Kidney donations and behavioral economics
Submitted photo Shai Robkin (center), flanked by the recipient (in bed) and her daughter Latausha, who also donated a kidney
Submitted photo
Shai Robkin (center), flanked by the recipient (in bed) and her daughter Latausha, who also donated a kidney

Guest column: How a rabbi’s father made
decision to give organ

By Rabbi Yogi Robkin
Special to the TJP

Two weeks ago, my father donated a kidney. There was no one in our family in need of a kidney (except their own!) and there was no one he was aware of who could use his spare, and so he decided to become what’s known as an altruistic living kidney donor.
His kidney would go to a stranger, someone he could meet only if the recipient agreed to meet with him, and the rules being the way they are, he would have no control over who would receive his lifesaving gift.
That being said, my father had no interest in earmarking his kidney to a person fitting any particular set of specifications (age, ethnicity, religion, favorite baseball team etc.) even had he been able to. His sole motivation: Get his “extra” kidney to another human being who needed it. The lucky recipient ended up being a 70-year-old African-American mother of three named Glorious from Carrollton, Georgia. Glorious had been on dialysis for five years leading up to her recent transplant and is, thank God, doing great now and fully off dialysis! Glorious’ daughter, Latausha, who was willing to give her mother a kidney but was unfortunately not a match, signed up to become a living donor herself, thereby pushing her mother up the transplant list and increasing her odds of eventually receiving her lifesaving transplant.
In the very same Atlanta area hospital, on the very same day, two kidneys were removed, one from my father and one from Glorious’ daughter Latausha, and two kidneys were inserted into two individuals whom the two donors had never met before in their lives!
My father got to meet Glorious and Latausha the day after the surgeries and together with my mother and sister in the hospital room proceeded to have the mother of all cry-fests. The nurses cried with them. It was the ultimate Kodak moment, a moment to remember for a lifetime. Through her tears my mother explained to Glorious and Latausha that we were Jewish and that as Jews we saw this deed as a mitzvah, an obligation to help our fellow man. It may seem to an outsider that this moment was short in coming, but the tears in my father’s and mother’s eyes were two years in the making.

Researching process

Two years prior, my father had begun the process of researching the possibility of his becoming a kidney donor. He spoke to his doctor, read medical literature and subjected himself to the many tests one was required to pass in order to become a donor. On his final test, he failed.
He was told that he had high blood pressure and would not be a candidate for the surgery. My father argued that he had never had a high blood pressure result in his life and asked if he could retake the test, and they eventually acquiesced to his request. He would not fail this test twice!
When a match was found for his kidney, he called us all to let us know that there was a date on the calendar set for his surgery. The rest, as they say, is history.
This feel-good storyline is certainly worthy of public dissemination on its own merits (all the more so in an endless “if it bleeds it leads” media cycle) and yet I feel that I would be remiss if I did not share what is, perhaps, a more profound lesson for us all that lies not so much in the public details of this story (as it’s easy and enjoyable to read a moving real-life account of heroism and return to our regularly scheduled lives) but rather in the private and perhaps difficult decision to donate one’s kidney in the first place.


After the operation was finished, and the nerves that pulse through the heart of a child whose father is on the operating table died down, I found myself trying to pinpoint the roots of my dad’s decision to donate a kidney. Why had he done what so few people had done? What gave him the courage, the vision, the desire?
It would be easy to turn to the life and pattern of giving that has been the hallmark of my parents’ lives as the explanation for his desire to give the ultimate gift, and, although certainly true and central to his decision, I knew that there was something else inside of him, some missing link that was helping inform his decision-making process that was unaccounted for.
Just a day before the operation was scheduled to take place I received an email in my inbox from my father with a link to a story in Vanity Fair about a pair of Israeli psychologists, Amos Tversky and Daniel Kahneman, pioneers in the burgeoning field of behavioral economics. Next to the article’s link were a few words from my dad.
“If you took the time to read my behavioral economic analysis of Trump’s election, then perhaps you’ll have the patience to read a fascinating piece (fascinating for me, at least) about my heroes, without whom I probably wouldn’t be donating my kidney next week.” In the excitement and nervousness of this time in our family’s lives, I hadn’t been fully cognizant of the import in my father’s message. Something in this article unlocked the key to his decision to donate.
But what?
More than anything else, the study of behavioral economics attempts to understand the determining factors in the human decision-making process. How much weight does logic have in our decision-making process? Do we rely upon probability or statistics to help us resolve our queries? What role does heuristics play, the reliance upon our gut, rules of thumb or other classical decision-making tools in the final analysis?

Story speaks louder than facts

And what of the role of our subconscious biases? Daniel Kahneman had an early formed proposition that would be vindicated time and time again through the course of his many years of study: People don’t depend upon hard data like probability and statistics to form a final decision. As Daniel stated later in life, “No one ever made a decision because of a number — they need a story.” This, and the compound effect that “gut feelings have a mysterious power to steer us wrong,” led Kahneman and Tversky on a two-man crusade to re-educate the world and its decision-making leaders to reconsider the way they solved problems and made both small and large determinations.
The pair of Middle Eastern psychologists also noticed a fascinating phenomenon in the human psyche. Human beings have a much more acute response to the possibility of impending loss than we do with the possibility of a consummate gain that might come our way. In other words, we are programmed to run from danger more than we are programmed to run toward opportunity. This mental default position may help us escape from impending threats but it also compromises our decision-making.
In the world of finance, our fear of loss leads us to sell our shares when stock prices fall dramatically even as we know that a statistical study of the stock market over the last century would lead the discerning investor to buy at this juncture in time instead. Our collective aversion to loss leads us to take risks when we shouldn’t and stand still when strict logic and analysis advises us to move.

Decision analysis

The decision-making process surrounding kidney donation (“to give or not to give, that is the question”) starts the way any decision-making process might begin, weighing the pros and cons, the potential gains versus the potential losses. The thing is, a sensitivity to the findings of Kahneman and Tversky in “decision analysis,” as they called it, would naturally inform us that most of us, when made aware of the possibility of our becoming someone’s kidney donor, would run far away from the procedure for fear of what we would perceive as severe impending loss.
Unlike what we currently know about the real risks of kidney donation, there is no end to the scope and limitations of the human imagination. This is not to say that the decision to give a kidney is without any serious cause for concern. Any surgery has its dangers, as does the loss of any organ.
The point is that my father understood as a student of behavioral economics that we tend to overestimate loss and underestimate potential. Knowing what he does, my father was able to push aside his natural fear of loss and focus instead on the facts, statistics and advice of medical professionals. Were the dangers great enough to impede my father’s desire to save another’s life? In my father’s final analysis they were not.
After years of prodding people in high places to reconsider the way they make decisions, Kahneman and Tversky grew pessimistic about the role they could play in decision analysis.
“We have attempted to teach people to be aware of the pitfalls and fallacies of their own reasoning.”
It’s hard to know whether we have made all the right decisions in our lives, but my dad is convinced that he got this one right. He put it to me this way just the other day: “Imagine you were given 1 million dollars that could either be thrown into the grave along with you, or could be given away to your favorite charity during your lifetime. Which would you choose?” To my father it is as simple as that. God gave us a gift at birth — one kidney for ourselves and one kidney to share with someone else in need.
Two weeks ago my father gave his kidney to a woman who is no longer a stranger and we are all the more proud of him for it.

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