The Checkup with Doctor Mike - The Happiest Day Of Jesse Eisenberg's Life

Episode Date: April 26, 2026

To learn more about kidney donation please check out NYU Langone Health on YouTube.I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/00:00 Intro01:40 Jesse The Body Builder07:38 Generational Trauma14:36 Hollywood Sell Outs18:00 Social Anxiety / Award Shows25:15 Playing Villains30:17 Kidney Donation54:17 Legos59:48 AI01:02:15 How Could You Not Donate?01:18:43 Dr. Robert Montgomery01:24:15 Research / Living Donors01:31:26 90,000 Transplant List01:38:20 The Process Of Donating A Kidney01:49:00 His Own Heart Problems02:02:12 Pig Kidneys02:09:55 ResourcesHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

It's the Family and Friends event at Shoppers Drug Mart. Get 20% off almost all regular priced merchandise. Two days only. Tuesday, April 28th and Wednesday, April 29th. Open your PC Optimum app to get your coupon. How does one wake up in the morning and say, I want to donate a kidney to a stranger? What would you do to save the life of someone you love? Would you donate an organ?

I bet many of you would if it meant you could save the life of your spouse, a member of your family, or even a friend. But how far would you go to not only save the life of someone you don't know, but the life of someone you'll never even meet? When I heard about kidney donations, my first thought was, why is there not a line down the block of the hospital? I would just think everybody would want to do this kind of thing. I really am fascinated by people who look for a connection through something dark. Well, you may know him as a Hollywood superstar for movies like the Social Network

or is Oscar-winning film A Real Pain? someone out there has a different relationship to Jesse because they're walking around with his kidney. Here's the thing. They don't even know it. They received a kidney from an anonymous donor. So why endure an abdominal surgery to help a complete stranger with no strings attached?

That's what newspapers and magazines have been asking Jesse for months, but he's refused to give anyone an interview. Well, as you know from our messages, I was like incredibly hesitant. I've turned down every interview that I've been asked to do and I've been asked to do tons of interviews and speak at things and I don't do it.

And I thought you have a young audience and people who are health curious, those are the people who are going to hear this and think, oh, I'm that person. And in a first for the Checkup podcast, Jesse doesn't tell the complete story. To help round out the clinical side of organ transplantation, we have Dr. Robert Montgomery, the director of NYU Langone Transplant Institute, which handled Jesse's donation. But for now, please help me in welcoming Jesse Eisenberg to the Checkup podcast. Working in Hollywood, you have a diverse array of characters, quite literally, figuratively,

theoretically, is it difficult to mingle with people who come from such diverse backgrounds and schools of thought, especially when it comes to politics and such? I think you might be mischaracterizing Hollywood. It's much more, it's much more homogenous politically than, well, yeah, of course. I mean, you know, it's people who get into the arts, you know, and have maybe like a real feeling of not only rebelliousness, but. but also driven by, you know, great empathy because you want to think about characters and stories

and embody those emotions and you feel comfortable expressing yourself. You know, it's all things that I would associate more with like liberal politics and, you know, kind of, you know, we most Hollywood stories are underdog stories. We value kind of the Mr. Smith Goes to Washington kind of thing. And so that to me is all associated with what I would consider to be, you know, liberal ideals.

Yeah, I guess I was thinking about it more from a science perspective, and when we look at the perhaps less than ideal scientific environment, that has shifted across aisles where perhaps 20, 30 years ago, it was more prevalent on the liberal side of things. Now it's kind of overreached into the libertarian conservative side of thought. So I'm curious when you're speaking to someone in Hollywood who's perhaps anti-science, anti-vexie. Horseshoe theory of healthcare. Oh, tell me about the horseshoe theory. Oh, no, the Horseshoe theory of politics is just that, you know,

and the extreme left and the extreme right are far closer than they are to the center. You know, but so in terms of like, yeah, health stuff, yes, you occasionally see somebody who has a, like, notion about, you know, an epidemic that's different than your notions. I love that you call them notions. Well, I don't know what else to, you know, I don't know what other euphemisms I could use. Yeah, but it's, first of all, it's far less frequent than you might imagine. Really?

Yeah, yeah, yeah. I mean, yeah. Yeah, I mean, to be like working on like a major movie, you know, it just requires, sorry, a major movie. All I mean is like to, you know, it's like a very, it's small and like a big production, basically. Yeah, I just mean like, you know, you're vetted by so many levels of a system that, you know, you tend to be a little more like I would say mainstream about your, you know, thoughts about that stuff. And, you know, for a while, like, you know, I think for COVID at least, you know, it was a requirement that you're vaccinated. to work on a big production. So, you know, maybe it weeds out some people.

Yeah. Being as grounded as you are, empathetic as you are. Yeah, continue. Yeah, I'm here. Okay. Do you ever get questioning, do you ever begin questioning yourself about things perhaps you should be doing for your health but aren't doing? Do you ever go down that path?

Looking for quick fixes, thinking about preventive health care. in a way that is very exciting, very passionate. Oh, that's interesting. Not really. I, you know, I had to like, I played like a bodybuilder in a movie like four years ago, three years ago or something. And, yes, I was just like trying to gain weight.

It was like a struggle for me to gain weight, you know, which I know is like enviable, I guess. But like in my situation for that, it was difficult because I really wanted to gain, you know, not just weight but muscle. And so, yeah, I was like taking, you know, creatine. I mean, I'm not doing steroids or anything like that. But yes, I was trying like I would be, I was working with a guy, a trainer or whatever, but I was taking like all sorts of supplements I didn't know anything about.

Did you notice a change with the supplements? Yeah, yeah, yeah, of course. I gained a lot of muscle, you know, for this movie. But probably not from the supplements, more so from the workouts. I'm sure. Nutrition. Yeah, sure. I couldn't tell you if I was taking like a chalk in a capsule or creatine or we,

I have no idea about that stuff. And I recognize that or I have like a skepticism about, you know, the supplement industry. You do? Yeah, of course. Well, that's exciting. I don't know. These days, a lot of people just have natural belief in it. Oh, I understand the temptation to have a belief in it.

But am I wrong in saying that it's like just a totally unregulated market and we don't know what's in there? And every time they test, people come back surprised. Keep going. That was so good. Is that true? That's very true. Oh, yeah.

Okay. Okay. So that seems to be the case. And it's, I think your view of it is quite pure because of if you're spending a lot of time on social media, which unfortunately I do because of my work and trying to understand these perspectives, I find that there is this huge belief in this unregulated industry, so much so that it corrupts people's relationship with health care as a whole. And that gets me really upset and frustrated. Oh, you're saying the suspicion around something that you should be suspicious about then

bleeds into things that you should not be suspicious about? Partly, yes, but also the fact that they have created an enemy of the health care system, of the pharmaceutical industry, they've heard so much negative about it that they now view this as the cure for it. Oh, I see. Where it is... This just comes from a sense of boredom? I think it's going to be individually dependent a lot,

but... If we were in a war zone, wouldn't we all just want penicillin at the ready? Yes. And is it based on the fact that we're not in a war zone that we want fish oils? Do you see what I'm saying? Yeah, yeah, yeah.

It's problems of progress. Yeah, problems of progress? Yeah. or a safetyism. Of what? Safetyism. That we live in a safer society. You know, crime rates are lower than they were the decade before and the decade prior.

So as a result, we're creating worries that perhaps are unnecessary worries and we have more free time, especially these days when we can have food delivered to us, pretty much everything delivered to us at our beck and call. And you don't have to be a billionaire in order to have that happen. That's interesting. I recognize a kind of kind of. cousin of that in myself, and I wonder if you share it too, because we have semi-similar backgrounds, which is like Eastern European families. And I recognize in myself a kind of like anxiety about

nothing. I feel, I think just based on like, you know, generations and generations of people worried about getting killed, I feel a kind of paranoia, but I tack it on to things like I had too much coffee this morning and I might not sleep in 12 hours from now because I had too much And I find myself worrying about things that are just fantastical nonsense. But I think maybe it's because I have been wired for war. Do you know what I mean? Yeah, yeah. And like, you know, my wife's family is a similar immigrant story to your family

and experienced real horrors. And my wife is, you know, a paranoid. But she thinks it's because that there might be asbestos in our house, you know, when it's been painted over for generations and it's fine. stuff like that. Do you have this feeling at all based on your family history as well? I don't know that I necessarily have that feeling, but I definitely yearn for control probably more than the average person, which is why being on a plane freaks me out, more so now than ever before. I see, just not being in control of the...

Yeah, just not being in control of the scenario. Did your family suffer the horrors of the past? I don't know that they suffered specifically horrors of the past. I know that there was a lot of anti-Semitism where we were going to. growing up in Russia, and that's the reason why we left. Yeah. And during World War II, they were, where? Are they fighting in the Russian army?

Hard to know. My grandfather was part of the war. He was part of the Russian Air Force, and he was very pro-Stalin, go-Stalin, and my dad was very anti-Stalin. So it was interesting how the generations would debate amongst themselves, and I didn't know which side to take on. Your dad was alive during Stalin? No, but, you know, the ethos of Stalin.

and discussing how terrible he treated the population versus my grandfather, who served in his military, believed that he should support it. So I saw their conflict about it. I see. I get confused in thinking about the notion that anxieties could be coming from generations of the past is because on one side, it seems like sci-fi, right? Oh, we're suffering as a result of our past generations. suffering. Oh, that's not how I think about it at all. Oh, how do you think of it? I don't think about it

in any kind of like molecular level. But here's the cool thing. There is a molecular pathway. I bet there is. That's just, I'm not smart enough to conceive of that. So I just think of it very practically is that my mom, you know, who grew up with paranoid parents, who grew up with paranoid great-grandparents, she used to wake me up in the middle of the night because she would have dreams that I was drowning and she wanted to make sure I was alive. So she would wake me up and tell me that she had a nightmare about me drowning. And so of course, I never learned how to swim. So yes, there perhaps is a cellular, you know, whatever memory. But there's a human aspect.

Yeah, I just think of it at this very obvious thing of my mom was paranoid that I was going to drown because her parents were paranoid that the Cossacks are going to, you know what I mean, something like that. And it highlights the notion of how much humans are in nature and nurture. Of course. And the combination of the two. Can you explain to me the biological? Yeah, I wish I was smart enough to explain it well.

But there is something called epigenetics where your experiences and how you move through the world can impact your genetic. code and your genetic expression. So if you have this family history of people who were highly anxious, highly nervous about not dancing in the prairie because there were lions about or there was a military coming, perhaps that has been passed down genetically to you in a way where perhaps the genes weren't impacted, but the expression of those genes were impacted. And then there's the behavioral aspect because,

from a survival standpoint, if your parents are a certain way, and it taught you to survive in that way, you then pass that down to your children. But now I'm seeing it kind of on the flip side where a lot of my patients, children, are doing the opposite of what their parents are doing or perhaps disagreeing with them on the political side of things. How do you fall on that when discussing politics or stuff with your family?

Oh, we're completely in line. Really? Okay. Yeah. I mean, you know, we're... I don't like discussing politics in public because I just feel silly. Because my platform is not from politics. My platform is from, you know, running from zombies in an effective way. So I feel a little silly talking about politics because I feel unqualified.

But, you know, I come from a very, very cliche, you know, liberal Jewish family, you know, 100 years of voting for American Democrats. I mean, you know, and and it's, you know, and it's. You know, and it's very simply summarized by my aunt, who was my mentor in my life. She died at 108, 107 in 2019. I lived with her in my 30s. She was my main, like, you know, relative that I was close to and admired, you know. Anyway, she...

