The Good and Evil in Humankind

"The idea is that the same basic biological structure that can help us understand psychopathy -- I think everyone is in agreement now that there is a strong biological basis for psychopathy -- maybe can help us to understand people who are on the other end of the spectrum."
"A number of the kidney donors, when they heard about our paper, said: 'You are not looking for evidence that we are crazy are you?' People think they get treated like heroes, but that is uncommon."
"Many of them have said they don't bring it up in day-to-day conversation with people they have just met because they have got so many (negative) reactions."
"I think the assumption among a lot of people is that if you volunteer to give one of your own internal organs to somebody you have never met, you must be nuts."
Dr. Abigail Marsh, psychology professor, Georgetown University, Washington

"Directed donation policies that produce a net gain of organs (for life-saving transplantation) in the organ pool and do not unreasonably disadvantage others on the waiting list are ethically acceptable, as long as donors receive no payment beyond reimbursement for travel, lodging, lost wages, and the medical care associated with donation."
American Medical Association guidelines on organ donations solicitation

The phenomenon of living organ donations to supplement the (always inadequate) supply of volunteered cadaver organs available for transplant purposes is growing. So are the ethical concerns that if directed living organ donations benefit particular people, what of those on waiting lists who are desperate for a cadaver organ to relieve the pain and agony they suffer not knowing whether an organ will come available before death takes them, who have no family members or people at large to volunteer on their behalf.

On the other hand, if through the generosity of some virtuous-minded people for whom helping others anonymously by undergoing voluntary surgery to make available to others part of their liver, or one of their kidneys, some people's lives are saved, the medical community grapples with its conscience, weighing the reality of life not always being scrupulously fair to some while circumstances make it kinder to others.

Into this maelstrom of confused medical response, and ethical concerns there is the puzzlement that many feel on hearing of people who step forward to offer one of their organs to help someone, anyone from a perfect stranger to a family member or a friend. They do so because they feel they must, to respect themselves. Their spirit of extreme generosity is difficult to understand since most people would never dream of deliberately placing themselves on an operating gurney to benefit someone in medical distress.

So researchers at Georgetown University thought they would study the brains of the most altruistic minded people they could come across. For that purpose they assembled a group of anonymous kidney donors. Discovering through their research that the organ donors' brains were designed differently than those of a control group. Most fascinating of all, their brains were the direct opposite of the brains of psychopaths, people without conscience who think nothing of causing pain to others.

Dr. Marsh and her colleagues at Georgetown University tested nineteen kidney donors of whom 17 had donated one of their kidneys to a perfect stranger, preferring to remain anonymous. Those donors proved to have larger amygdalas than those of the control group. Their amygdala showed increased activity in the part of the brain associated with feelings of empathy and they were larger than those of the control group.

Imaging on the brains of psychopaths discovered that they have smaller amygdalas. "The smaller it is, the more psychopathic they are", explained Dr. Marsh. More reactive symptoms occurred in the brains of organ donors exposed to fearful or distressed facial expressions compared to the control group. And they were similarly in reverse less reactive to angry facial expressions. Indicating their responsiveness to distress. They were better at recognizing the fears that people experience.

Dr. Marsh noted that it is a common perception in society that human nature is inherently selfish, that when people behave in a manner that is contrary to their perceived self-interest, others are predictably suspicious of their motivations. Just as society in general is suspicious of those who don't conform to majority expectations those who act out of a spirit of altruism often encounter skepticism and hostility.

Neural and cognitive characteristics of extraordinary altruists

Altruism, and particularly costly altruism toward strangers, such as altruistic kidney donation, represents a puzzling phenomenon for many fields of science, including evolutionary biology, psychology, and economics. How can such behavior be explained? The propensity to engage in costly altruism varies widely and may be genetically mediated, but little is known about the neural mechanisms that support it. We used structural and functional brain imaging to compare extraordinary altruists, specifically altruistic kidney donors, and controls. Altruists exhibited variations in neural anatomy and functioning that represent the inverse of patterns previously observed in psychopaths, who are unusually callous and antisocial. These findings suggest extraordinary altruism represents one end of a caring continuum and is supported by neural mechanisms that underlie social and emotional responsiveness.

1. Abigail A. Marsh^a,¹,
2. Sarah A. Stoycos^a,
3. Kristin M. Brethel-Haurwitz^a,
4. Paul Robinson^b,
5. John W. VanMeter^c, and
6. Elise M. Cardinale^a