Intro. [Recording date: October 15, 2024.]
Russ Roberts: Today is October 15th, 2024 and my guest is filmmaker Penny Lane. This is her second appearance on the program. She was here in January of 2022 talking about her documentary, ‘Listening to Kenny G.’
Today we’re going to talk about her new documentary, ‘Confessions of a Good Samaritan,’ which is scheduled to air on Netflix right about now. Penny, welcome back to EconTalk.
Penny Lane: Great to be here, Russ. Thank you.
Russ Roberts: In 2016, a while ago, you made a decision to donate a kidney to a stranger. And, in August of 2019, about three years later, you had surgery and one of your two kidneys was removed and put in someone else’s body. And you made a movie about it. And, that’s what we’re going to talk about. And, I want to start with the obvious question: Why would you ever think this was a good idea?
Penny Lane: Why?
It’s such a hard question to answer. Why does someone choose to have a child? Why does someone decide to move to another country at some point in their life?
I mean, there are things you do that seem good to you, that seem like they’re going to have a good outcome for you, but without a cultural script attached to it can be hard to say why. I think with children–if you want to make a parallel–people will say, ‘Oh, I think about my legacy,’ or, ‘I’m tired of being selfish,’ or, ‘Isn’t that the purpose of life, to give life to others?’ And, I think those are scripts that we’ve learned to explain something quite deep and complicated inside of us.
So, to answer your question: it just seemed like a good idea.
It seemed like, you know, if you look at the benefit to the recipient–likely benefit to the recipient–and you compare it to the transient suffering of my own–going through surgery and all the fear that goes along with that and everything–it’s, like, in a mathematical way, an obviously good idea.
Then you get into the complications of why is it that I feel it’s an obviously good idea? And, I’m putting finger quotes around that quote right now, “obviously good idea.” And, to everyone else, it just seems strange or maybe even crazy or suspect in some way.
And that question–that psychological mystery–is why I made the film. You know, on a secondary level, of course, I hoped it would encourage others to consider this saving-a-life option. But, to be truthful as an artist, the psychological mystery of that was why I made the film.
Russ Roberts: And, I would say it’s an extraordinary film. It would have been extraordinary if you’d made a film about why people donate kidneys to strangers, but you made a film about Penny Lane giving a kidney to a stranger. And, the level of vulnerability and openness is a little bit hard to watch, but you can’t stop watching. It’s really a really powerful and thought-provoking–not just powerful–it’s thought-provoking about this phenomenon.
We’ve done many episodes on kidney donation, I realized after I watched it. We’ll put a link up. I’m laughing because what podcast has lots of episodes about kidney donation? But, we’ll put up links to those episodes.
Part of the [?] reason this is so fascinating–and when we talk about your place in it, is it–people said, ‘Oh, you’re making this because you want to get a movie out of it.’ And, you talk about that on the film. Why is that kind of a implausible argument?
Penny Lane: Well, it’s not totally implausible, I suppose, other than the fact that I’d already signed up to give the kidney and was well underway in my testing before I also then made the decision to make the film. So, just factually, that’s not true.
But, I think the thing you’re really asking about is why did that upset me so much? It really upsets me and it made me almost not want to make the film because–I guess, and we could get into this maybe more later–but, there’s some idea that if you do an altruistic thing and you seek attention for it, or if you’re perceived to seek attention for it, that that undermines the goodness of the act. That there’s ideas, and I think a Judeo-Christian–but more Christian–worldview that good deeds should be secret or should be not advertised in any way, and then that’s how you keep them pure. I get that. Look, I did an anonymous kidney donation. Clearly I get that. I’m not seeking thanks from the recipient or anything.
So, I was just so anxious that people would think I was doing some stunt for a movie. I don’t know, I guess I felt like the fear of being misunderstood. I think that’s a big fear of mine. The fear of being misunderstood.
And so, that’s the thing that maybe made me the most afraid about making the movie–that and the fact that when you make a personal film like this, it’s like you’re giving the whole world the secret to hurting you. You’re like, ‘Here are the things that I’m most afraid of. Here are the things that make me the most ashamed. Here are the things that bring me the most angst.’ And you’re like, ‘Here they are, World.’ It’s like you’re handing the world the key to hurt you.
So, I would say what was more courageous, Russ: making the film or doing the surgery? Maybe making the film was the more.
Russ Roberts: Well, having watched it–I watched it last night in one sitting. I think you could make a case for making the film because it is–you said it better than I could–you revealed what makes you vulnerable, what scares you, what you fear. It also of course revealed what makes you happy, and cheers you up, and all that, too. But, there is something very brave about it. And, I’d like to ask if you had any regrets about that, but it hasn’t aired yet, so we’ll talk in a year.
Russ Roberts: But, let’s do cover this. You do say early on in the documentary that as this process goes on–and if you haven’t explored it or watch the documentary yet, it is surprising how many hurdles. You’d think [?] would say, ‘Come on, come on. Oh, great. Oh, come on.’ You put the gown on. When you say you’re actually willing, you said people think it’s weird. And, I think it’s honorable, brave, glorious, commendable, spectacular. Just a lovely, lovely human thing to do. And yet, early on in the process, which is quite long–we’ll get into some of it–you felt like you’d made a terrible mistake. Which is strange because you haven’t done it yet. You could say it now. You could say it right the day after the surgery in 2019. We’re now five years later. But, why at the time think did you feel in the process you were making a terrible mistake?
Penny Lane: I think that the process can kind of wear you down a little bit, I think. It is a slow process. There are many tests you have to go through. They really make you wait. And, it makes sense. The transplant centers, the last thing they can bear would be an altruistic donor who has a bad experience and regrets it and goes public, and that would be bad. Right?
And also, they want to make sure you’re not doing it for reasons that we as a society have decided are bad. For example, if you go to a transplant center and you say, ‘I want to give a kidney to a stranger because I hate myself and I hope this will help me like myself more,’ which in my opinion is not that bad of a reason–
Russ Roberts: No–
Penny Lane: they will say no to you. That is not considered an acceptable reason. I think there’s a lot of fear, and again, suspicion around the idea. And, even in the transplant world, I think there’s a lot of fear and suspicion around the idea and fear that people are doing it for the, quote, “wrong reasons.”