What did you admire about her? Oh, you know, she just was so practical from, you know, she grew up in Poland and she was just like, so, you know, comically, you know, sentimental, you know, and I just like, I like, I wish I had that, I wish I grew up in her era where I could be like that too, instead of this kind of, you know, worried, you know, anxious about social situation, you know, this nonsense that just seems like fantasy. But anyway, just to explain my politics quite briefly, really briefly, I just asked her once, you know, have you voted for a Republican ever? And she said no, and I said why. And she said, um, uh, because I care about the poor. She said this so bluntly. And I know, I'm sure many Republicans care about. the poor and everything. But for me, it just explained this kind of like, you know, coming here poor to America and just kind of caring about, caring about the people that you, um, um, um, um,

so anyway, that was our family's politics, but there's nothing more fascinating than that about it. Um, or strident. Um, yeah, in terms of her, I, yeah,

I admire that so much, you know, this kind of, because it's the opposite of the word. I live in. The world I live in, because I'm an actor, is where we talk about everything that we're thinking and everything that we're doing, and I'm sitting here with a mic, an inch from my face, as I often am, sitting with a mic, an inch from my face. And I'm so disgusted by that, by myself, that, of course, I end up admiring these people who not only are, like, not touting their own

accomplishments, but actually kind of turned off to the, you know, the idea that their accomplishments should be discussed. You know what I'm saying? Yeah, it's interesting how, In Hollywood, it almost forces you to behave in that way in order to be successful. Yes. Right? Because if you're not promoting the movie, it seems like you're disinterested and you can actually come off more problematic. Great point.

That's a great point. I'm in this weird industry and in a weird time where, you know, when I started acting, there was like, you know, people would go on Jay Leno show, you know, the Tonight Show and Jimmy Fallon. People would go on Leno and it would be seen, everybody like Jay Leno personally, but it would be seen as like, oh. I gotta go on this show. It felt like selling out.

This was in the late 90s, early 2000s. And it felt like the worst thing you could do is I have to go talk about the movie and everything. And now you have to wrap on Jimmy Fallon with your shirt off in order to sell your movie. And again, it's fine. Like, that's all fine. And Jimmy Fallon's really great too.

And everybody loves him. And he's brilliant. And the show's great and everything like that. But what we, but the kind of like the slope of kind of what we open ourselves up publicly is so steep since I started acting. And so I have a little bit of that old mentality of like, I should not talk about myself so much.

I should not do all these games and make myself look so cute and accessible. Because A, it makes me uncomfortable, but B, does it really help my job when I'm trying to play a character and you're trying to believe that the story is this? But primarily it just makes me feel a little strange. Sure. What do you think has driven that change in Hollywood that people feel they need to be more Well, first of all, it's a necessity of the industry. You're auditioning for so few parts. You know,

actors are up for so few parts. And, you know, I cast movies now because I'm making movies. And, you know, when I get, uh, what's that? Lex. Yeah, no idea. Um, but like when I get, like, resumes from the agents, it talks about how many followers they have. And this is something that I don't consider because my movies are not like big commercial things, but it's something definitely somebody is considering. Interesting. And maybe even my investors. are considered, you know, so that's like a thing. So that's part of it. A lot of people would say this is a necessity. And then of course, there's the temptation to have your thoughts and feelings and jokes in public. And people just have that temptation. I do too, but I do it in different ways. Like I,

you know, I wrote a comic essay that's in the New Yorker this week. Like that is my version of Twitter, you know, I want to have my funny jokes, you know, public, because whatever, narcissism. but I have like maybe access to old style media like a magazine or a traditional movie that allows me to exercise all that stuff that I want to do, you know? And if I didn't have that stuff, then sure, I'd be on Twitter all day doing my jokes. Of course. Yeah. You know what upset me so much after our Thai magazine meeting was that I went to go try and find that Time magazine in a bodega somewhere in New York. Yeah. And I walked two miles, stopping at every bodega. not one sold magazines.

Wait, oh, was that right? Yeah. Not one sold magazines. That's true. That's true. So as a medium, it was like, oh, man, magazines aren't a thing anymore. People don't seem to want to purchase them. But what about the internet time?

Well, yeah, you could find it online. Yeah, yeah, yeah. But I imagine that. Just the medium has changed. Of course, of course. Maybe I romanticize it a bit of like opening the thing and seeing like, oh my God, there is. Yeah, of course. Yeah, you're exactly right.

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Visit edac.ca.com to learn more. I'm curious, you talk a lot in other podcasts, and we've actually discussed it a bit with your experience with social anxiety. And interestingly enough, like even with the Time Magazine event that we were both very lucky to attend, I saw you for sitting across the room. And I have also, I consider myself an introvert. I have social anxiety. And I said, oh, I'd love to approach you to have this conversation that we're having today.

And it took 100,000 effort to just come over and say hi to you. how do you do that at scale in Hollywood when you're meeting all these very big name high profile individuals? How do you handle your social anxiety? What strategies do you use? Oh, I guess I don't go to a lot of things. There are some people who do go to a lot of things.

I'm just not one of them. And so I don't really have that. But a lot of times when I'm at some industry thing, I went to the premiere of a play the other night, like I knew half the audience because we worked together in theater. And so when you know somebody and you work with them in theater, there's a, especially in theater, you know, where you're, you know, you kind of, it's, you know, you're overwhelmed with the feeling of warmth for these people, you know, at least that's my feeling. And then some, yeah, some like bigger industry things that I'm forced to go to an award show or something. Yeah, that's not like my place of comfort. And I don't know that I have any good strategies. But, you know, it's like an obligation. You know, when I was, you know, first got kind of well.

known and I got invited to award shows and stuff. I would complain to my father all the time. This was during the Obama administration, so I would tell my dad, I can't believe I have to go to this thing. It's so stupid. It's so shallow. It's so fake. Everybody acts so fake. My dad said, Obama is probably, you know, sitting with, you know, a contingent of, you know, farmers in Iowa right now. You know, does he really want to go to that so he can listen about, you know, corn seeding, you know, for three hours? No, but you do things out of obligation because they're a bigger part of your job and respect for your industry. And as soon as you said that, I saw everything completely different.

I saw these award shows as promoting an industry that's been good to me and televising an award show. And sure, awards are all shallow and all that stuff. But my father gave me such great perspective to understand that these are like, you know, the kind of obligatory things of being lucky in a competitive industry and supporting an industry that's allowed me to have family and an apartment and everything. Is your daughter a therapist? Because that's like cognitive behavioral therapy with, changing the, I have to do something.

We call it musterbation, actually. Say it. What do you mean? Musturbation. Because we all often say, like, we must do something, we have to do something. When in reality, you're fortunate enough to do it, or you actually do want to do it. So Obama wants to sit with those farmers because he wants to be president. That's right.

That's a great way to think about it. So that mindset set that he created for you is what we would achieve to do in cognitive behavioral therapy. Oh, that's interesting. Yes. Is there some point? though where you would tell somebody, yeah, don't do that. Create your boundary.

Well, it would be a choice. And you have to come to a place where you're comfortable making the choice and living with the consequences of making that choice. So perhaps if you don't want to meet with farmers, you'd be making that choice in perhaps the risk of your presidency or your campaign. And if you're okay with that risk, that's a risk calculation that's comfortable for you. Right. Which is all life is.

Yeah. Anything else. That's really interesting. Yeah, that's really interesting. So I guess that's what, yeah, I guess that's kind of what I was doing. But I guess also it just kind of made me look at things in a way that was less worried about them being shallow or meaningful and more just about. Yeah, and it's also a little bit of like humbling of my own, you know, kind of pretense,

I would say. Sure. This is a bit of a strange question, but do you find it more difficult to fail in private or succeed in public for your nervous system? Wait, more difficult? Yeah. Like what's more of a strain for you? Because it seems like going to these award shows is succeeding in public.

Yeah. But would you rather succeed in public and have that difficulty on your nervous system or fail in private? Yeah. I'm like a wired as like a not very happy person. And so both things kind of make me, yes, yeah, feel really uncomfortable. And so I do notice that like when I'm, you know, I went through like a period of like not working that much and stuff. And like I was really depressed and I thought my career is over. And then, you know, two years later, I don't have a second free, you know, and I'm getting praised or whatever. And I feel like this is so awful and meaningless. This is so disgusting. Who have I turned into? You know, and so, yeah, I think I'm wired a certain way to like kind of be. you know, um, not pleased, um, you know, with my own, you know, feelings about things. And so I'm not

sure. Both are really uncomfortable for me. I guess at least if you're working, you're making a living and you know, I guess there's some like, you know, practical sense of, this practical benefits of like being unhappy about success. Yeah. Yeah. Yeah. Yeah. Yeah. That's really interesting. Because, uh, you know, in thinking about the hedonic treadmill of it all, of seeing follower counts or movie, box office results, you constantly want to see better. When you don't see better, you get upset. When you take a break from doing it, you're wondering why you're not doing it. You start questioning yourself. And that anxiety is just perpetually there no matter what, it's kind of ingrained in us in humans. It's the power of negativity or the power of bad that we all

experience. And I think the power of negativity is why I think podcasts have risen to such popularity and social media as a whole as a sort of platform because people love to look for controversy. That's why rubbernecking exists. Why humans, when they see a fight, we all want to run and watch. So social media is just an extension of that. In fact, in a lot of ways, the social media algorithm is just a mirror of us as a society. What's the purpose of us being attracted to that kind of thing? That's a good question. Perhaps with your bachelor's degree, you'd probably be more suited to answer that question. Anthropology over the course of 18 years,

getting a bachelor's degree. No, I'm like the least qualified to answer anything. I don't know. I don't know. I remember when there was like fights in school and remember middle school, they were like, they're going to fight on the lawn, which was like a block and a half away.

And I remember just being terrified. I remember just a little kid. Like I can't look at that. Like worried for them? Yeah, of course. Yeah. And really like turned my stomach that there was this bloodlust amongst my peers.

Like we want to go watch that. Oh, it just scared me so much. I can remember it now. I could remember these sweet, thin kids fighting each other on the lawn and just how sad I was to be there and I couldn't look up and I was sad. And I knew these kids.

They were sweethearts. They were sweet kids. They were both in the good spelling group and reading group and everything and then they were fighting. It just disgusted me to this day. Wow. You have such a strong level of empathy.

Oh, is that what it is? I mean, you're seeing someone else experience something and you're having all the feelings of it, which is the mirroring that our neurons do quite well. but you're doing it and experiencing at such a high level. So I'm curious, does that help you in your line of work? Because you're able to mirror so well? Oh, maybe I didn't, you know, think about it.

You know, the only thing I do think about it, maybe I had never connected this. But like I'm, I started my writing career as a playwright and I, you know, I've had like four plays, five plays here in New York. and I'm often criticized for writing not or unlikable characters and to me these characters are incredibly likable because they do mean things and the plays and everything

but to me my heart breaks for these these kind of broken people who are misbehaving and I was always shocked that I would get characterized this way and then after I did the social network too I did a few other movies where I played a mean person I did a Batman movie.

I played a villain. I do these, Now You See Me movies. I play these arrogant characters. We just had a new one come out a few months ago. And to me, I sympathize with these people. They're control freaks and they're, you know, they're anxious because, and I get criticized for once again playing an arrogant, mean, unlikable character.

And it's funny, I'm just connecting this now for the first time because you brought up empathy. Maybe I do have empathy for people like that. Whereas mainstream audiences, it seems, between my plays and these movies. maybe don't connect to my characters as much as I do. You know, they see it as unlikable, whereas to me it seems like, no, these are flawed humans like we all are. We should have the most sympathy for these people. The first movie I directed, I got really criticized. It was called When You Finish Saving the World for having two leads that were like not relatable lead roles.

And to me, I just, my heart broke for those two people. And mainstream audiences really rejected the movie as, not finding a way into these characters. And it taught me a lot about what audiences want. And then for my second movie, which was the one I made in Poland, I completely reimagined my connection to, completely reimagined what an audience would feel for characters. And I made them far more likable.

Interesting. So you actually had to shift as a result of adapting to the mainstream audience. To, yeah, out of a complete terror and panic. Because I was editing my first movie. and we were sending out the screeners early on while you're editing. You sent it out just for kind of feedback from other people. Yes, we sent it out to like an editor who was like one of the great editors in American film. And, you know, he just screamed at me for an hour on the phone.

