risk to donate their kidneys to strangers. How many Covid-19 patients will die if we fail to consider that possibility now?

The current pandemic is affecting every member of society in one way or another. We need to seriously consider any approach that could speed the development of an effective vaccine to prevent further deaths, illness, school closures, and economic hardships.

As a nation, we’ve fallen behind on too many fronts during our battle with the coronavirus. Needlessly slowing down vaccine development shouldn’t be another of them.

Sam Beyda is an altruistic kidney donor and a first-year student at Columbia University. Abigail Marsh is a professor of psychology and neuroscience at Georgetown University and the author “The Fear Factor: How One Emotion Connects Altruists, Psychopaths, and Everyone In-Between” (Basic Books, 2017).