Anyway, the reason I felt like I was making a terrible mistake in that moment in the film is that it was about five days before surgery, and I was terrified. I was absolutely terrified of surgery. I had never had major surgery before. I really didn’t know what it would be like. I was scared. Not that I would die or something, but that it would be some kind of existential suffering that I had signed myself up for.
It ended up being fine. Let me just jump to the end. It was fine. I was way overwrought about how terrified I was about surgery. But, I think I felt like I was making a mistake because I was scared and because so many people, whether it was inside the transplant world or outside the transplant world, had just looked at me with that expression on their face that they thought there was something wrong with me, that I thought maybe there is something wrong with me. Why am I doing this to myself?
Russ Roberts: And there’s so many fascinating questions that your work raises. And, one of them is this idea that there must be something wrong with you. Right? This kind of donation–meaning not to a loved one, not to a close friend, but to a stranger, called an altruistic donation or an anonymous donation–reminds me, if I may say so, a little bit of people who harbored Jews during the Holocaust. It seems to me to be a remarkably brave and, as I said, commendable thing to do. And if anything, you should get either, like, a permanent tattoo or a placard or a sandwich board you could wear around town: ‘I once gave a kidney back in 2019,’ or ‘I saved Jews.’
So, and the reason I make that slightly absurd comparison–there’s obviously some: they’re about saving lives–but the reason I make it is that only hundreds of people a year make a altruistic donation.
And, I can’t decide whether that’s a small number or a big number.
On a certain level, it’s a small number. America is a big country and hundreds seems, like, tiny. But that anyone would do it–any one person–would be an amazing thing. And, why wouldn’t we have an annual day for those people or a parade for Penny Lane and applaud? And, if you said, ‘I’m not feeling so good about myself. I’m thinking this will cheer me up a little bit.’, I would say, ‘Great.’ The list of people waiting for a kidney who are suffering through dialysis or who die before they get one is so long. I would think it’d just be a gloriously good thing. What are your thoughts on that? Why do people think it’s weird? Or even worse, grotesque?
Penny Lane: Well, there’s so many reasons, Russ. And, the film gets into some of this. But, let’s start with the word ‘grotesque.’ Because I do think there’s an element of visceral reaction, an element of disgust, that some people have about transplantation in general. And, I think that it grosses people out. It seems just wrong somehow. Like, if I have two kidneys, surely I must need them both. You don’t. But, God made me that way. And there’s something disgusting about it. The idea–for some people–just the idea of an organ from one person going inside another person’s body, it grosses them out and it makes them think there must be something wrong with it. So, there’s that objection, which I think is usually more unspoken and not even necessarily conscious. But, I do think there’s a disgust element there.
On another level, there’s the newness of the procedure.
Most people don’t know that you can give a kidney to a stranger. Or, that the surgery is–you have to be careful in how you say it–not without risk, but relatively safe. So, I think a lot of people think it’s more dangerous than it really is, and they’ve never heard of the idea, and it just sounds, therefore, crazy.
But if you look at the history of organ transplantation–and we get into this in the film–every stage of that technological advancement was met with the same moral objections.
So, at the very beginning of the era of transplantation, which would be the 1960s, surgeons started to figure out they could do it between identical twins because the organs wouldn’t be rejected because of the match, genetically.
Even then, if you go back and you look at the news coverage–the contemporaneous discourse–this was so controversial. People in general thought this was a terrible idea and that doctors should not do it, and that there was something probably wrong with the brother who wanted to give his kidney to his twin to save his life.
I know you’re making a face, but this is true.
Can you flash forward a bit more as that technological advancement goes wider and wider? So now you can have more distantly related people: mothers, cousins, whatever. Same thing. ‘Oh, this seems like there’s something wrong. Mothers shouldn’t want to do this for their son. What’s wrong with them? Maybe they’re suffering. Maybe they’re psychologically off in some way.’
So, I do think there’s a historical contingency part of it where it’s simply a new idea and people are weirded out by new ideas.
The third thing that I think is happening there with the reaction of–the negative reaction–is something that in psychology is called ‘do-gooder derogation.’ Which is such a great phrase. Do-gooder derogation.
And it’s this idea that–you know, the studies have mostly been done with vegans. People hate vegans. They hate vegans. Why? They hate vegans because there’s something about the idea of looking at someone who is doing good in a way that feels like a judgment against themselves. And, I do think that’s a factor as well. We say we like do-gooders, but when we come across one, certainly the intellectual part of us is meant to, you know, kind of question critique. You know: What are they really doing this for? Are they really good? And, I think that’s a self-protective defense.
And, I just want to say, like, I think I do that too–just in different areas. I think we probably all do–see someone who is doing good in a way that we don’t do or that we don’t know how to do or that we think we never could do, and that maybe we have a little bit of, like, judgment against them as a protective measure.
But, I also just want to say: most people think it’s a good thing to do. I don’t want to overstate the negative reactions. It’s just that it’s palpable and it’s real. Like, something like one in 10 people that I’ve interacted with on this topic has an actually negative reaction. Whether they say it or I can just see it in their face, it’s negative. But, that’s still like one in 10, you know.
Russ Roberts: People give blood, which is real similar to donating a kidney. The difference is you, your kidney doesn’t grow back. You just have a backup. Whereas with blood, your body generates it again.
So, it’s surprising to me. There’s an ick factor. I get it. There’s an ick factor for giving blood, but nobody would feel justified in expressing it, I would suggest. I would just mention, by the way, it’s laparoscopic–the surgery–meaning it’s a very small incision. That doesn’t mean it’s minor surgery. It’s a serious surgery. But it’s not what you might imagine when you think about having your kidney removed. So, it’s fascinating to me that there’s even 10% that view it as somehow inappropriate.