How could I have made something like this? The characters, there was no way in and they were not, you know, doing things that were sympathetic. And I realized, oh, he's going to be the voice of a lot of people. And so, you know, even before we were halfway through finish editing, that movie, I wrote my next movie, which was about two kids going to see where their, you know, family died in the Holocaust, you know, how much more sympathy can you have? And a lot of that was just a reaction to feeling like, oh, I had done something that was not aligned with general audiences. Do you share the same empathy that you have for these villainous characters that perhaps

you would also feel for those who are part of the justice system that are criminals that have been sentenced to crimes? Do you also feel that level of empathy for them as well? Oh my God, of course. Yeah, of course. I mean, you know, unless somebody seems, you know, like an immoral, you know. Yeah, I'm curious. Like, what is your level? Like, if you see someone do a truly heinous act, because I'm trying to think about this from a movie script perspective. Oh, yeah. So you have someone who is a serial killer. Yeah. But do you then start wondering about their mindset? How do they get there? Yes, that's where my mind goes immediately. I don't have this bloodlust or feeling of like, you know, deep revenge or retribution. No, I don't have that. I have a feeling of what is driving that person. God, their lives must be miserable too. Does anybody want to be a killer? From a place of curiosity or from a place of I'd like to fix that? Oh, I guess, yeah, that's a great question. I guess I don't really think of myself as a,

you know, fixer. I just am reacting to it kind of on a gut level of feeling bad. I feel very lucky to be able to be nice. You know, to me, that's a great privilege. It means I don't have to worry about where my next meal is coming from. It means I have enough resources that I can go and help somebody if they drop something on the street or donate an organ or whatever. You know, this is a great privilege, you know. When there are limited resources, it's understandable that people become competitive and mean. When you're hungry, you think about how angry we get when we're hungry now. And we're angry. We have a word for it. Exactly. So imagine a population who's experiencing that and what it must do to them. Yeah, of course.

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Saving those children is how we all go home. From binge all episodes exclusively on Paramount Plus. How does one wake up in the morning and say, I want to donate a kidney to a stranger? You know, for me, I just, like I, you know, I think we briefly spoke, I had heard about it on a podcast, and they were talking about, um, uh, effective altruism. It was an interview with somebody who was part of that movement. And they talked about, um, yeah, done in a kidney not being like a big deal. And interesting. Well, I mean, it's not. I mean, I have experienced zero negative consequences. Zero. I don't have to, even watch what I, the alcohol I drink. I've, I've experienced zero negative consequences. I love that that's the brabler. Do I have to watch how much alcohol? Well, yeah, no, for me,

it's like, I don't drink much anyway, but like all I'm saying is like even my most, you know, let's say debaucherous activity doesn't have to be curtailed. You know, I'm not that I'm so thrilled I get to drink, you know, but like, no, but it's true. So, you know, I don't know. Look, I come from family of vegetarians, you know, I'm not a vegetarian. I, you know, when we just did Thanksgiving, what we do is thanks living. where we adopt turkeys, put the turkey's pictures on the table while we eat tofu. And my sister reads from Jonathan Saffron Fowar's Eating Animals book, where she stands up and reads,

they clip the beaks off the turkey with a boiling knife. And so we're not eating meat, but we're also shamed about meat eating as a concept, and we adopt these turkeys. And the pictures of the turkeys are on the table with names and what they like doing, like facing into a nice breeze or something. Where do you adopt them from? How does one adopt a turkey? Oh, you know, from like maybe the farm sanctuary, which is a place upstate, which adopts, you know, which rescues animals.

Got it. Anyway, I say all this because I'm a meat eater. I leave that knowing everything that my sister's read in the book about the hot knife and, you know, and, you know, factory farming. And I eat meat. And I recognize totally this is not ethical. You know, this is something I think we'll probably look back on the factory farming system as completely, you know, unethical, retrograde, brutal. And I don't do that. So I'm not like a great person.

I recognize that. There are things in my life. Is that the barometer? That like you have to be perfect. It'll be great. No, but I think if you know a lot about something and you still choose not to engage with it, then yeah, there's some ethical gap there. I know so much about the factory farming system because I grew up in a family, vegetarians

and vegans. And so I don't do anything about it. So yeah, I think there's a gap there in my ethics. You know, if I was ignorant about it, I wouldn't have as much, I think, complicity. So with the kidney thing, to me, it was like a non-sacrifice in any way. To me, you know, I talk to my sister about it. She's nervous. She wants to do it because she heard about it from me and everything,

but she's nervous to do it for a dozen reasons. Like a lot of people who say that they're very nervous to do it for a dozen reasons. And yet I look at her getting a soy milk latte or something, and I'm like, I can't believe she's not getting that. Yeah. So I think, you know, I think we think of sacrifices. My wife's a teacher. She goes to school every day.

I sometimes go in with her and I'm like, this is a grueling job. You know, you don't get to talk about what you want to talk about. You have to talk about, you know, this, you know, this, you know, this, you know, this, you know, this, you know, gothic series. The curriculum's forcing them to read, you know. And so, you know, everything, we all have sacrifices. You drove in two hours today from your house. I, you know, walked from 13 blocks, you know. You made a sacrifice because you have dogs and you want to live in the suburbs.

I live in the city because it's convenient to everything that I want to do. So I think we all have sacrifices you want to make. And we're all calculating the risk rewards of those sacrifices. And for me, don't know your kidney, I can't even, I don't even call it a sacrifice. I got treated like a king in a hospital for three days. I got, you know, they give you a lunch order and you could order anything you want on the thing. It's exciting because you press a little button on the computer on your TV of what you want to eat. And to me, it was like just this fun experience where I got kind of like treated really nicely.

And yes, it also ends up, you know, saving some. somebody's life, but it's too abstract a concept for me to even understand that it's saving somebody's life. I don't know who the person is. I don't know what it means to have... Did you choose not to know the person who the person is? Kind of. Like, you have to opt in to know who the person is. And so the baseline is not knowing. You know, if you want to know who it is, it's kind of an effort. You have to write a letter to them and they have to choose to accept and write a letter to you. And it goes through the intermediaries through the hospitals. To me, it was like, you know, the truth of my surgery

was unusual, which is that the person who was my intended recipient, who I did not know, was, came into the hospital while I was getting my operation. They came into their hospital in Pennsylvania or Chicago or something, and they were sick. They couldn't get the operation that day. So while I was like halfway through my surgery, obviously I'm unaware, they had to find another recipient. They called the next person down in a different state, you know, and that person has to get their bags, pack up their family, whatever they need. and go to the hospital. Because my kid comes out of me,

gets put on a helicopter at the hospital. Very VAP kidney, you have. Yeah, yeah, yeah, exactly. Yeah, exactly. It goes to Teterboro Airport, the private airport and outside the city. And it flies to another city, goes to a helicopter and goes to that hospital.

So it's an immediate process. My kidney was out by, I don't know, 10 in the morning and was in somebody at 3. Is that incredible? Wow. And is that person aware that it's your kidney? Like you might not be aware, but are they? They're not, but I was thinking, since I'm, like, doing some interviews now about it,

and I may have mentioned when I donated my kidney, maybe if people are, like, internet savvy and curious, maybe they would suspect, but there were probably, you know, a dozen people getting new kidneys that day. Okay, fair. Because it would be interesting if you come home one day and there's a letter, and it's like, Thank you for the kidney. And you just, you wouldn't know if that's real or not. Yeah, I started writing a movie 10 years ago and I didn't finish it,

but it's about, you know, somebody who donates their kidney. And then this is before you donated your kidney. Yeah. So you weren't interested in this process long before you pulled the trigger. Well, I really am fascinated by people who, uh, look for a connection through something dark. Um, and so I, you know, thought of a guy, a very lonely person, and donates their kidney to a man with a family and a life and a job.

And then because this donor has not much going on in their lives, they attach themselves to this person who then feels compelled to be friends with them because they save their lives. But that donor overtakes their life. And I mentioned this to a doctor. And the doctor was saying, like, please don't do that. Just scare people. Yeah, yeah, yeah.

Yeah. So it's on the back burner now. So why, when you're writing this 10 years ago, you weren't thinking about donating a kidney but then in 2025 you were. Really what had happened was this. I was listening to this podcast and maybe 20, maybe 10 years ago,

maybe 2015 or something. I was listening to this podcast and they were talking about kidney donations and effective altruism and they mentioned something called Be the Match, which was I think for like bone marrow or something. And so that, I listened to the podcast

and I went online and I ordered a Be the Match Kit which is they send you like a swab for your cheek or whatever. And so I sent it in and I never heard back. I knew I was on the list because I would get emails from Be the Match. Well, yeah, yeah, yeah.

They're like, this is, your mouth is gross. But basically, I would get emails. I knew I was on the mailing list because I would get emails from Be the Match, but it was never that I was a match. Okay.

And I conflated that with not being able to donate a kidney. And so I thought, oh, I'm not a donor, but I think really it's just for bone marrow. I suspect that's the case, yeah. So now it's 10 years later. This is this summer. I'm trying to write a move

you about doctors in Guatemala. So I go to Guatemala and I'm with a doctor. She's from California, but she's my guide in Guatemala and rural Guatemala. She runs clinics there. And she's great. And we're talking about health care for a week because that's what the thing I'm writing is about. And I told her, you know, I really do want to donate a kidney. And she said, oh, yeah, you could do that. I said, I've been waiting for 10 years. I haven't heard back from this thing. And she goes, don't you live in New York? So yeah, she goes, go to NYU across the, across the, I'm on the west side. It goes across the city, go to NYU. And so I got back from that trip.

I made a call to NYU, and I don't know, within five days, I was in there getting tests. Do you just call, like, the 1-800 number and say, hey, I'm trying to donate a kidney? I called the kidney donation, whatever, or I sent an email saying I would like to do this or whatever. You check a box. I don't know. Everything's so easy now. And then maybe I got a call from the person who became my coordinator, this wonderful woman, Angie Bello. And she took me through the process.

It was quick. I could do the surgery whenever I wanted. I did it around my schedule, which strangely turned out to be a December 30th kidney donation. Happy New Year's. Yeah, yeah, yeah. And so, but that's just because, like, I ended up, I didn't have time off work, but otherwise I could have done it earlier, you know. No, and it couldn't have been an easier process. Who was the first person you told that you wanted to do this?

I told my friend Jim, and Jim told him. me wait till your parents are dead. Why that's specific? You know, because the idea is if you need your kidney, you know, if your parents need a kidney, you should be there to give it to them. Okay. And the way the kidney donations work, though, you're probably aware, but I think most people are not aware that when you donate a kidney, you know, anonymously, like I did,

you can put a list of five people who will all rise to the top of the list. So there's a waiting list of like 90,000. thousand people. But if I donate my kidney, I put my wife and kid and my parents, sister, on this list so that if they need a kidney, they're at the top of the list. The idea being they shouldn't suffer because I donated something anonymously. And so that took care of that. And my friend Jim was pacified immediately. I told my wife and I thought, you know, maybe she would make a bigger deal. She was like, oh, okay, that's a good idea. My wife works in social service. my wife's mother ran a domestic violence shelter for 35 years. They're all activists and, you know,

um, do-gooders. You know, my wife works, she's a teacher, but she also, she started disability justice program and, you know, she, they're, they're do-goaters. And so they, my wife probably looks at my thing as like kind of this, you know, easy little thing, you know, because she's doing more work and it's life's work for them. I told my parents and they were, yeah, I guess they were, you know, like they said oh that sounds really nice you know my mom you know tried to do a thing later you know a few weeks later like I do want to talk to you about it you know this kind of like you know to try and talk you out of it or I think it was more just to like show a concern got it you know I don't know if it was she's very sweet I don't know if it was like a performative thing like

not performative but like um just felt like she had to instinctual yeah um but goodness after I did it my whole family was like, this is amazing. We're all looking into them. My sister immediately spoke to a friend of her doctor, because she's thinking if she has children, when she should coordinate it. And my dad was saying I'm thinking about doing it too.

You know, it really, because it was such a non-issue and because I recovered so quickly and so, you know, not perfectly, but no, perfectly. I recovered to be 100%. I don't know what the medical term for that is. Do you have a cool scar? I have a, you know, like a, you know, like a, you know, like a four, three or four inch bikini line scar is what they call it.

And then I have three holes, but they're tiny, tiny. Nice. Okay. The bigger one is where they pull the kidney up, but the other ones are where they do the, you know, the laparoscopic operation, you know. You know, so anyway, because my family saw that the consequences were essentially zero, we're zero, we're zero. You know, fewer consequences of my wife having a C-section, then women having a C-section, which we don't look at in the same way.

we look at somebody donating their kidney, oh my God, you know, you went through surgery. But, you know, if you have a C-section, it seems just like another option. But my wife had more trouble recovering from a C-section than I did my thing. Did you have to go through a screening process of any kind, making sure you're healthy, that you're not at risk for kidney stones that might hurt your other kidney or something like that? This was the most amazing part of this, which, you know, maybe you've heard of before, but I'd never considered the following. So I had a battery of tests done.

