Nigel Hawkes: Give a Kidney – One’s Enough

Nigel HawkesThe late Sir Jimmy Saville devoted much of his life to public service, raising £40 million for various good causes including hospitals, and even working shifts as a hospital porter. Yet to read his obituaries this week has been to witness a struggle, not always availing, against disbelief.
Could any man be that altruistic without also being slightly unhinged? That’s the unspoken message. The psychiatrist Anthony Clare concluded after interviewing Sir Jimmy on Radio 4’s In the Psychiatrist’s Chair that the DJ was “at odds with himself.” True or not, he was certainly at odds with a cynical media.

I thought of Sir Jimmy at this morning’s press conference to launch a new charity devoted to altruistic kidney donation. The brainchild of Annabel Ferriman, the BMJ’s News Editor, Give a Kidney – One’s Enough aims to provide information and support to would-be altruistic donors. A number of people who had already given a kidney were there, looking anything but at odds with themselves. Unlike Sir Jimmy, who favoured shiny tracksuits and chunky jewellery and wore his hair long and platinum blonde, they appeared quite normal.

A study presented last week at the Canadian Psychiatric Association’s annual meeting found that, mostly, this is true. The numbers were tiny, just 10 would be donors, but the results tie in with another recent study (Transplantation, 2011;91:772-778). Six out of the ten were adjudged to be acting out of altruism rather than psychopathology.

Hmm, but what about the other four? (See, I can’t keep suspicion under control even when I’m trying.) Well, one suffered from antisocial personality disorder, one from a major depression and avoidant personality disorder; a third had a cognitive disorder, unspecified; and the fourth was found to have incomplete individuation. I think that may be Latin for being at odds with oneself. 

These four were rejected, and quite right too. One can’t have people with psychological disturbances giving kidneys as a way of working free of their demons. Yet think how many saints the Catholic Church would have missed out on if it had enforced a psychiatric test. Joan of Arc, who heard voices, would have been diagnosed schizophrenic. St Francis of Assisi’s love of animals was borderline obsessive-compulsive. St Paul had a very odd attitude to sex, and even Jesus said: “Let the little children come unto me.” Stop, stop! The church is in enough trouble already.

The origins of altruism have long puzzled the evolutionary psychologists, who can’t see any genetic imperative for helping those who are not kin. But it exists, and was made manifest at today’s launch. The charity’s poll shows as many as eight per cent of people might be willing to donate one of their kidneys to a complete stranger. If even a fraction of them did, waiting lists for kidney transplants could be eliminated.

So good luck to the new charity, and may it not probe too deep into human motivation. Altruism is a bit of a mystery, its origins sometimes lying in individual unhappiness. But exercising it benefits both those who give, and those who receive.