The fascinating thing for me that your film illustrates is this change over time. That, during the twin procedure, which was more dangerous, and then as they’ve developed a drug that would let you donate a kidney to a stranger by suppressing their immune system response to the kidney and not reject it, attitudes changed in response to that technology. And, I think that’s extremely interesting.
But, if we could imagine a world where if I could snap my fingers, my kidney would jump into your body, I guess you wouldn’t get any disgust and you wouldn’t get much commendation either, because ‘Ehh, you didn’t suffer.’ Right? So, you suffered.
Penny Lane: I did suffer. And, I want to say, not being totally certain about making the film, but I did decide to start filming just before surgery. I was like, ‘I just need to film this. This is a once in a lifetime thing, literally. I’m very well positioned to make a film about this. If someone is going to make a film about this, here I am, a documentary filmmaker about to do this surgery.’ So, we started filming.
And, actually the footage that convinced me to make the film, Russ–and you’re going to know exactly what I’m talking about–is the footage of my body coming down the hallway, out of the surgical procedure. My camera person is filming; I’m unconscious; and I look like all bloated, white as a sheet. I look like a corpse. And, you watch me wake up from surgery sobbing for some reason, and it’s so vulnerable. And I felt looking at that footage that I had to make this film. Because, there was something about the image of it–I don’t think I would have understood the nature of my own sacrifice had I not seen that footage. It just is so real. It’s like: This person has put themselves through a lot to get to this point; and it made me feel so strongly and so complicated about the whole thing–in a good way. So, I was like, ‘Okay. We’re making this film.’
But yeah, so the fact that I suffered, the fact that I really didn’t–I had kind of a bad experience through the whole thing, and I was freaking out and anxious and neurotic and questioning myself–that to me, I felt such guilt and shame about, because the whole thing was that I’m supposed to be thinking about the recipient, man. Like, they’re suffering a lot worse than me. And so why is my minor suffering now so salient, and why can’t I just think about this recipient who I’ve never met and never will meet? It was so interesting. It was the parable of the good Samaritan in real life. Like, did the good Samaritan as they were dragging the dying man to the inn kind of think, ‘Oh man, why am I doing this? Now I’m going to be late for work. I’m going to give the inn some money, but I don’t really have that much money. Is my wife going to yell at me?’ Yeah, probably all those things happened, but it’s not in the story.
And so, when you’re doing it, you’re like, ‘Oh man, I’m a bad good Samaritan. I’m supposed to just be walking through this feeling, like, good about myself and honorable and so happy that I was helping this other person.’ In fact, it was very hard to keep the other person at top of mind throughout the experience. And, as it would be. Maybe if I’d given to my dearly beloved sister, I could picture her face and really remind myself why I was doing this. But I had to remind myself of why I was doing this in a very abstract way, and that was challenging.
Russ Roberts: And you interviewed a bunch of other donors who are so happy. At least after the fact, by the way–let’s be fair to you. They were glowing. For them–at least the ones you showed us; there may have been others–but the ones you show us, it’s not like, ‘Yeah, it was a tough decision.’ My favorite was, ‘If I had a hundred kidneys, I’d give away a hundred.’ Well, 99. I think he says a hundred, period. But, ‘I wish I had a hundred to give away.’ And you said, ‘One a year for a hundred?’ ‘Absolutely.’ It’s, like, who are these people?
Penny Lane: Yeah. I definitely wondered about that. And that’s a big tension in the film; and for me, very unresolved. Are the Good Samaritan donors special and different in some way? Or are they not?
And there’s kind of, like, evidence on both sides. You know, like, on the one hand, you could go into the neuroscience aspect of it, and I do interview a psychologist in the film who has done brain scan studies of Good Samaritan donors and have found that their brains are different from normal people in significant ways on average. I don’t know what that tells us, but there is a data point.
On the other hand: No, they’re not special at all. They’re just people who, like, saw an opportunity to help and took it. There’s nothing unique about this population.
So, I really struggle with that. Like, at the end of the project I still don’t know whether there’s something special about these people. Are they different from other people, or are they not?
I will say that on an anecdotal level, I met the psychologist who studies the brains of Good Samaritan donors actually totally randomly in the world before I knew that she was this expert, and before I’d had the surgery myself. And she said, later, ‘Oh, I knew. I knew when I met you.’ And I was, like, [?]–‘How? How did you know? I don’t think I’m one of those people. I’m a normal person.’ But, she claimed that she could tell that I was one of these altruists, one of these super-altruists that she studies. I don’t know.
Russ Roberts: How did that make you–
Penny Lane: I don’t feel like that. I don’t feel like I’m an altruist. And she would say, ‘That’s what all the altruists say.’
Russ Roberts: Yeah. It’s a dead giveaway. How did it make you feel when she said that?
Penny Lane: Confused. Just confused. I have not walked through the world believing that I am a person who is especially empathetic or especially altruistic. And, ultimately–I mean, I don’t know if anyone does. I have no idea. I can’t inhabit anyone else’s mind. I do feel now, five years later–five years after the surgery–that whether or not I believe I’m an altruistic person, there’s, like, some facts at hand that suggest that I must be. That gives me a little bit of self-confidence in some way. A little different than maybe before. I feel like I have, like, some evidence that maybe I am an altruistic person. I at least did a very seriously altruistic thing once in my life, and that’s not nothing, you know?
Russ Roberts: Yeah, in fact, watching the film, I found that whole part–that’s something fascinating that you would be worried about it or care about it or have anxiety about it. Most people don’t. I don’t think they care. They may feel they don’t do, quote, “enough.” But, one thing that screams out in the movie is your need to feel that you are a good person. And that you had doubts about it made me sad, watching the movie, because, like I said–first of all, you’ve been on EconTalk–you’re obviously you’re a nice person. And secondly that you gave away a kidney. ‘Oh, only one good deed.’ But, it’s a big good deed.
So, watching as an outsider, I didn’t have any doubts about it, and I might have thought, if I didn’t watch the film, that that was sort of–I don’t know–shtick that you needed to put in to make the film more interesting. But, when you watch the film, I don’t think it’s shtick. I think that’s the way you really felt, and I don’t think you were acting for the camera.