You have, you know, you go through, what is it, cat scans of your entire torso. Tell me what the medical things are. I mean, you know. I don't know, which maybe MRI. Blood work, your analysis for every possible, possible thing. So, you know, one of the things they say about kidney donations is that people who donate a kidney live longer than their non-donating peers. But that is just because it's a self-selecting process. So if you are in a position to donate a kidney, you're very healthy.

And therefore, you live longer than your non-donating. peers in the sense that you've been filtered out because of your good health. So I got, you know, a battery of tests on, you know, multiple visits to the hospital. And the most interesting part of this entire experience for me was sitting in waiting rooms with people who were having the worst day of their lives. I'm sitting in waiting rooms getting an MRI of people who are finding out they have cancer. I'm sitting in waiting rooms to give blood multiple days with people who are there because they're worried they're dying, you know. And I am there on this kind of like happy little quixotic jaunt of like doing this kind of

fun thing because I have a week off now and I could do my blood work and I have, you know, such good health that I could donate a kidney. And I was having the exact same day that somebody who's having the worst day of their lives is having. And so I was going through these like machines, these like, is it cat scans? Is that where you go in the thing? RMRIS. Was it really loud?

No. Okay, so the cats can. So I'm going through these machines and I'm looking up and there's this little light which tells you when to stay very still. It's a red light and then with like a little picture of a person on it and I can. Forgive this details but it's really interesting. Very interesting. Going through these things, I'm looking at the red light and then it counts back from

three to one and then it's a green light or then it's a red light where you're supposed to not move for 10 seconds, 20 seconds, right? And I'm looking at this light thinking I might be the only person today looking at this light without panicking because I'm here for something good, you know? And I remember thinking all of these things, this whole hospital system is designed, you know, because it's a really wonderful facility, to kind of make people feel a little more comfortable with getting the worst news of their life. And I'm there going through this kind of experience decades earlier than most people

and in complete health without a care in the world. And I remember just thinking like, this is a fascinating existential experience to have, to essentially experience what it's like to have health trauma, to cosplay, health scare. As a patient, exactly.

And it was fascinating. So I'm getting this CAT scan and they put this kind of warm dye in my arm. Is that right? Yeah. And everything I was experiencing was, oh, this is so interesting, this warm dye in my arm.

And then my mind would switch of, oh my god if I had cancer and I was waiting to see how big my tumor had increased this warm die would scare the shit out of me because it would further indicate how awful my situation is that I had to have this warm die you know put in my arm and you know your butt feels really weird for a few minutes and like weird stuff and I remember just thinking if I you know had cancer something really bad all of these details would be staying with me as signs of terror but for me they were just signs of fascination and interest and curiosity and I would ask the doctors why does that die feel weird and they would say oh it has this thing in it so it makes your butt feel weird and I was like oh that's so interesting you know and I realized they're probably not having this

conversation a lot with people like me who are kind of just these like you know easy going yeah yeah kind of curious you know no it's so interesting how does that shift your perspective about health care in general both my parents work in health care my mom just got her doctorate in medical humanities. So she specifically works in the field of trying to make the health care industry have a human face. She teaches doctors how to give bad news while making eye contact and being sensitive rather than looking down at the floor and walking away. My dad teaches at Empire State College, which is part of the SUNY system, and he teaches people who work in the healthcare industry. He started like an MBA program at Empire State. So it's an MBA program. So a lot of his students are, for example,

people who work in healthcare is like nurses, but they want an MBA so they can move up the hospital system. So both my parents work in health care, and my mom is very specifically involved in trying to put a human face to the healthcare industry. So when I'm looking at that red light and that green light, you know, I'm thinking a little bit of like the, what is that woman who did the Temple Grandin, you know, she did, Temple Grandin, she was this, she's this, you know, brilliant autistic woman who designed the factory farming system to make the cows less scared. You know, anyway, so anyway, I'm thinking about like how these things are designed to make the, you know, mammals feel less uncomfortable by them. And I guess it makes me think, wow, I'm very, very lucky to be in

this country, to have my insurance, to have access to a place like NYU, which is so state of the art that you kind of can't believe that you're not in the future. I feel very lucky to be in a position to be able to donate a kidney when some people are born with diseases that, you know, make them suffer throughout their entire lives. So I felt very lucky. And then I also had this weird feeling of like, oh, I'm experiencing my death before my death. I'm experiencing what it feels like to go to a hospital a few days a week because you have to get more tests. I'm experiencing what it feels like

to be worried about surgery, but I'm not worried about any of this stuff. And it was like a dry run for death is what I thought about. And I was like, wow, this is really fascinating. You know, I also know statistics about, for example, doctors not wanting to be, doctors like overwhelmingly not wanting to be kept alive are with artificial means.

And I was thinking a lot about that because I was just looking at the facilities and realizing, wow, we really could, you know, it's almost possible to stay alive at our own expense, you know, at the expense of not our finances, but well, that too, but our own expense of happiness, comfort, quality of life.

Yeah, awareness, you know, consciousness. And so I was just kind of like I was contemplating so many things, and it had a kind of existentially meaningful experience. Yeah, it seems really powerful. The effect of altruism of it all, did the notion of being in service to others help you in anyway? What do you mean, help me? You said that you were interested in this effect of altruism.

A big reason why people seek out altruism is because they feel like it helps with their anxieties and it's also good to be in service and others in general as well but there is a component that helps people feel more at ease with the struggles of today yeah yeah that's why i mean it's almost selfish but yeah that's a part of why i did it you know i want to have a connection to something bigger than myself i noticed in my life i am only at ease you know we're talking and you know i'm like you know an anxious person or whatever and um i've all i you know i've all i the thing I described with my therapist is the one day I was like, what was the one time you're ever happy? And I was like, the only day I can remember being totally happy was my friend was moving and I was boxing up his apartment.

And we went downstairs and we got this like gross food of this little like hole in the wall Chinese restaurant with like, with big plexiglass windows. It was like, and like we got the, you know, Chinese food at a place I normally wouldn't go to because it was, you know, it was like a hole in the wall kind of place or whatever. and then we went up back up and ate really quick because we had to box up this stuff. And I just remember saying this was the absolute perfect day. And we determined that perhaps it was because I was thinking outside of myself. I was helping somebody else and therefore, and it's not because I'm a great person. It's just because the way my mind is wired is I have this strong sense of guilt and that I'm going to be yelled at randomly. This is my two pervading problems in my head.

I think I'm going to be yelled at randomly for something I wasn't aware of. Like, why are you wearing that shirt today? You know, we're on camera. Why are you wearing a sweatshirt? Are you such an idiot? I have this fear, like constantly. And I also have a strong sense of guilt for having luck, privilege, whatever, et cetera, et cetera, all the reasons I should have guilt. And when I was boxing up my friend's stuff, all of that was gone. I was totally relieved because I was doing something for somebody else. He wasn't going to yell at me because I was there entirely in service of him in his boxes. And I didn't have any guilt because I was doing something for somebody else. And so what we kind of determined is when I'm doing stuff like that, I feel at ease with myself. I'm not talking, I feel thrilled. No, I don't have those feelings. I feel at ease.

And that's my favorite thing. During the pandemic, we were living in Indiana where my wife grew up. And I was volunteering at my mother-in-law's domestic violence shelter. So I was painting every day. And I would listen to my podcast and I was painting the shelter every day because it was a big place. And I was fixing toilets and garbage disposals and kind of just doing handiwork that I was taught how to do during the pandemic. And it's also the other happiest period in my life. And again, it sounds like I'm trying to say, you know, I'm a good person.

So that's when I, it's not that. It's that it relieves me of all the anxieties I feel about myself. And so part of the reason I was attracted to kidney donation was a little bit of that, was a little bit of like, this is another opportunity for me to kind of get outside myself, do something where it won't trigger my guilt. I'm doing this interview with you now because I'm famous and it's triggering all sorts of guilty things. I'm hoping that people listen to this and hear me say that the consequences of my kidney donation were completely fine. none, zero. I would donate a kidney every single day if I had them, if I regenerated them.

But I'm going to walk out of here going, I can't believe I just did an interview. I'm such a tool. You know, I did an interview. Why did I talk about myself? I'm so obnoxious. What a narcissistic thing to have done. And so this is triggering for me too. Again, not that I need sympathy, but I'm expressing my brain. I think it's totally understandable why you feel that way. In fact, it's the logical way to think about this scenario, and you're trying to be very empathetic and logical. So very reasonable that you're feeling that first and foremost. Second of all, the fact that you are describing this allows other people to feel seen in a way where perhaps they would consistently be thinking of themselves negatively and spiraling down a dark pathway. Because in reality, we're all seeking some sort of human connection.

It's why a lot of these programs, AA as an example, are successful. Just the idea of someone else experiencing something that you have or defining it in a way that you've never heard can be quite powerful for some. So I actually am very grateful that you're putting yourself in this situation of discomfort to talk about these scenarios and get people. Yeah, that's interesting.

I went to an A meeting with a friend and I was revelatory for me. I understood the appeal from the first second that it started and it was the same thing of boxing the thing. It was like thinking outside yourself, commiserating with other people. Yeah, I understood the appeal. For me, it's when I could do something helpful, you know. I don't know why.

It just makes me feel it ease. It seems like you enter this flow state when you're thinking of yourself or larger than yourself in a given moment. Do you ever feel that flow state of where you return to perhaps a less anxious version of yourself when you're doing something you love? Sports is a common one for folks. you mentioned painting doing something in service of others writing is a big example of that do you feel that then as well yes my other happy times which are unrelated to social service um is um you know i i write obviously you know and um i you know yeah when things are going well as a writer yeah that's another it's both cathartic i'm not i'm thinking out i'm outside of my head oftentimes

yeah acting i'll get outside my head and it'll feel really good i think i've been was attracted to acting a lot because it was like, again, I have this fear that I'm doing the wrong thing. I'm being held that. Acting had this kind of very prescribed set of behaviors. I had to walk to this square and cry. And to me, it's like cathartic because I get to be emotional and walking to the square. No one's going to yell at me. I know I'm supposed to walk to that square. That's where the box of light is and I have to stand in the box of light. So I love that prescribed way. My character is being mean. I'm not being mean. My character's being mean. So I can almost exercise those weird feelings. Yeah. So part of that, yes, part of the reason I like my work

because it allows me to have enough of a boundary where I'm not going to feel like I'm going to get yelled at. But of course, because my work is public and I get known for it, it does the other thing, which is like triggering the feelings of guilt that I'm, you know. It's why I empathize with this so much, and it's the reason why I love Lego so much.

I like getting a set of instructions that I know I can't mess up if I followed the instructions. Yeah, yeah, yeah. Because it's predictive, but it's predictive in a way that's almost meditative, where I can just zone out and follow the instructions, and it's going to tell me step by step how to do it because in real life, every time you're making a decision,

there is no stepwise manual for it. How do you relate your interest in Legos and my interest in the things I talked about to the safetyism that you brought up a while ago? I think safetyism... I'm saying, do you think we like these things because our lives are safe? Like, or is this, let me phrase it.

Do you think this is a new thing wanting these like instructions? No, I think that is a natural human state to seek order. And I even zoom out further to think about how this impacts, how we think about fairness. One of the things you'll see in kids, especially as someone who sees kids of all ages and watching their development, how they think about fairness and how they think sharing is important or this person did this and it's unfair. kids will oftentimes use that vocabulary very early on before it's even something that they've seen replicated in front of them, where it's a natural thing to seek order, to seek fairness, why kids love playing with blocks and putting blocks into different shapes. Because we like seeing that order.

It feels good. It strikes the heart of our neurons, if you will. Oh, that's fascinating. You brought up social media a few times when we first started talking. Does the chaos of that make us long? for that more or is the social media a form of putting boxes and I think it's an artificial version of that where we're being that neuronal circuit is being hijacked by social media oh oh oh how so like because we love the order and we love feeling this rush of

neurotransmitters when we get the box in the right square and then social media will give that to us by giving us the alert and trigger a similar response. Oh. But you're saying hijacked. So the implication is it's doing it kind of insidiously. It's doing it in a way where it's self-serving to itself and its own survival. Is the Lego company not doing the same thing? The Lego company is probably doing that to some level because obviously they're selling you a product.

