The drive to donate a kidney to a stranger is not a desire I—nor the majority of the population, for that matter—can relate to. (But then again I’ve personally no great love for humanity in general, as arguably the planet would be far better off had we gone the way of the dinosaurs. And luckily for Mother Earth, we still may!) Which puts me at philosophical odds with veteran filmmaker (and main protagonist) Penny Lane, whose latest doc Confessions of a Good Samaritan is a deep dive into the science as well as ethical implications behind altruistic donation. It’s also a surprisingly self-deprecatingly funny quest to discover why one person’s blatantly obvious decision can be another’s sign of inexplicable insanity.

To learn all about the unusual project, I reached out to the altruistic donor director herself just prior to the film’s SXSW premiere on March 10th.

Filmmaker: You’ve said that every film is a personal film, though this certainly feels like your most personal project yet. So why did you ultimately decide to turn the camera on yourself and your own journey to kidney donation? (Especially since you managed to find such an engaging cast of supporting characters from the scientific community.)

Lane: It’s an interesting question because actually all my earliest short films were extremely personal. For example, I made a short film in 2010 called The Voyagers, which was a love letter to my then-fiancé. Even earlier, in 2005, I made my first proper “documentary” The Abortion Diaries, which was a pretty raw and intimate film about having had an abortion and all my mixed feelings about it. So while Confessions of a Good Samaritan is the first feature I put myself in, it’s really a return for me to a form of filmmaking that came quite naturally early on.

The decision to turn the camera on myself in this case didn’t really feel like a decision; it felt like a calling or a necessity, one which I heeded with some trepidation. It had to be me at the core of it for a few reasons, but the main one was that I wanted to really interrogate the decision to give a kidney to a stranger in a way that I would never have felt comfortable doing to another person. I would never have put another person through the kind of questioning I put myself through in this film. It would have felt wrong and probably cruel to question the motives and ethics of another person the way I questioned myself in this project, or to ask them to go into detail about the worst parts of the experience. I would never have done that especially to a living kidney donor who is after all just trying to do a nice thing for another person.

Ultimately, about half the film is “about” me and my experience, and the other half is about the history, science and ethics of living organ donation more broadly. I thought a lot about personal essay form in terms of using my own voice and experience as a kind of guide through this terrain, moving my character through a kind of unearned moral confidence into the murkiest confusion, and ultimately into a more nuanced position. This was true to my experience, and it also mirrors my favorite type of personal essay.

Filmmaker: You’ve described your 2018 film The Pain of Others as an attempt at “an act of radical empathy,” which made me wonder how these two projects are related. Had you been considering altruistic donation while making that previous doc?

Lane: Yes, I had the idea to become an altruistic donor much earlier, but it took me a few years to kind of just make it happen—choose a good time to take off work, find a transplant center and so on. I am sure the projects are related on some level, perhaps at the level where I like to find something that makes me intensely uncomfortable and kind of run into the core of it.

But the inspiration to donate a kidney was not a “project” to begin with, nor was it consciously an attempt to sort of think about empathy in some abstract way like The Pain of Others was. I simply heard about the idea of altruistic donation, and it seemed like something I too would like to do. I didn’t decide to make it into a film project until 2019.

Filmmaker: While watching Confessions of a Good Samaritan it also struck me that your last few films have been less reliant on archival imagery and more inclusive of contemporary interviews and characters. How do you determine what materials you work with?

Lane: Early on in my career I was quite insecure about being a director and working with crews and “getting access” and all that. I really loved editing, so that had a lot to do with why I worked a lot with archival materials. I also didn’t know how to access funding, so I was just doing what I could do as much on my own as possible (which I recommend as a practice to all artists starting out).

As I have made more films, I’ve become much more confident about collaborating with larger crews, and also interacting with, negotiating with, and filming living people and places in the real world. So I’ve found that my toolkit is just a lot bigger now, and I can choose the form of my films based on more than just “what am I comfortable doing?”

That said, I am bored easily and never want to do the same thing twice. So with new projects one of the big questions I am asking myself is, how will this film push me and challenge me to do something I’ve never done before? What new things will I have to learn in order to make this film successful? There needs to be a pretty big chance of failure or I don’t see the point.

Filmmaker: You admit onscreen to being a bit troubled that folks might think you chose to donate a kidney in order to make a film about it—as a “stunt” rather than as a “good samaritan.” But isn’t this overwhelming desire to help strangers its own form of narcissism—a potent high that’s likewise not dissimilar to the parental drive to see oneself continue on through another body?