Penny Lane: Well, thank you for saying that.
I do think that I have always worried about whether I’m a good person. I’ve been a diarist my whole life, and so I have pretty good evidence of this. I have diaries from when I was 12 and 13 were I worried about being a good person.
Again, one of the great lessons of the film for me is that we imagine that we can inhabit the mind of another, and that it’s probably pretty similar to our own mind. And, in most cases, that might be true. I mean, that is the basis of empathy: that we can look at another person and kind of imagine how they’re feeling, and probably have a pretty good guess how they might be feeling in any given circumstance.
That said, there’s a limit to that; and there is great mystery in terms of another person’s mind.
One of the things I said in my monologue for the camera in the film–but I don’t think I used it in the film–was: Are there just people walking around feeling confident that they[?there?] are good people all the time? Like, I can’t even imagine what that would feel like. I have absolutely no idea. And, I bet there are people–I just can’t imagine it. Like, to me, it’s like, aren’t you all, like, neurotically concerned about this?
Yeah. Again, I love in the end that what I was drawn to was the diversity of our internal experiences, and actually honoring that and appreciating that. Because, I think I started the film and I started the experience in a very kind of utilitarian, consequentialist mindset, you know, where it’s, like, well, I was very influenced by the Effective Altruism movement to some extent. And, I was very concerned with extending my sphere of concern to distant strangers who might need my help more, actually, than my next door neighbor. And that was such a revolution in thought that it really influenced me for many years. And I think that that laid the groundwork for the kidney donation when I heard about the idea–which by the way, had to have been on EconTalk. I’m sure that my knowledge, it came from EconTalk. I have to go back and find out.
Anyway, so then I do the surgery, I go through all this stuff and I’m, like, ‘Why aren’t more people more concerned with strangers?’
And, this is a big bugaboo for me for years, ethically. And, I do it and I’m clear[?] in myself. And, as soon as I do it, I’m, like, ‘Okay. Maybe now it’s time to think about being a good neighbor to my actual neighbors. What about my family? What about my friends? How can I be a better person in those ways?’
So, it’s like the journey never ends. I feel like I give a lot of my money to charities that purport to do the most good worldwide, and that’s money that goes to, again, distant strangers. But, now I’m kind of, like, ‘Okay. Let me look around more closer to home.’
So, there’s not just one way to be a person or to be a good person. And, that’s one of the things I think I kind of gently learned through the journey–is that thinking of all this in one way doesn’t get you very far.
Russ Roberts: So, we’ve never met in person. We spent an hour or so about your last documentary on EconTalk; we happened to talk about this phenomenon of your kidney donation in an off-camera conversation a few years ago when I was doing some research on altruism. I don’t know if this will communicate, but: if I were to see you on an occasional basis–say, we were in the same social circle and we would have friends in common or we’d be friends and have coffee together, and I would see you in those settings–I would look at you very differently than I would have if I had not seen this documentary.
And, what I’m trying to say is the following. We spent an hour together talking about Kenny G and I saw you questioning him on the film: I learned something about you. But what’s beautiful about this film is it forces the viewer to remember how complex human beings are and all your roller coaster of ups and downs in this experience that’s so open, it reminded me of a recent episode that we did with Susan Cain where we talked about this empathy ad that Cleveland Clinic did where all they show you were people walking around and they put up a little description of what’s going through their mind. And you, of course, have a lot on your mind. One does. And, we don’t remember how complicated people are. We might say, ‘Oh, Penny, she’s friendly,’ or, ‘Penny, she’s smart,’ or, ‘Penny, she’s talented.’ But, your film and what you just said forces the viewer to remember something profound about the human experience, which is: So much going on in there. I know that about myself, and yet I have trouble remembering that about the other people I see. My interactions with you, were we to interact face-to-face now and then, I’d be totally changed by this film. But, what’s important to remember is: that’s true for everybody we already do interact face to face with. We’re only getting such a small part of who they actually are and their complexity.
Penny Lane: Yeah. And, I think that you started this interview, as many people do with the question: Why? Why did you do this? And, I just want to say, I don’t know. The answer is I honestly don’t know. And, I don’t think we know why we do what we do.
And I think it’s okay to interrogate our motivations and our intentions, but you can go crazy doing that. And, I almost did during this experience. And, at the end of the day, it’s okay. I think it’s okay if we don’t know why.
I don’t know why. I can give you a lot of reasons why. I could say, ‘Well, Russ, I’m 40. At that time I was 40, whatever, but now I’m 46 and I didn’t have children and that’s why.’ And maybe you nod your head and say, ‘Ah, yes, I can see.’
And, another reason on another level, it’s because of my deep involvement in the effective altruism movement, which has ko faded now, but was very salient for me at that point in my life. That’s why.
Maybe it’s because I could and I had good health and I saw my health the way other people see their money. I didn’t earn this good health, and perhaps I should share it.
There’s so many reasons. Maybe it’s because I heard about someone else who did it and I want it to be more like them in particular. There’s so many reasons, Russ. We don’t know why we do what we do, and we can only guess as to why and try to find answers that satisfy other people.
Russ Roberts: We’ll come back to this question about whether the number is large or small: you know, that anyone thinks it’s, quote, a “good idea.” And when you talk about it so-called rationally–and you do this in the film; you mentioned it earlier–well, the cost to me is small relative to gain to other people. But those are other people. They aren’t gain to you directly. You don’t get to wear the sandwich board all the time saying, ‘I was a kidney donor.’ And, again–
Penny Lane: Well, I could, but no one would like that very much.
Russ Roberts: No. It’s a bad idea. Let me recommend against it.
But, similarly, people who harbored Jews from the Nazis–it’s a small number, but again, it’s amazing. It’s anyone because they put their own life at risk, and it’s maybe harder than a laparoscopic surgery. And, when those people I think are asked, they say, ‘Well, it was a no-‘–the phrase ‘no-brainer’ is a great phrase because we use it to mean it seemed like an obviously good idea. But, I think if you think about it literally, it also means: I didn’t use my head. It wasn’t a rational decision. It was something I felt compelled to do for reasons that I can tell you, but I don’t know if they’re the real reasons. And that’s, of course, just a fascinating thing.