But I feel like it's less malicious because it's clear what they're selling you. And to me as a doctor, when, a doctor, like I will oftentimes judge doctors who oversell supplements and overpromise supplements. And it's not because they're selling a supplement. Because in reality, like, they could sell a supplement that's reasonable. Patient might need vitamin D supplementation iron, if there are in deficient anemia. So there are reasons why. But if they're doing it without informed consent by overpromising things and deceiving the person, that's where I view it as a problem. So the Lego purchase to me is less deceptive because you know what you're getting when you buy a Lego.

They know that you get joy and they continue making Legos. Social media companies like, what are they trying to sell me? What are they trying to get me to do? And it's less clear in that way. I see. Yeah, the social contract is not. It's not as self-evident. Yeah, that's interesting. And also, I think it's done in a way where Lego, you could only spend so much. much time doing Legos. But you can really miss out on life by being on social media and the digital ethos. Yeah. Although I'm sure the Lego company would want you to spend more time with Legos. Yeah, yeah. The thing with Legos, though, I don't know, there's a rate limiting step there of some kind of your fingers getting time because there's a physical. And then you step on one and you hate it

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Running a business means moving in many directions all the time. TD's new small business banking accounts are built for how your business moves. It's how we're making banking more human. Yeah. And your mom would probably be best to talk about this as how medical humanity is impacting our world with the intervention of AI coming into play.

Yeah. So I'm curious if she's ever discussed. I think she got her degree prior to like any of the large language models. Thank God, because we need people like her more than ever to remind us of how important the medical humanities are. I'm sure you're incredibly cynical about people self-diagnosing on chat GPT. No. You're not?

No, I love it. Oh, I was going to actually challenge you if you were. So I was going to ask you. No, no, no, no. I was sorry, not challenge you. Who am I? No, you should challenge. No, I guess what I mean is...

A good podcast is all about challenge. I guess what I meant is like, if I would have said, I'm sure you're probably cynical, but don't you think there's also some great benefit? Because I noticed like sometimes I'll be totally paranoid about something. And like 99 out of 100 times the internet tells. the internet tells me, no, relax. It's definitely not that. Yeah. Does that help when the internet tells you that?

Of course. Does it help more when the internet tells you that or when a human doctor tells you that? Yeah, a doctor, obviously, obviously a doctor. It's obviously, I don't know, some people believe the internet more than the doctor. I'll put it this way. I like love information and I love going like down a rabbit hole with what the thing is. So, you know, I have a, you know, a mole on my knee or something like that. You know, is it cancer?

You know, you write into chat GPT. Is it cancer or something? And it, you can go for five hours. And I find the information to be, okay, maybe doctors will hate me saying this. But like, I find the information to be really, like, satisfying because it'll tell me like nine times, you know, it will say, you know, most likely it's X, Y, and Z. And if, you know, and I like kind of doing that. Is that bad? I don't know if it's necessarily bad because, you know, you know, it's, you know, it's necessarily bad because

you have to ultimately make the decision if it's bad. If you're enjoying it and it's scratching some sort of itch for you and you don't see any problems with the result. Maybe it's entertainment. Maybe that's kind of why I'm on it. Or perhaps soothing. It's soothing to be able to have your questions answered. Yeah.

Of course, we'll go to a doctor. But I also recognize that I'm lucky to be able to go to a doctor. That's a kind of lucky thing to be able to very quickly make an appointment. You know, I have good health insurance through my union. My friend doesn't have good health insurance through his situation. And so for him going to a doctor is quite a difficult. The health insurance industry in the U.S. is absolute poop, to put it lightly. Yeah.

I'm curious in going through your surgery because you said some really powerful words at the Time magazine event where you said that you don't believe people who will donate a kidney ever need to think about it so that your hope is by being on this Time magazine list, presenting your speech. And I encourage everyone to go on social media on time on their Instagram and see your words because they did publish it. Why do you think that there's this notion that when you hear about potentially donating a kidney,

you either are all in or all out right away? This is a totally uneducated, unscientific analysis of my experiences speaking to people and watching a documentary where they interviewed lots of people who were donating their kidneys. And what was that? What did you learn from that?

What I learned is that everybody I spoke to who did it, who came out of the wordbook to talk to me about it, had the exact same experience. I heard about it and I signed up. I got a text message from my friend's little sister. She said, can I have your brother's number? So she texted me. She said, I heard about it, and I tried to, I heard about it.

I went to the hospital that week, and they said I had to wait until I turned 18, or 25. And so on my 25th birthday, my blood work appointment was scheduled for my 25th birthday. On my birthday, I went to the hospital to start the blood work to donate a kidney. And then I watched this movie called Confessions of a Good Samaritan by Penny Lane, great documentary filmmaker. And she interviewed all these people. They all said the word no-brainer. And then I looked back at the first interview I gave about it. And the headline was, Jesse Donate Kidney says it's a no-brainer.

They all said it to the point where she cut together a montage of them all saying no-brainer, which is not like an expression I ever use. I come from academics. We never use the word no-brainer. You know, and so like it's just, so what I thought I loved. learned from this, again, unscientific study and unprofessional poll. Observation. Is that people who are inclined to do this thing have no fear about it or question about it. And the people who are not inclined to do it are never going to get there.

This is what I learned. Now, I'm sure there's a gray area where some people are nervous, but they realize maybe it would be good and they finally do it. Or their uncle had a kidney transplant. And so they are feeling a little more comfortable with it, even though they have all the same nerves that somebody who would never do it, would do it. You know, a personal experience would make them do it.

And, but for people like me who do it like anonymously, it's almost like this obvious activity. There was a guy who said in this documentary, he said, when I heard about kidney donations, my first thought was, why is there not a line down the block of the hospital? And this was my thought, too. I could not believe I got an appointment.

You know, I would just think everybody would want to do this kind of thing. However, my sisters believe that why would anybody eat meat? Have you seen the pictures? You know, my wife would think, why would anybody not want to be a teacher? Do you see how many students need guiding? So I think we all have the thing we think is obvious. So do you think I'm a bad person for not donating my kidney? No, because I think you're a better person than me. You've devoted your life to being a doctor. I devoted my life to being in violent movies. I'm far worse than you. I just think that for whatever reason, the way my brain is, is designed, this to me is like a non-thing.

And weird that it's not a non-thing because my patients who have a history and they label themselves as an anxious person get very worried about being put under anesthesia. In fact, I just had a patient the other day who unfortunately was diagnosed with a tongue cancer and young patient. And I was doing his presurgical clearance in addition to the initial counseling of the diagnosis. he had to reschedule his appointment numerous times, even on the day of surgery being in the surgery suite, because of his anxiety of the fear of not wanting to, of the fear of not waking up post-surgery.

Oh my goodness. But you never felt that. Can I tell you a weird story? Yeah. I was doing this movie, Now You See Me. And in the movie, we're performing on stage, and then I play magician,

and then we rise up to the rafters. So I'm in a harness, because my character is to rise up to the, rafters and it's this huge theater in New Orleans, really high, high, many stories high. And they pull us up. And then they said, it's lunchtime for the actors. And I asked the guys who were good and doing the wires, they weren't going to luncheon. I said, can I just stay up here for a little bit? It's so cool. Okay. So I got to stay up at this thing, at the top of this thing. And I was like, this is amazing. I get to look out. I can see everything in this theater. It's amazing. It's so

beautiful. And then I realized I have a fear of heights, a terrible fear. If there was a balcony, We're on floor right now recording this. If there was a balcony, I could not go outside. It hurts my toes even thinking about going outside. I was thinking as I was suspended in the air, why do I not have a fear here? Then there was another scene a few weeks later where we're supposed to jump off a building

and some of the actors are really nervous, because we're jumping down into a mat, but it's on the side of the building. It was a little nervous, nerve wrecking. And I love it. I'm first over the building. I jumped down. And I'm like, that's so weird.

I don't have a fear of this either. And I realized that when I'm doing something with a purpose, I have no fears at all. When I'm doing something for some reason, I have no fears. My fears are entirely fantastical. I have the fantastical fear that if I walk out into a balcony

that I'm going to be compelled to jump for some dumb reason because I can and I'm going to be compelled to jump off the building. But if I'm in a scene it takes place on the balcony, I have this thing to focus on

and doing it for some other reason. So the fantastical nonsense in my head doesn't get triggered. And so, when I came back from New Orleans, I realized if I donate blood, I might not have a fear of needles. I used to not like it when they had to do blood.

Sure. So I go to the Red Cross or whatever in New York City. It's not the Red Cross. It's a blood centers or something. I go to the thing. I donate blood and I love it. I love it. And I'm like, when can I come back?

Like 52 days, 56 days or something. I schedule it 56 days. I'm going back there and I want to do the double blood donation. No fears at all. I love it. I love it. And so I realized, and then I would get blood drawn for medical purposes, no fear anymore.

Or stole a little fear from that, but basically I got over the fear, you know? what I discovered in myself is that when I have some purpose I have no anxieties I was taking care of somebody when they were

dying over the course of months and I remember not having any anxieties I have to call and I had to like lie about getting an oxygen machine because we needed extra oxygen doctors wouldn't give us

the prescription for the extra oxygen so I had a call and say we lost a tank I don't lie I don't like to lie I called and I was like we lost the tank I could do an accent You know, like we lost the tank. I'm so sorry, we need to get a new tank. It's immediate.

I realized I had no anxiety at all because I had some purpose. Whereas normally if I'm lying to somebody I never met, you know, terrified. They're going to find out or yell at me. Anyway, with the kidney thing, the exact same thing. I had zero anxiety about getting the surgery, zero anxiety about getting the test, the blood work, the urine stuff, whatever, going under the anesthesia. Just zero, nothing. I don't know why.

I have a question I want to ask, but I fear that it's too existential to ask. My favorite kind of question. Okay. You say that when you have purpose, you feel less anxiety, so you're able to conquer your fears or go through difficult moments. And I know I've said I relate many times on this podcast, but I relate to that as well. I have the same fear of heights that you have that suddenly an earthquake will happen while I'm on the side of the thing and I'm going to fall or the wind will blow too hard in a way.

I also have those irrational fears. And yet I flew with the United States Air Force Thunderbirds in an F-16 pulling 9.3Gs. because I needed to do it for the video. Oh, really? Yeah, for the views, basically. And how did you feel? I was nervous, but I was like, we have to do it. The guys were waving to me as the plane was taken off, and I was like, yeah, we just have to do this.

Of course, right. So, knowing that purpose makes you less anxious and not worried, does that mean in your everyday life when you are very nervous, very anxious, that you haven't yet found your purpose? Yeah, I mean, that's not too existential. Yeah, that's exactly what I think about is when I don't have something to do for an hour. Yeah, that's when I feel worse. I don't feel worse when I'm like, you know, I've been in very, really high pressure situations as a performer. I just did a one-man show, a block away from here. And I felt like incredibly nervous. But I also felt like I believe in the show that I wrote about a personal experience and I want to do it. And yeah, it overrised that. I used to, you know, for years I would perform in my own plays. And what I always said to myself is I am so nervous before a show, but I would feel worse sitting at home at 8 o'clock and doing nothing. That, you know, I need to have some kind of purpose.

And if it could benefit somebody else, I feel even better because it takes that second thing away from me, which is like I'm not doing this for selfish reasons. I'm not going to get yelled at. Well, does being a celebrity help in all of this? Because as a celebrity, you bring so much joy to people, right? Like an average person walking into a room, people usually don't light up and get excited.

You walk into a room. I saw people's reaction at Time Magazine. I felt my own reaction. Very excited to meet you, seeing you on screen before. There's familiarity. Do you have an advantage in bringing joy to the world because of your career? Okay. So we met each other at this like Time Magazine thing.

And after it ended, people were coming up to me for like another half hour to like talk and take picture or whatever like that because I was like the actor in the room. You know, I don't filter that as, wow, look at all this good I'm bringing to these people. That's not how I metabolize what's happening there. The way I think about it is they saw me on a TV show. They want to take a picture to show their friends. Do they like me? I don't know.