Lane: There’s a lot to unpack in this question. First, I would never describe any aspect of my experience of being a kidney donor as a “potent high.” At its best, there’s a kind of quiet satisfaction in it, the knowledge that I know I concretely helped someone in a very difficult situation to improve their lives greatly. I can say more briefly that I saved someone’s life, which is true, but to say it that way makes the feeling sound more noisy and dramatic than it really is.

I also don’t think I have an “overwhelming desire to help strangers.” I gave one kidney to one stranger one time. It’s not something that I’m constantly thinking about. But if you mean more generally, is the idea of charity itself basically bullshit and “narcissism” in disguise, certainly some people believe this, most famously Ayn Rand. I’m not a Randian and I don’t believe that to be true.

I do think, however, that whether or not it is the reason we do good things, doing good things does make us feel better about ourselves. And I believe it should! What better reason is there for experiencing a sense of self-worth? Even though I didn’t get this in the beginning, this was a morally challenging thing to do. It was hard for me; it was a real sacrifice and it demanded a lot of me and there were times I wished to back out. But I didn’t back out—I went through with it—and it gives me a sense of satisfaction to know that I worked hard to do something virtuous. Virtue, after all, demands much of us! There is nothing easier than to just lay back and be selfish, lazy, greedy, impatient and so on. It demands a lot of humans to be better versions of ourselves. Giving a kidney was good practice, but it’s hardly the end. I’m still a basically horrible person who has to work hard every day to be better.

Filmmaker: On your quest to learn why an act you consider a “no-brainer” others often view as “crazy” actually leads you to a brain scan and the discovery that altruistic donors seem to have larger amygdalae than that of the general population (while sociopaths have smaller). Did you find this revelation comforting (i.e., your brain made you do it) or perhaps depressing (since it suggests most people won’t ever feel that compulsion to donate)? Did it at all cause you to consider the limits of advocacy?

Lane: I have no idea what to make of my apparently very large amygdala! We are very far away from ever really knowing what any of us should make of these brain scan studies. The correlations are interesting, and raise far more questions that they answer.

What I love about the psychological and neuro-imaging aspect of this exploration is precisely that it gestures at the eternal mysteries at play here. I set out to ask why my “no-brainer” was someone else’s “crazy” because for all the talk about human nature, people really are different. As your previous question points us to, the tendency towards altruism, like all personality traits, falls on a spectrum and is hugely contingent on any number of factors. And this variability is a good thing, not at all depressing! Altruism is not the only virtue. There are other aspects of what makes a good person and a meaningful life. The incredible diversity of humankind is what makes us a successful, not to mention fascinating, species.

But I don’t think of this film as an advocacy film at all. I don’t think it’s my job as an artist to tell people how to live. I’ll leave that to the activists and the policymakers. Of course, I never would have had the idea to donate a kidney had other people not done it and then spoken publicly about it, but watching my film is not going to convince anyone to do it or not do it. Frankly, my Facebook posts about it already led to at least three people I know becoming altruistic donors; and they did not need my film to get them there, they just needed to know it was an option and to look more into it.

Even more so, I feel intensely uncomfortable being seen as an advocate for this, because while it is relatively safe it is not without risk. There can be bad outcomes. Can you imagine if I was like, unequivocally, “Do it!” and then that person died in surgery or had life altering complications? As of now, as far as I know, no altruistic donors have died; but if enough people become altruistic donors someone will die, and that will be a horrible tragedy. In many ways the current system is exploitative of donors, or doesn’t take good enough care of them. Probably we should get out of the business of living donation, which at its core will always be ethically a bit problematic. (See, I’m a terrible advocate!)

Anyway, I hope the film gives people a little on-ramp to consider why or why not they might want to become a donor, because it’s an interesting thing to think about and debate and discuss. As for the limits of advocacy in a more general way, not specifically about whether my film is an advocacy film, I think most people have some desire to do good by others without any tangible benefit to themselves. We can call this altruism or generosity or whatever. Most people also want to be admired by others, or to be seen as good by others. You can call that narcissism or self interest or whatever. In any case, I agree with Adam Smith who said that most people in their nature want “not only to be loved, but to be lovely.” The most advocacy can do is to direct those pre-existing impulses—to be loved, and to be lovely—to this or that particular cause or activity. I don’t think we can make a particular person any nicer through advocacy, but I do think effective advocacy can direct those desires toward something better than simple self-gratification. And the really beautiful thing is that once you’ve done a good deed, it inevitably makes you feel more excited to do more good deeds. I’ve never felt I’ve lost something through generosity; I’ve only ever felt my own life was improved and blessed by it. It’s the best kind of paradox!