Russ Roberts: But, let’s go to the neuroscience. You interviewed a neuroscientist and talk about MRIs [Magnetic Resonance Imagings], and you yourself go through an MRI, which is amazing. The amygdala, which is a primitive part of the brain, her claim–I don’t know what the magnitudes are–but her claim is that altruistic kidney donors tend to have larger amygdalas than non[?]. And, that pathologically psychopathic people have very small amygdalas, suggesting both–amygdalas are related to fear and flight, a few other things; I’m sure everything in some way–that psychopaths are not afraid of other people, and they’re not very good at recognizing fear. Whereas empathetic, altruistic people are really good at it and their brain is just wired that way. And–we won’t spoil how in the film, what we learned about your amygdalas. But, this idea that somehow generous people are just, quote, “hardwired” to be generous is a little bit disturbing to me. Right? And, I think to most of us. Talk about that.
Penny Lane: Well, it gets back to what I was saying earlier, my own ambivalence or–you know, kind of, I don’t know–tension around the idea of, like: Are the altruists different in some way or are they just normal people? And, I think the answer has to be both.
I mean, I guess the way I think about the brain science part of it is there are many paths to the same outcome, many paths to the same altruistic act in this case, let’s say. So, I wouldn’t put too much stock on the amygdala per se. I think it’s an interesting data point. I think it’s worth studying more; and people will study it more. And, it’s fascinating: What’s going on in there? It’s, like, our attempt to understand psychological mysteries when you start trying to pin it to, like, the brain and brain regions–I mean, to the extent that we can do that, we’re pretty early in the process and we don’t really know. We don’t know much.
But, my neuroscientist–were she here–would say the same thing. But at the same time, like, it does gesture at something, doesn’t it? Also, why is my amygdala the size it is? Did that happen over time? Was I born that way? Were the experiences in my life, did they shape me to have an amygdala of the size that it is? Things like that I think are worth remembering. It’s a snapshot. It’s not a predictive test.
And also, you have to always remind everybody all the time with this stuff we’re talking about averages. So, there are altruistic kidney donors with small amygdalas, and there are psychopaths with large amygdalas. They’re not statistically the norm. So, it’s not a brain test where you can find out where do you fit on the altruism scale? And, it’s just super-important to remind people of that. Statistically it’s on average.
Russ Roberts: In your list of stories one might tell oneself about why you do something like this, there’s one thing you didn’t mention. You did not mention the way you were raised, which I think people would–maybe it just was an oversight. But, I’m curious, do you think your upbringing positioned you to do this? And, my other question would be: Are you a large-amygdala person in other aspects? You did something extraordinary, again, a one-time thing, and I give you great honor for it. Is that elsewhere? I mean, a psychopath is usually a psychopath pretty much all day long.
Penny Lane: I actually wonder about that. I wonder if that’s true. It’s probably true.
Russ Roberts: Maybe not true. I don’t know.
Penny Lane: I’ll answer the second question first.
Russ Roberts: Yeah. Go ahead.
Penny Lane: Because, I have thought a lot about this. I’ve thought a lot about the nature of creativity and the nature in particular of storytelling, which is my career and my vocation. Probably would have been my avocation even if I hadn’t done this for a living. You know, I’ve wondered a lot about whether my ability to make good documentary films has something to do with my ability to be empathetic. I now see that that might be a superpower I have that maybe some other people lack. I don’t know. But, I wouldn’t be surprised if that were true in some way. I think not everyone could have sat down with Kenny G and had such a critical but empathetic exchange with him for that amount of time. So, I do think that might be related.
Your first question about how I was raised is very interesting. I only gesture a little bit in the film to my family background because it’s kind of private. I just put in as much as I thought was required.
Russ Roberts: This is just you and me, by the way, so you don’t have to–
Penny Lane: Yeah. Just me and you.
Russ Roberts: Not for the film. But you can say whatever.
Penny Lane: Yeah. The camera’s off.
Russ Roberts: Yeah.
Penny Lane: Now that the camera’s off. Yeah. But I have thought about this more recently, and I do think there might be something to it because I’ll say in brief, most people think of family as the source of safety, as the source of love, as the source of caring, compassion, support. I’ll just say briefly, that was not my experience. My family was not the source of any of those things in a quite sad way. But, when I look back over my life, I do think, aha, maybe there’s something here. Because, the care of near-strangers, let’s say–guidance counselors, teachers, random adults in the world who cared about me enough to do things like take me to get a library card, encourage me to go to college, helped me with my applications, guide me and mentor me and show care–that really didn’t come from my family, that came from people who had no familial obligation to me.
So, I kind of wonder if there isn’t part of me that actually thinks that’s normal, and more normal. Because when people say: ‘Oh, of course, when you think about your mother, you think about this boundless source of love and care.’ I’m like, ‘That sounds good. I don’t know what you’re talking about.’ So, I think that there might be something there, but I’ve only just started to think about it now, whether my care for strangers was almost more learned than I think it was, in a way.
Russ Roberts: But, you talk about it as mainly a modeling role for a parent. A lot of parents demand of their children empathy, demand compassion, demand good deeds in hopes that their children will not just be happy but good. They may even think that being good help should be happy. But, I don’t think so. I think most parents who encourage their kids to do good deeds, I think it’s just an obligation of being a human being. And, that’s not, it sounds like, part of your upbringing until the effective altruism movement–
Penny Lane: Influence. Yeah.
Russ Roberts: influenced you and gave you a different way of thinking about a justification for selflessness.
Penny Lane: Correct. And, I think that’s so beautiful and so well put.
And, it is part of my attraction to the idea of organized religion, which I also was not raised with. My film is called Confessions of a Good Samaritan, but I have no grounding in Christianity other than the ambient cultural Christianity we were all raised with in America.