But that's joy you're bringing them. It's too abstract an idea. Am I bringing them joy? Listen, I think a lot of people when they meet me, they want to take a picture to show their friends that they met somebody famous. They might say, look, I ran in, they might text them with a picture saying,

look, I ran into that guy you hate. You know, that guy we make fun of when we watch the TV show, whatever? I got a picture. with that idiot because that's, I recognize that fame is not correlated to value. You know what I mean? And unnatural to some degree. Oh, it's totally unnatural, of course. But I don't think people coming up to me, it doesn't make me think, I'm a good person. Look at what I've done that this person is wanting to talk to me. That's just not how I perceive it. But the fact that like, right,

an average person will go and donate their kidney and they'll feel good about it. Yeah. But you can come on a podcast, and there's a world where thousands more, I mean, maybe I'm thinking too far, but millions might see this and then go, I want to also donate my kidney. Isn't that tremendous value? Listen, I really hope people do that. There are 90,000 people on the wait list for a kidney that are in various stages of real, real suffering. I mean, if you know people who are on dialysis or need a kidney, you know, people are at death store. You know, my friend's dad died during COVID, you know, needed a kidney. I have a very good friend who knows that his kids are going to also need kidneys because he has a genetic thing, you know, and the horror of a parent with young children who realized too late that their kids are going to need this thing. So that's a real thing. And I hope and pray that people listening to this will donate their kidneys or people not listening to this will donate their kidneys through osmosis. I really hope that happens. However, I find a little bit doing this interview in a way devalues the thing I've done.

And sorry, this is not a criticism of this platform. What I mean by that is, you know, when we donate money and tell everybody we donated money, it starts to, I think, make that currency go down a little bit, you know? I don't know why that is. I just have that instinct. And maybe it's a pretentious instinct I should shrug off. But that's my feeling a little bit, is that me talking about me doing this a little bit devalues the act. That's how I feel a little bit.

That's my kind of instinct, right? It might be wrong and it might come out of guilt or... I think it's a good instinct. What? I think it's a healthy instinct that you have that, that you're trying to not, at least you don't want to be perceived in that way. Do you think it's more about the perception of it all or genuinely how youth are pursuing it? No, it's entirely this internal ickyness, I feel. No, the perception is, perception is good.

You know, oh, look, this actor did a nice thing or whatever. No, it's entirely, I feel incredibly icky. I don't know how to articulate it more than that. I'm grateful for you overcoming that ick to get this message out. Well, as you know from our messages, I was like incredibly hesitant. I've turned down every interview that I've been asked to do, and I've been asked to do tons of interviews and speak at things, and I don't do it.

But when I met you and I saw what you do, I thought, well, actually this, and we had a good discussion, and I thought, well, actually, this platform is probably most likely to affect people, because you said, not only is the size of your audience big, but you said people are health curious. And so, and I thought you have a young audience of people who are health curious. Those are the people who are going to hear this and think, oh, I'm that person.

And I think most people are going to hear this, or listen, watch this or wherever people receive this information and say, oh, wow, that's interesting that he did that. I would never want to do that. But there's going to be maybe a lot of people who are going to say, oh, I didn't know that's possible. Oh, and look, this guy who looks like me, doesn't seem like a superhero person, whatever, this guy who looks like me, who has my levels of anxiety, my levels of concern about things, my levels of medical panic, did it and experienced no consequences. I will say I did experience one pain, which was a day and a half after the surgery. I started feeling real pain in my shoulders for about two or three days.

And that pain came from... Is the position? From the gas that they put in in the laparoscopic procedure to fill you up a little bit. The gas travels up to your like shoulders. And so my biggest pain out of this entire process, getting cut open or organ removed, none of that bothered me. I feel nothing from it. My scars look really, really integrated into my, you know, otherwise perfect torso.

So, you know, the biggest inconvenience was that I felt almost like, you know, it was like a pain in your muscles like after you, you know, throw a football after you haven't thrown a football in a while or sleep on it wrong. That was my biggest pain. So mild sorenness. Yes. And this is what I would warn people about. And my warning really is more indicative of how easy everything else was.

Yeah. Well, that's awesome. And I'm hoping that message lands well for people. And even if they choose not to do it, they tell someone about it that perhaps can be influenced, kind of like a down-the-line process. Yeah. I find this to be kind of like a very awkward aspect of me doing this, is that I know I can make an impact, like a practical impact, especially because I seem like a regular person. You know, I seem like an average person. I'm not somebody who jumps off skyscraper.

You know, not somebody who's like looking at the, I'm a worried person, you know, and I think, yes, that could inspire people, that word, in a way that, or inform people, in a way that I was informed by this podcast. Yeah. My final question to you is, is there a world? where for Jesse, Hollywood is no longer a thing. Well, Hollywood itself is becoming less of a thing, unfortunately, because the industry is leading. Broadly.

You know, Hollywood, the way I think about the arts is kind of it's what you make of it. You know, the same time I had this movie, now you see me three come out, which is this big international kind of, you know, Hollywood-style production. I was doing my one-man show about a guy who has trouble connecting to his newborn baby at a 200-seat theater down a block. from here. The arts are what you make of it. You know, some people want to do the Now You See Me and then they also want to speak at an advertising convention and do a toothpaste commercial. For me, it's like, oh, that's the Now You see me thing. I get to do this thing and maybe I'll do a toothpaste thing. I don't know. It's what you make of it. You like the variety of it. I love the variety and I like that the arts are the arts and not the industry of the arts. You know, the arts for me is,

you know, I do little projects that no one knows about. I directed a play in a, you know, tiny theater that my wife's friend wrote. You know, that's what I love about my job. And so, yeah, it's all connected to Hollywood in some vague way. But, yeah, I love that I don't feel beholden to an industry. Cool. Well, look, I seriously thank you

for coming on the show and taking the time out to put out this important message, despite all the anxieties of nerves that you felt before this. It felt like packing up my friend's house. So thank you. Perfect. And we're going to be excited to speak with a physician from NYU that will take us through the organ transplantation process

and some of the great processes that they have in place there. Yeah, great. Cool. Thank you so much, Dr. Mike. And now to help us better understand the clinical side of organ transplantation, we have Dr. Robert Montgomery,

the director of NYU Langone's Transplant Institute and recipient of a heart transplant from the very same program. Trust me when I tell you, this interview floored me. From learning his heart stopped seven separate times to receiving CPR for 40 minutes in the audience of a Broadway musical

to the future of kidney transplants from pigs being used inside humans. Wow. Dr. Montgomery, take it away. Sir, what does your day-to-day look like when you're working at NYU? So, you know, my sort of work life is pretty complicated because I wear a number of different hats that sort of mirror the main mission areas

of an academic institution. So I teach. I oversee a big residency program and medical students. We teach in the operating room. We do didactic sessions as well. I do research. So a significant amount of my time is innovating and doing translational research, which means, you know, bench to bedside and bedside to bench kind of work. and then I'm a transplant surgeon, so I spend a lot of time doing that, taking care of patients. Yeah, between the balance of all of those, do you like that you have different hats that you wear or do you favor one over the other?

I love that I do all those different things. And I like to, you know, in the span of a day to move from one thing to the next in an effortless way. For sure. And, you know, we have a very health curious audience, some people who are aspiring physicians, other health care providers. How does one become a transplant surgeon? Yeah, so you have to, you know, do medical school.

And then usually most medical students don't know what they want to do. Right. But at some point, you know, when you're a third or fourth year medical student, you get exposed to the different specialties in medicine and surgery. and so you get into the operating room and you kind of think, wow, you know. Was that what you felt? Yeah, yeah. I felt like I could connect, you know, best with surgeons.

And I just love the idea that you go into this room, you do a task, you complete it. You get immediate feedback on how you did. So it's very different than sort of managing a chronic disease. and then you form, you know, a bond with that patient that's pretty intense because you've actually been inside them and there's not too many things like that. And what I love about transplantation, which is kind of different than a lot of other areas in surgery, is that you also have this longitudinal relationship with the patient because we follow our patients, you know, over the lifespan of their order.

So all of that appealed to me. The surgery part and then the idea of having a close relationship with your patients over time. And yeah, I kind of knew, you know, right away when I first was exposed to surgery, that this was something that sort of clicked with me. And was it transplant that right away clicked or just general surgery? No, not necessarily. General surgery is what you're exposed to now. I went to the University of Rochester, and there was a really good transplant surgeon who did kidney transplants that I did get exposed to as a medical student.

And I thought that was a very elegant operation. Awesome. Well, there's basically a number of different steps that are very clear. You know, you have to sew two blood vessels. you know, between the donor organ and the recipient, and then you have to join the urator, which comes with the donor kidney to the recipient's bladder. And it's just, it just, you almost feel like you should, you know, have a tuxedo on when you're doing it because it's just a really elegant operation.

Very pretty to watch, I think. and that's how it struck me like right away that um you know a liver transplant uh can be very long um you know it's it it it can be very bloody and it um you know there's a lot of steps to it and it's i think for the uninformed or the novice it looks pretty overwhelming I mean, I enjoyed doing that until I decided not to continue doing liver transplants. But once you finish your residency then in general surgery, then you do a two-year fellowship in transplantation surgery, where you really learn the transplant procedures.

Did anything shock you in going through that education of how transplants are done, how transplants are viewed by society? Does anything stand out in your mind from this couple of? What the most shocking thing is how sick people are when they go into the operating room and how they almost immediately emerge in a position of health and improvement. It's so striking. And, you know, particularly, I think, you know, patients who are getting a liver transplant who are really kind of on death store. you know, we have dialysis, which is for kidney disease, which is kind of a poor substitute for, you know, your own kidneys and certainly not, by any measure, not as good as a kidney transplant, but it can tide people over for a period of time and keep them in reasonable shape. You know, it's, if you talk to people who are on dialysis, it's a miserable day-to-day existence.

It really just takes over, you know, their whole lives. But, you know, heart transplants, lung transplants, livers these things where there's not kind of a good substitution. They get very ill and then suddenly, you know, they are transformed during, you know, the, time that you're putting the organ in. Sure. So it's an extraordinary thing to see. And what encouraged you or got you curious about doing research in the field, not just being a transplant surgeon?

Yeah, you know, the immune system was always very interesting to me for some reason. No particular connection, you know, from my early life. But I started doing research actually in high school and immunology. And so, you know, it all sort of came together because it's so critical for, you know, transplantation. It's all about kind of holding the immune system at bay so it doesn't attack the new organ. Were you experiencing in your practice rejections and that's what led you to want to do these bits of research? So, you know, I think that, you know, immunology is something that is so, fundamental to transplantation that we all, those of us who go into this field, have to have some

kind of a basic understanding of immunology. My main research interests have been for the first part of my career in trying to create more living donation opportunities for patients and try to expand living donation because it seemed like the area that was most expandable, if you will, because deceased donation, you know, it's really been a tough nut to crack to figure out how to get, you know, more people to donate organs after their death. What's their rate limiting step there? I mean, I think kind of old ideas, ancient ideas about the, body and about death and, you know, not necessarily people think that there's, you know, we come into this

world with these organs and we should leave them. I see. Leave with it. So like a cultural belief. Yeah, I mean, it goes, I think back to the Egyptians and, you know, there's, there's, yeah, these are kind of old ideas that somehow find their way into our minds, you know, and, you know, and, you know, and, And so some people just have this immediate reaction when, you know, you talk to them about donation. And people don't like to talk about their own death. Yeah. It gives you meaning to the term organ rejection. Yeah, exactly.

Yeah. So, you know, the most important thing about deceased donation, you know, donating after you die, is letting your family know that it's something you want to do, right? and I think it's a kitchen table conversation that often never occurs. And so your family is left in this terrible spot of, you know, emoting over your loss and not really knowing exactly what your wishes were unless you've made that clear. So I always say, yes, you know, it's really important to register because then it's it couldn't be more clear. as a donor.

But I think even more important than that is to have that, what I call a kitchen table conversation with your family. So they really know how you feel about donation after death. And it also then I think, you know, it's an opportunity for them to talk about what they want as well. And, you know, for whatever. reason, you know, the donation rate from people who have died, you know, at least early in my career for years really didn't change much. And so I saw living donation as that opportunity. And so I became

very interested in how to make it easier to donate. And that's how the laparoscopic nephrates. for donation came from the work that we were doing talking to people who had come, you know, and wanted to donate their organs, but during the process decided not to. And we did these questionnaires. And the number one reason was the magnitude of the operation and the recovery period. It wasn't at all unusual before we use minimally invasive laparoscopic procedures to remove the kidney type of procedure that Jesse had. That the recipient would go home from the hospital before their donor would because it was this huge incision on their flank. We'd remove the 11th rib. it was a big deal to donate an organ.

So introducing that new operation, which is now the standard throughout the world, it was something that I was involved in. We were a team that brought that forward. And then this idea of swapping kidneys, because if you take any two people like you and I, there's a 35% chance that we would not be compatible either by blood or tissue.

And so if you were my only donor, you know, then I'd have to get on the deceased donor list, right? So we did two things. We figured out a way to remove the harmful antibodies that really create that incompatibility through a procedure called plasmapheresis. And then we also figured out a way to get around the incompatibility

by saying, okay, let's say the two of us are incompatible, we find another pair that have the opposite incompatibility, and then the donor from that pair gives to me and the donor, and then you would give to the recipient in that pair. So it's a swap. And then to that, we made the tweak of starting a chain of transplants with somebody like Jesse Eisenberg who is a non-directed donor so doesn't have someone in mind that they want to give a kidney to. They can start a chain where they give their kidney to someone who has an incompatible donor and then that donor gives to somebody who's on the list. And you get two transplants instead of one from, you know, in this case,

Jesse's act of kindness and humanity. And then you can extend those chains as long as you want. And that's a concept that we came up with. And that's been responsible for 11,000 living donor transplants. that wouldn't have occurred otherwise. And there is, Jesse mentioned, 90,000 people actively on a wait list for our kidneys, is that true? That's true, yeah.

Yeah, that's gotta be weighing on you. Yeah, and only one third of them will ever receive a transplant. Because of the length of time it takes to get one? Because of the length of time, and the impact of dialysis, dialysis is very hard on the body. and people, you know, start to develop what we call comorbidities or other diseases,

cardiovascular disease gets accelerated. And so they get too sick to benefit from a transplant or die. So two-thirds of the patients never make it across the finish line. But, you know, when you talk about the list, you're talking really about a relatively small, part of the impact of organ failure. How so? Only 10% of the people with organ failure, and you can take any organ, heart, lung, kidney, liver,

ever make it onto the list. 10%. And then only a third of them actually receive a transplant. And that means that every year we're transplanting about 3% of the total number of people who could potentially benefit. Why do only 10% make it? Because we don't have enough organs.

We're in a place of rationing. Meaning onto the list itself. Right. So we're always thinking. Who is a good candidate? Who is a good candidate? And what does that mean? Who's likely to benefit from the most from a transplant?

God, that's a heavy decision to make. Yeah. If we had unlimited. Who makes that decision? I mean, it gets made many steps. You know, people unconsciously know that, you know, it's difficult to, you know, it's difficult to. receive an organ. So it starts in people's own minds. Like, and, you know, maybe they're older,

maybe they're frail. And then it's, you know, for kidney, it can be at the dialysis center, you know, to the point where they're not encouraged to go and seek out information about transplantation because somebody says, oh, I don't think you're a good candidate or you probably wouldn't benefit. And so, and then once, you know, you do go to a center to get evaluated for a transplant, you know, we kind of have a sense of how likely it is that you're going to be able to wait, you know, five or six years and to, you know, be in a position to benefit. So these things are, it's just baked into the process now that we're rationing this.

It's the most highly rationed thing in medicine that works. Like if we were talking about a cancer drug, it would be a completely different conversation. You know, we would be sure that that was available to our patient. Even if it only extended their life for a month, they would get that cancer drug, right? But in Oregon transplantation, it's a very different thing. Is the process of the laparoscopic, minimally invasive kidney transplant for a donor, as easy as Jesse makes it sound? I think Jesse, you know, is a very unique person.

I mean, it's a major operation. You know, I think we're at a point now in the development of the operation that it's much easy. if you will. It doesn't require as much time out of work. It doesn't have, you know, a major impact on your health, perhaps as it did, you know, 20 years ago. But it's, you know, it's something that one has to take very seriously. It's a big deal to donate a kidney, but, you know, people do it every day. And it's such an, it has such an amazing impact on the recipient. It saves their life. I mean, just literally. When you think about what I just explained in terms of the, you know, the, the fact that we have such a scarcity of organs to save a life by adding an organ to the mix is,

it's just an amazing thing. And what, how early in the process do you first meet with the donors? Well, so, you know, if somebody wants to donate either altruistically, I mean, I think all donors are altruistic, right? But, and perhaps a better term is a non-directed donor like Jesse, who really doesn't know someone who needs an organ, but just out of the goodness of their heart, you know, knows they have two organs and you only, or two kidneys and you only need one. And then, so they would either, you know, present to something like the National Kidney

Registry or to a transplant center and say, you know, I'd like to donate an organ. If it's somebody that you know, then generally, the recipient will, you know, go to get registered at a transplant center and then inform the center that they have a potential donor, will give the recipient a phone number that they can give to, you know, the candidate donor, and then they get in touch with us because we keep those, you know, two processes completely separate because we want to ensure that, first of all, the donor, you know, is well-informed, really understands what's involved, is completely on board with it, because obviously you can imagine, you know, if it's a family member, they might be feeling

some pressure to donate. So we have to go through all that and make sure. Does that happen? Have you seen that play out? Yeah, yeah, sure. And that's why it's kept completely separately because the recipient just finds out, yeah, the donor was cleared for donation or they weren't cleared for donation. They never find out why, right? Okay.

So you give them a backstory cover there. Well, just by saying that they weren't cleared for donation. You know, those are kind of the two ways that, depending on whether you're not. undirected donor or you're connected with a recipient, you know, how you get into the system. But then we might uncouple you again if you're getting a kidney pair donation where you go into one of these swap pools, right? And maybe my head is still in Hollywood because Jesse was just here.

But is there ever a world where someone comes in and you worry that there's some ulterior motive? Someone is paying someone. Is that unethical? Is that disallowed? What's the process with that? Yeah. All of those things. Unethical, not allowed.

It's pretty rare. Globally this happens, though, right? Yes. Yeah. I would say in this country, in the U.S., it's pretty rare. But, you know, we have donor advocates, you know, sort of third parties that interact with the donor and have a series of questions that they ask. And so that is vetted, you know, and honestly, if that's the case, and again, it's pretty rare, it's usually pretty obvious,

you know, right away. But yeah, it's illegal. You know, we do compensate donors for their expenses in the process of donation, travel, there are various different funds, you know, that are out there through the government, through some of our societies that, you know, just make it so that the donor doesn't have to, you know, spend their own money going through the process of doing this wonderful thing

for society. Yeah, maybe this is an incredibly dumb, question, so I apologize ahead of time. But why is it that folks are allowed to sell certain bodily fluids, but they can't sell their kidney? Yeah, I mean, look, you know, this is an ongoing debate. Oh, it is? It's, yeah, I mean, I think that, you know, it's actually something that isn't completely resolved, but it's illegal. You know, it was part of what's called Noda, you know, the original legislation that went through in the 1980s that, you know, set up the governance for our system of organ donation. And but it, you know, it does, it does come up and it is debated.

I think, you know, it's, it's a bigger deal than, you know, donating eggs or, you know, sperm or something like that. It's, you know, the operation is, it's of a greater magnitude. Well, wouldn't that mean that compensation is even more appropriate in those scenarios? I mean, there is a, you know, definitely a school of thought, you know, that this could really change this scarcity of organs if we, you know, if we moved in that direction. But I think, think the idea of donation and, you know, the idea that you're doing this to help someone, there's not some, you know, monetary reward that you're getting that might, you know, be coercive. In many cases, would be coercive.

and might, you know, someone who's vulnerable. Yeah, on a societal level, it could be quite destructive. Yeah. Yeah. There's this fear that a lot of my patients have when we discuss whether or not they should be an organ donor, when we're filling out forms, their pulse, end of life care, et cetera, that they believe if they write that they wish to be a deceased organ donor, that they will not get good quality care.

Yeah. Why do people believe that? It's kind of, it's like those old thoughts that we were talking about earlier than, you know, because the idea that, you know, it's sort of, you know, in the vapors that when there is an opportunity for donation, why wouldn't that influence people's thoughts, right, who are caring for you? But the truth is that the people are trying to save your life are a completely different team, totally disassociated from, you know, those who are involved in Oregon allocation, who would come in at a much later point in this process after you've already been declared brain dead

or after the decision, you know, has already been made about what's, you know, going to happen after your death. look, I've been in this, you know, in medicine for a long time and I've been in medicine longer than I've been in transplantation. And that really does, that does not happen. I mean, that is really an unfounded fear. But it is, you know, a fear that people have. Yeah, do you ever go to dinner parties and people find out what you do and they say, oh, I would never do that because of it. Sure, sure. And many other reasons. You know, I would. What other reasons do people have? Well, what I mentioned earlier, what if I need my organs, you know, after I die? Do you get into those debates ever?

Yeah, sure. I tried to inform people, you know, about, you know, truth and what's fact and what's fiction. That's more important than ever these days. Yes, of course, yeah. Although I've tried to put myself in those shoes by having debates with those who are anti-vaccine. and some people in the medical community say that we shouldn't be doing that. So I'm always curious how medical professionals feel about whether or not we should be debating topics like this, where there's a clear scientific answer, but perhaps societally there's disagreement.

Yeah, I mean, you know, vaccines are, you know, that's health care for people who are living. there's something quite different about the decision to, you know, to donate organs at the end of life. But now with altruistic or the type of donation Jesse did. True. Yeah. In those cases. But we have great data on, you know, so there's been almost 100,000 people who have donated. Wow.

Kidneys. And so we have longitudinal, really good data about the safety of donation. Jesse also mentioned that he was able to put people on a list that if his loved ones ever needed a kidney because he already donated his. What happens if Jesse's, God forbid, his kidney fails and he needs a kidney donation? What happens then? Yeah, so that rarely happens, but it does happen. Obviously, there's a certain level of, you know, renal failure that we all, you know, are subject to a certain risk. And then the other thing is that sometimes if you donate to a family member, you know,

and they have some genetic predisposition, then that could affect you later in life. Now, we really know a lot about those things now. So we're, you know, able to screen during the donation process for the vast majority of those things. But yeah, so there are some people who develop renal failure. who have donated an organ, and they go right to the top of the list. So if they, you know, need a kidney, they'll, they'll get one and they don't have these long waiting periods. So that's already baked into the system. And transplantation is obviously your passion, your career, but it's also near and dear to your heart in many ways. No pun intended. Yeah. Tell us about that.

Yeah, so I've had a heart transplant. I'm coming to. I'm coming to you. I'm coming to you. I'm Coming up on my eighth anniversary, I have a genetic disorder. My dad died at age 52, got sick when I was 14 years old. We didn't know then that his, what the disease is called dilated cardiomyopathy. We didn't know that his, and it's the disease of the heart muscle rather than the coronary arteries.

You know, when people have heart attacks, it's usually because they're coronary arteries. are blocked. This is a disease of the muscle, but it can affect the electrical system and cause short circuits in the electrical system, which can cause sudden deaths, cardiac arrest. So my dad died. We thought it was a post-viral type of cardiomyopathy. And then when I was an intern at Johns Hopkins in surgery, got a phone call from my sister-in-law who told me that my 35,000, my 35,000, five-year-old brother, Rich, had just died while water skiing and had a cardiac arrest. I had his heart sent to the pathologist at Hopkins, and they said, you know, this is the same

disease that your father had. And so we knew we had, you know, a problem, big problem. And then about eight years later... Well, before we go eight years later, how do you... how does that hit for you? You find this out and you're worried about your own heart. Yeah. So, yeah, I got on a treadmill and I had a very dangerous rhythm. On a stress test. On a stress test.