As I get older, I yearn more for that kind of structure, that rule-based structure. And, I do think wherever it comes from–Confucianism has an element of this, Buddhism does, wherever. There’s an element of these organized religions that is essentially at the core about how to be, and how to consider others in relation to yourself and to do the very hard work of decentering yourself from every single thing in the world. We’re psychologically hardwired to think we are the center of the universe. And, it seems to me that many of those rule-based systems and learning how to be polite and just say thank you for a gift, like, that’s something you have to learn and be taught.
So, there’s something very deep about that, that I found very moving and mystical in this experience. And that’s why the film is the film it is. If I could express to you in words what this experience meant to me, I just would and I’d move on. But, film is a visual medium. It has other ways of expressing truth. And, some of the things in the film are images. They’re not words. I couldn’t say it with just words. There’s a lot more to the experience.
And, this religious iconography was part of that. Part of me hearkening back to, like–these are ancient questions. I did not come up with them. I certainly didn’t solve them. But, I felt that ultimately what was beautiful about the experience was that I was participating in this centuries-old human dilemma and kind of touching this mysterious core of what it means to be a person–not just a good person–just a person in the world. Yeah. It makes me want to cry. It’s so deep and it’s so meaningful to me, ultimately. So, much more meaningful than the way I was thinking about it initially, which was like a math problem: ‘I have this much kidney function and this person has this much, and therefore.’ You know.
Russ Roberts: I should just mention that in Judaism, according to Maimonides, one of the great Jewish thinkers, the highest level of charity is when it’s anonymous. That when neither person knows the other, neither the recipient nor the donor. And, I think part of that is to strip away the selfish component, even as mild a selfish component as getting thanked by the person you’ve helped. And, I think that your point about–I’ve said it in different ways on the program over the years–we are very self-centered, human beings are. And, growing up is realizing you’re not the center of the universe. And, whether a religion helps you get their literature or meditation or psychotherapy, these are all ways of learning to be self-aware about your relative unimportance.
Having said that, you have a scene–and don’t worry, no one’s going to watch this film and think, ‘Well, she is kind of a Christian.’ You’re not particularly into Christianity, it appears. But, you have a clip from a Billy Graham speech, a live clip from his speech. And, at some point he asks people to come down and either–I forget what they’re asked to do. But, it’s a common thing in these kind of evangelical moments. And, people stream down. And, some of it’s surely social pressure or a need to join the group.
But, when you think about religion, one of the strangest things about it–and it’s similar to being a kidney donor–is that, as much as we have this impulse to take care of ourselves and to put ourselves first, we have this other impulse, which is to not do that, to rise above it. I’m not sure it’s all cultural. There’s a huge cultural component, of course. But, there’s something glorious about diminishing oneself, of recognizing one’s own finitude, one’s own smallness. And, it’s interesting that that is rewarding rather than degrading for some people–not everybody, of course. But, I think you could say–I’m not going to say it; it’s your call–that your desire to give a kidney is fundamentally a religious impulse. Not in the organized sense, but in the sense of recognizing your relative unimportance.
Penny Lane: Well, I agree. And, a hundred percent I agree. And, that’s why the film has the title it has, despite my lack of knowledge about Christianity. Luckily everyone knows the parable of the Good Samaritan, and you don’t have to really even be a Christian to be inspired by it.
There’s something amazing about the parable format. And, I think that that’s part of what I was trying to mimic with my own film in a weird way. Because, Jesus brings these people together and he tells them a story. And at the end of the story, he says, ‘And, who is your neighbor? Who was the neighbor to the man?’ And, everyone says, ‘Well, the Samaritan.’ Most people don’t know that the Samaritan was a distant stranger to the people that Jesus was talking to. He’s a man from another religion, from another race–I think even, like, a despised, disliked other religion and other race–and that’s why he chose that example.
And so, anyway, at the end of the story, he’s, like, ‘So, who is your neighbor?’ And, what are you supposed to say? Everybody? If everybody is your neighbor, how many billions of people on the planet are there? How are you supposed to deal with that? What do you do with that?
And I love that, because it’s a question. It’s not an answer. And I think the parable format is a challenge. It’s a provocation. And, I really relate to that artistically. Like, the last thing I would ever do is just be, like, ‘Anyway, so go give your kidney. Here’s a phone number to call.’ I would never do that in a million years, even though it would probably help me explain my film better. I’d have a much easier answer to why I did this film if I was just, like, ‘Tell other people to do it.’ It really wasn’t my goal. I hope other people will do it, and they have and they will, and that’s great. But, I wanted to do a parable. I wanted to do, like, a challenge. Like: ‘Here’s a provocation to you. Do with it what you will.’ And, that was my kind of goal artistically. But, yes, I do agree. I think it’s a religious impulse. I think ultimately that’s why I did it.
Russ Roberts: To the extent there is a why.
I will let you know–you know, I’m a Jew. I really didn’t know what the Good Samaritan parable was until I saw your film. Don’t tell anybody. We’ll get some people to criticize me or to correct me, but I think they’re all Jews. Jesus and his buddies and the Samaritan. But, there may be some–
Penny Lane: Yeah. Let’s look into it. Someone will have to tell us. Someone who knows better than me.
Russ Roberts: There’s some judgment definitely there.
Russ Roberts: But, the deeper point for me is: somebody has to step up. And this is true many moments in our lives. We don’t all step up to give a kidney, but there are many times in our life when we’re asked to do something that’s not just for us. And, will you answer that call?
I just heard a remarkable set of remarks from Rabbi Benjamin Levy, who was talking here in Jerusalem about upcoming Yom Kippur, which is a day of self-reflection. And, he quoted a bit of a parable from Alan Paton. And, I forgot the novel. It’s not Cry, the Beloved Country. It’s a different one. And I’ve forgotten all the details [Ah, But Your Land Is Beautiful–Econlib Ed.]. But, the gist of it–and I was reminded of this when I saw your film–the gist of it is a person dies and goes to the afterlife and is asked about what they’ve done. And at one point, the angel or God says, ‘Where are your wounds? Where are your wounds?’ And, the person says, ‘What do you mean, my wounds?’ And the response is, ‘Wasn’t there anything down there worth fighting for?’
And, I find that profound. It’s a different version of what we’re talking about. And, Penny, you have a wound. Yours happens to be physical. Some of us have physical wounds, but many of us have psychological wounds for the things we fight for and the things we endure and our challenges as human beings. And, you flash your scar very briefly. It’s not a very bloody film; but, you have a wound now that you’ll carry the rest of your life, that says something that you thought was worth fighting for.
Penny Lane: I think that’s so beautiful. Again, I’m trying not to cry. I think, yeah–where are your wounds? I also find it symbolically moving that the scar–it looks like a C-section scar. It’s just a little smaller. It’s in the same place. And I do think there’s a fundamental aspect to this. There’s a reason that my 10% tithing to charity doesn’t give me the same feeling that that scar does. We’re talking about our bodies. We’re talking about our visceral, frail, needy, dying bodies that we’re spending most of our time trying to protect and keep alive in the face of death. And, giving of your body–which mothers do for their children–I think it’s really profound. And, I do think there’s an element of this that was that for me. Again, as a childless person, I don’t want to say that was the case for any other donor. Many donors are parents.
And, let me say, too–because in my fundamental interest of reminding people that not all families are loving and kind or a source of goodness in the world–in fact, many families are terrible. And, if you speak to to transplant surgeons, off the record, they’ll tell you that while everyone walks around saying, ‘Well, of course, if it were my child, I would give a kidney’, that is not true. In fact, many, many, many, many supposedly close family members do not step up to help their family member in need, even if they can.
So, it’s worth saying that. Because it’s sort of taken as a almost for granted that of course, people step up. But, I know a transplant surgeon who works in pediatric transplant, so he does kidney transplants for babies. And, he said to me–off camera–‘You’d be shocked at how many parents will not step up for their infant child.’
So, I just want to disrupt the kind of, like, automatic assumption that we all have that: Of course, we do it for our loved one. No, actually most people won’t do it for their loved one. Not maybe, not most. I don’t want to make a number. But, a good number of people won’t even do it for someone that they feel bound to in some way.
So, there’s something deep there that it is a difficult thing to do. It is a sacrifice. I think even people who don’t know all the details instinctively understand that this is a sacrifice–a real sacrifice–that is very different from sending 10% of your paycheck to someone else. It’s really different.
Russ Roberts: Yeah. I mean, you talk about the reaction some people have to this, that the human body–I’ll phrase it a little differently. It’s a cathedral. Your body is a cathedral. It’s given from God. You shouldn’t despoil it by–well, certainly not to sell a kidney–or to get a tax benefit for getting a kidney, which comes up in the program, in the film.
But it’s fascinating to me how it’s a visceral sacrifice, literally, by turning your body into a stuck house of spare parts. That’s the ugly way to say it. The attractive way to say is by allowing your most precious vehicle that carries you through life, your body, to risk it, to save another human being–seems not like a commercial, crude thing to do, but a rather holy thing to do. And it’s fascinating to me that some people find it repellent.
Penny Lane: I mean, think about the immune system. The immune system is a major part of this surgery, right? Because, in general, your body will reject tissue from another being. There is an attempt on the part of your body to prevent this kidney from coming in, and it will kill it immediately if you don’t suppress your immune system–for the rest of your life.
And actually, eventually it will be rejected. My kidney, God willing, if it were successful–which I assume it was–and this stranger out there is doing good with my kidney five years later; on average, it should last about 15 to 20 years if all goes well. But it will eventually reject my kidney.
So, there’s this kind of, like, naturalistic argument you could make that, ‘Well, your immune system is trying to tell you something, Russ. You know, strangers are dangerous. Keep them away.’ And so, it’s not that that’s really an answer, but I do think we have a lot of reasons to fear the stranger and to keep them away. I mean, there’s something to it.
So, it’s not all like, ‘Oh, we should all just rip open our bodies.’ We’ll die. So, there’s somethere there–there’s a question mark there I think for a lot of us.
Russ Roberts: It’s really weird, but, you know, my dad passed away a few years ago. I’m 70. And I think it’s been at least 50 years since I felt the following: that my grandfather didn’t have–I think he lost a kidney, had to lose the function of a kidney. And, in the back of my mind when I was a little boy, I always had this fear that my dad would have to give up a kidney for his father, and then I’d have to give up one for my dad if his kidney ever went awry. And, I remember that anxiety as a 10-year-old, a 15-year-old. And, yet decades past, I’ve totally forgotten about it, even though I’ve done kidney donation episodes. It wasn’t until the emotional power of your film that maybe remember that anxiety.
Russ Roberts: And–I don’t know if this is answerable, and of course part of your movie is an illustration of this–but, why are we so afraid? It’s interesting. The surgery you went through–it’s pretty safe. It may be very safe. And yet, it’s fearful.
And, most people give blood. Not most people: Many people give blood. It’s such a level higher. It is so much scarier. Right? People who give blood do it with some unease sometimes. I don’t know why it’s so hard. And, you talked earlier about derogation–what kind of derogation?–do-gooder derogation?
And, I confess, I’m talking about how great you are, and I aspire to be a good person, and yet I can’t imagine it. I can’t–I can imagine it–
Penny Lane: Why for you? You have to tell me why. Why? Why can’t you imagine it?
Russ Roberts: I’m afraid. I think it’s pure fear. I think it’s pure selfishness.
Penny Lane: I think that’s fair. I think that’s fair. I think it’s fair to be afraid of surgery. Most people are.
Russ Roberts: Yeah.
Penny Lane: And, one of the things I found out when I made the film that I didn’t even know until after I did my own surgery–and I drop it in late in the film to reflect that–is that 90% of people who say they want to be an altruistic kidney donor drop out at some point. Some of that might be social pressure or pressure from their families. I’ve seen a lot of that. That’s a real thing. But, I bet a lot of it is fear. People are afraid of surgery. That’s okay.