And this was in the 1980s, the late 1980s. And at Johns Hopkins, where I was, the implantable defibrillator had just, been invented. I was in the first 1,000 people to receive that device. They told me that I was at high risk for a sudden death and that given the family history and the fact that it was clear that I had the disease that I needed this. I was the first surgeon in the world to receive one of these and they told me it was the end of my surgical career and that they were worried that the equipment that we use in the operating room, one particular piece of equipment called the electrocottery,

which is vital to, you know, sealing blood vessels while you're doing surgery, that the electrical noise from that would probably set the device off. And that's, you know, a thousand volts of electricity, right? And so, you know, they said you should probably think about another career entirely. Oh, my God. I had, you know, good support, good mentors who I was about to go off, actually, to do my research years at Oxford and work on my PhD in immunology. And, you know, my boss, the chair of surgery, said, well, you know, let's see how things go over the next few years. years and after I had the device implanted. Now, you know, you probably know people who have

pacemakers and, you know, defibrillators now look just like a pacemaker. It's a small. My previous guest before Jesse had one. Yeah. And it's just implanted in the shoulder. It's this tiny thing. Back then, it was like the size of a Coke can and it had to be implanted in my abdomen. Wow. And I had to have my chest opened and two patches put around the heart, the capacitors that delivered the shock. It was a big deal. But when I came back from my research years, they allowed me to go into the electrophysiology lab

with all the equipment that we had in the operating room and to demonstrate that it was fine. Almost like a penicillin challenge. Exactly. And so they said, okay, they cleared me to continue. How happy were you that day? Yeah, it was everything. I mean, you know, to be so, you know, certain that this was what, how I wanted to spend my life and then have that sort of taken away was one of the most difficult things that I, you know, had faced up until that point. in my life.

So, you know, the next 30 years, I was protected by this. Was it shocking you randomly? Well, not randomly, but I had, during the next 30 years, I had seven cardiac arrests. And for the first several of these, the device saved my life. And then my heart disease progressed to a point where, the device, you know, didn't capture, didn't reverse the arrhythmia. And I had, you know, one time 40 minutes of CPR. Acistally or a non-shockable rhythm or what?

Well, eventually they shocked me externally. And, you know, the likelihood of surviving that is about 5%. it's really low. I was very lucky. Probably high quality CPR in those. A really good CPR from, I was actually at a Broadway show, but there was a doctor and a nurse

who were nearby, and they, I don't know who they are. Oh, really? If they're watching this, I'd love to meet you someday. Wow. What was the name of the show

in case they were able to? It was School of Rock. Oh, nice. Yeah. It was a showstopper, literally. It was a real New York moment because, you know, my wife screamed and the lights went up and they did, you know, this work on me. And the first alarmers arrived and shocked me.

And I woke up and they lifted up the gurney, you know, like they do up into the air. And I got a standing ovation wave to people as we were going out. And then another time I had a cardiac arrest and was in a coma for almost a month in Patagonia. So in the middle of nowhere and was very lucky to survive that. When I woke up, I couldn't speak, you know. A lot of PTOT, probably. Beach therapy, walk. Swallow evaluations.

Exactly. Yeah. Wow. Why in Patagonia? I'm an outdoorsman. Yeah. So my first cardiac arrest was in Patagonia, and then seven years later I had that one. So I wasn't smart enough not to go back.

And then how did the heart transplant come into the picture? Right. So, you know, and I think this is, I think, you know, one of the reasons that it's so important to sort of talk through this is because it's a great demonstration of what we were talking. talking about earlier. Our allocation systems are based on severity of illness. So you have to be really sick in order to get an organ. And even to get listed for an organ, we're not going to list people, put them on the list, unless they're likely to, you know, be in a position where they've got allocated an organ. So unfortunately, Most people die before they even get on the list, you know, as we mentioned earlier, like 90% of the people

because you have to get so sick. And each one of these cardiac arrests, you know, you put it all together. I was just very lucky because any one of them, you know, could have resulted in my death. in the end, I was in Italy at a medical convention and had something called a ventricular tachycardic storm where I had one cardiac arrest after another. Enrolled into, you know, it was a small place in Italy, into this ER, got the last rights. The first person I saw was a priest.

and, you know, and then had another cardiac arrest while I was, you know, on the table in the emergency room. And then the next day they stabilized me on drips. And, you know, I was like, okay, we're not going to do Patagonia again, you know. I got to get out of here. I'm going to say within call hour re-church. of a hospital. Well, no, because they said, we think, you know, you're going to have to stay here for weeks until we can stabilize this situation. And I knew that this was sort of my ticket,

because that's one of the things that gives you a status one listing. So you're high priority. If you have, you know, these multiple arrests one after another. So I needed to get back to NYU. And so actually I signed out against medical advice. And one of my friends who was at the meeting came and they gave, you know, the Italian people are so different than anyone else. They're so compassionate. And so they left my heplocks in my arm. And they gave my friend these preloaded syringes of resuscitation medications.

Like epinephrine. Yeah. He sat next to me and we got on a lift on. flight and flew back and I checked into the ICU and a month later I had a heart transplant. Now, you know, because of my size and it would be the same thing with you, it's very difficult to, for heart transplants, you have to have a heart that is the right size. And if you're, you know, over six feet, it's very hard to match you. So they thought, you know, it could be a year of staying in the ICU on drips, you know, until I would get a heart. We had just done a trial where we were using

because of the opioid epidemic, there were suddenly all of these hearts and other organs that had hepatitis C. About 25% of the people who die from overdoses have hepatitis C, have hepatitis C. see from needle sharing. And those were getting discarded. And so we did a trial where, because we had the new direct acting antivirals, these new hepatitis C drugs that were showing great promise, but no one had ever given someone hepatitis C while they were getting immunosuppression for an organ transplant. We didn't know what would happen.

But we did a pilot trial with kidneys where we did 10 patients, gave them the drugs right after we gave them a hepatitis C organ, and they were hepatitis C negative. And they got hepatitis C, but were able to clear it. So I told my doctors that that's what I wanted to do. That's what I had been telling my patients to do. And so I received a heart from a drug overdose victim, young person. who had hepatitis C, and I got hepatitis C on the third day after my transplant, took the pills for two months, and it cleared.

And that's really probably the only reason I was able to get a heart that quickly. Wow. And now, you know, everybody does that. It's standard of care. Standard of care, yeah. What's the future look like for transplant surgery? Are we going to be growing organs? What's the horizon?

So, you know, this whole journey that I had, and realizing, you know, believe it or not, as a transplant surgeon, you're really just looking through the keyhole of the problem, and you're just seeing patients who get a transplant, right? I mean, we're aware, like, when patients die on the list, sometimes, frequently they just get too sick, they fall off the list. You're, like, the people who are doing the surgeons, you know, the surgeons aren't aware of all of this all the time. And so we just see the successful, success measured by them getting an organ. Almost like a survivorship bias feeling.

It's a survivorship bias, yeah. And so you get this sense that it's, you know, you're, you're going to be okay, right? And then I went through this whole period of time, realizing that that was not the case that, you know, the likelihood of me not getting an organ was far greater than receiving a transplant. And I was just very fortunate, you know, each time I had a cardiac arrest that I didn't die. And so, you know, that experience made it just absolutely crystal clear, like the magnitude of this problem. And because I walked in those shoes. And so I decided, you know, during that as I was getting closer to my transplant, that really the rest of my career was going to be devoted to creating abundance of organs.

And there are basically three leading possibilities. Artificial organs, sort of like the fully implantable artificial heart, you know, which is a mechanical heart. Now that, you know, showing promise for hearts, but, you know, lungs, the livers, not so much. The, what we call bioartificial organs. So those are organs that are created basically either by decelerizing like an animal organ, like let's take a lung. You know, you remove all the cells. You have a scaffolding. And then you lay down human stem cells on top of that and coax them down different pathways to recreate a lung.

You can also do that with 3D printing. You know, you can create that same scaffolding, right? And so, you know, that's a possibility, but that's down the road a bit because you're starting from scratch, basically. And then xenotransplantation, which is what I... decided this is where I'm going to put my energy. And that's using animal organs. And we've decided that, you know, pigs are really the best donor candidates for xenotransplantation. For all organs or just kidneys? For all organs. Okay. And, you know, these pigs are cloned and for the most part, at least the really complex genes.

edits, you know, our cloned animals. They have, we use CRISPR technology to knock out certain genes that, you know, make it more difficult, cause immune response, and also put human trans genes, you know, that make human proteins in certain pivotal genes that, you know, encode proteins for like regulation of complex systems like blood clotting, like something called complement, which is really important for the immune response, inflammation. And so, you know, alter do these gene edits and then transplant those organs into humans, make them more compatible to humans. Wow. So is it fair to say that the future is bright? The future is bright. Yeah.

So we, you know, in 2021, we did the first gene-edited pig kidney transplant. We transplanted that organ into someone who was brain dead. Okay. As a trial. As a trial. And that allowed us to sort of fail safe, if you will. You know, it really de-risk the situation. So we weren't doing it directly into a living human.

at first, and we did six of those. So essentially, the idea is this is a person who had wanted to donate their organs, had, you know, expressed that desire. They were brain dead. We approached the family after it turned out that their organs, you know, weren't able to be transplanted. They had some issue that, you know, prevented. the organs from being suitable for transplantation. So we'd approach the family for whole body donation

for the purposes of testing these organs. So that's how it started in 2021. And from 2021 to now, we did a number of those decedents. We also tested some hearts. And then we did a couple of really sick patients who are sort of on death store. You know, those are sort of used to be called compassionate use approvals from the FDA. And now we're in clinical trials in just five years. So it's pretty amazing. It's moving right along. And we have two kidney clinical trials now, one for a really complicated gene-edited kidney

edited kidney that has 10 gene edits. And then a rather simple one that has just one gene edit, but we transplant the thymus from the pig. We actually operate on the pig two months before we procure the organ and we put the thymus underneath the capsule of the kidney. Now the thymus is what educates the immune system. And so we try to re-educate the recipient's immune system to not recognize that pig organ is being foreign. And it looks very promising. It's been done in a lot of animal models. So we have those two trials going on.

So sort of the extreme that 10 gene edited, all those pigs have to be cloned. That's a limitation. It's expensive. You know, it's harder to scale. The one gene edit, those pigs are bred. So very easy. You know, pigs breed three times a year,

have big litters, you know, up to 20 piglets. And you could really scale that and produce an unlimited supply of Oregon. So we'll see which one looks the most promising. Very, very exciting. Well, look, obviously, I have to thank you for your work in keeping humanity in this subject very much alive, both from sharing your story and the work that you're doing with your patients, with your residents, the med students that you're training, literally the future of transplantation. where can people go to be curious about your work, if their donation curious, where would you like to

direct you? Yeah, I mean, we're, you know, we're enrolling patients into these trials right now. So there's certain, obviously, you know, pretty stringent guidelines about, you know, they have to be more likely to not receive a kidney in the next five years than to get a transplant. So these are patients who, you know, will probably. probably end up in that two-thirds that doesn't get across the finish line with human organs. But yeah, there's, if you go to, you know, the NYU Langone website, there's, you know, and you type in xenotransplantation or clinical trials, or you can go to clinical trials. And you'll see our trial and you can inquire that way.

Yeah, we'll definitely drop those links in the description. so folks can easily click on those. Parting words for our audience. Well, so yeah. You know, we've, what we're talking about is kind of a bit futuristic, although I think the future is here. Yeah. But it's how we can really create abundance and solve this Oregon scarcity problem,

but we have to deal with where we are right now, which is that, you know, more people are dying, waiting for organs, then receiving them. And so, you know, this is donor, the month that we think about donor awareness. So, you know, if you haven't had that kitchen table conversation that I mentioned earlier with your family to tell them what your preferences are, I mean, we all think about life insurance. We think about, you know, things that we want to pass on. after we die, but very few people, as it turns out, really have that discussion with their family.

So have that discussion. Have it sooner. Don't put it off. And if you're healthy, you have two kidneys. You can donate part of your liver. And you either know someone who, you know, is in this terrible predicament that I was in. and so many people in this country right now, millions of people, please think about, you know, donating while you're alive.

And so those are the things that I think, you know, are so critical at this moment. And we'll keep working and trying to make this thing better so that, you know, at some point in the future, we don't have to rely on, you know, on people's, goodwill, although we'll always appreciate that. Of course. Dr. Montgomery, thank you so much.

Appreciate the conversation and the great work you've been doing. Thank you. Appreciate it. Yep. Huge thanks to Jesse and Dr. Montgomery for joining me on this episode. It was definitely a different format than normal, having a celebrity in the first half and a subject matter expert in the second. So please leave us a comment down below, letting us know what you thought.

And if we should make more stuff like this in the future, it would also mean a lot if you can give us a five-star review, if you enjoyed the episode, as it's the best way to help us find you listeners and viewers. As always, stay happy and healthy.