Russ Roberts: I’m a coward. Right? I’m a coward.
Russ Roberts: By the way: I think eating meat is wrong, but I love meat. And, that’s a purely selfish–‘wrong’ is too strong a word. I understand the moral case against meat eating. It’s multifaceted.
But, if you said to me, well, then why don’t you give up meat? It would be really hard for me. I could do it, but I’m not, quote, that “good” a person. And, I salve my conscience and self-image by saying, ‘Well, I do give 10% of my income to charity, so I can see myself as a good person.’ And, it’s a fascinating–again, your film obviously is deep into these issues, and viewers will enjoy seeing that. But, it’s a fascinating thing. We’re afraid of a lot of stuff, and we’re still pretty selfish.
Penny Lane: Here’s something else we’re afraid of. There’s this idea in bioethics that comes from the study of organ transplantation. And, the idea is the tyranny of the gift. The idea of this concept is that some gifts are so big and so incommensurable and so generous that when you give them the recipient has been tyrannically, like, tyrannized by it. The joke is, like, ‘Oh, someone gave you a kidney. What’d you get them for Christmas?’ And, it’s like, ha, ha, ha. But, like: Oh man, really though, what did you get them for Christmas? And it’s challenging, because sometimes we’re afraid of burdening somebody. And I’ve felt this in my own life. There have been times where I’ve helped somebody in a way that was maybe over the top and I’ve seen the discomfort it causes. There are people who give a kidney to their brother, and their relationship is never the same–and not necessarily in a good way.
So, there’s this other side of it where you don’t want to, in order to feel like a good person, do something that’s so big and so generous and so insane that you’ve now made it harder for the recipient to live with themselves. Obviously, that’s part of the desire of doing it anonymously, is to spare someone of that potential burden.
But, I do think there’s a lot of different fears that go into this. We started this conversation by talking about how I was afraid people would think that I was actually just a narcissist looking for attention. There are a lot of things to be afraid of in the idea of giving a kidney to a stranger. Many, many, many things, not all of them are just about you dying on the surgical table, which is very rare.
Russ Roberts: This idea of the tyranny of the gift, it makes me think as a parent: when you’re a kid, you don’t really appreciate your parents. You don’t know how much work it is. And then, you have a kid and you realize how hard it is and how much your parents gave you. And yet–and yet you really don’t feel that indebtedness the way in a normal human relationship would be. You kind of say to yourself, ‘Well, they’re my parents. Of course they took care of me.’ And it’s a one-way street. Parents feel very differently about their children than children feel about their parents. Obviously, there’s degrees in both directions, as we’ve alluded to.
But, it would be, I guess, unbearable to grow up if you fully internalized what your parents have done for you. And, it’s kind of a protective mechanism–because the parents don’t want it, by the way: the parents don’t want the kids to feel so indebted that they can’t function. And, it shouldn’t be that every Christmas or birthday the kid gets the parents an even nicer gift because that time, all those years–it doesn’t work that way.
Penny Lane: Well, to be fair, gift-giving isn’t supposed to work that way. It is supposed to be a free–we just know that there’s also networks of obligation that we’re all in. So, we can say, ‘Well, of course you don’t have to repay someone for a gift,’ but on some level you kind of do or you don’t. It’s a complicated thing, the gift economy, isn’t it?
Russ Roberts: Yeah. For sure. And, having said that, my kids gave me a wonderful 70th birthday present I will not reveal on this program, but I’m deeply grateful.
Penny Lane: Oh, good job kids.
Russ Roberts: It wasn’t just how much it cost. It was the thought with that.
Penny Lane: That’s sweet.
Russ Roberts: Yeah. We’ll move along here. Okay.
Russ Roberts: Listeners may hear some playground noise. That is unavoidable. Don’t worry about it. Penny would never–
Penny Lane: It’s recess. It’s recess across the street.
Russ Roberts: Yeah. And, it will keep you from having–it might keep you from having children, hearing these screams.
There’s an aspect of this that you capture in the film that a non-participant can’t appreciate. And, that’s how complicated it is. If you had said to me, ‘What’s hard about giving a kidney?’, I would have said, ‘Well, you have to have surgery.’ But, the challenge of getting approved took a toll on you. And, one example was the healthcare proxy and the psychosocial–or whatever it’s called, exam–because they want to make sure that, quote, “you’re not doing it for the wrong reason.” You may not be able to tell them what the right reason is, but they certainly don’t want you to do it for the wrong reason that we talked about earlier. Talk about that whole roller coaster. Very hard.
Penny Lane: Yeah. It is kind of hard. So, obviously, first there’s a very serious battery of physical tests. Like, you are not giving a kidney if there’s any chance that the kidney transplant centers can see that this is going to be bad for you. That’s why it’s so safe. It’s safer than other surgeries because of the intensive screening process–not because the surgery itself is safer than other laparoscopic surgeries.
So, that was a, kind of a pain, and unpleasant and just spending a lot of time in the hospital. It’s alienating and sad and not fun.
But the part that really got me–as you alluded to–was the psychosocial evaluation. I mean: Gosh, I had already spent three years failing to satisfy anyone with my answer to the question ‘Why?’ And, I thought, ‘Oh my gosh, what am I going to say to this social worker who is going to ask me why? Everyone else has seemed like my answers were very strange.’
And, I have a history of mental illness in my family; and in the past I had tried to sign up for certain psychological tests to, like, earn money in college, and I was rejected because of that past. And so, I think I had this vestigial, kind of like, ‘They’re going to reject me because of this. They’re going to reject me because my grandmother was schizophrenic.’ So, I think even the first time I called them, I was like, ‘My grandmother’s schizophrenic, just so you know.’ And, they were, like, ‘Okay. Okay. Whatever.’ They didn’t care.
But, I think I was just so afraid that I’d be rejected. And, that being a person who has a complicated interior life, who has struggled with depression at times, who can have pretty high anxiety, who has this family history of trauma and mental illness, I thought, ‘Gosh, what will I feel about myself if they reject me?’ [More to come, 1:04:53]
