In Andrew Flescher's new book, he extends some of his previous work on saints and heroes into the realm of organ donation and transplantation. More specifically, he addresses the practice of living organ donation as a means of addressing the gap between those on the waiting list for kidneys and the available kidneys from deceased donors. Of course, there are not enough living donors to bridge the gap either, which is where Flescher's argument for empathetic altruism as a species of civic duty really takes off.

Currently, there are about 120,000 people on the waiting list for organs in the United States, and the vast majority of them are waiting for kidneys. The number of people willing to donate organs after death is significantly higher than the number who die in a manner that allows for organ donation to take place. In short, Flescher argues that even recruiting more organ donors at the Department of Motor Vehicles will not increase the supply of organs enough to treat all of those waiting. Echoing a number of transplant surgeons, Flescher argues that the best solution to this problem is to increase the number of living donors. To be clear, a living donor is someone who undergoes surgery to donate a kidney or lobe of liver to someone else, often a family member or friend, sometimes a stranger. The donor then lives with one kidney or a partial liver for the rest of his or her life.

Flescher knows the ins and outs of organ transplantation from his position on the United Network for Organ Sharing Ethics Committee and his work as a Living Donor Advocate. He uses these practical experiences to fund his academic argument, which counters the oft spoken idea of developing an organ market by drawing on his observations of human nature. For Flescher, humans are at root altruistic, and the long‐held distinction between altruism and self‐interest does not hold. Humans can be altruistic and self‐interested at the same time; he even argues that it is common to engage in behavior that benefits others and increases your quality of life simultaneously.

Flescher buttresses this argument with evidence from his conversations with potential living organ donors. On his account, the donors would not be more motivated to donate their organs if they were paid for them, and, in fact, some would be less inclined to donate organs in exchange for money. What living donors want most on Flescher's account is recognition, a sense of community, and often to have a relationship with the recipients. He suggests that there are practical ways to offer these intangible benefits to living donors and that some organizations and hospitals already do so.

Ethically speaking, Flescher argues that being a living donor is one path to exercising virtue (in the Aristotelian sense), and that we have ignored this ethical dimension of the practice. Suggesting that donors be paid erodes the donation itself of virtue by turning a precious good into a commodity. Similarly, assuming that living donors are saintly or even psychologically impaired closes off the path to virtue for many potential donors. At the foundation of Flescher's argument, we find that he thinks people are fundamentally good, other‐regarding, and motivated by helping others and being part of something larger than themselves. Some may call this naïve, while others may call it hopeful.

Flescher's book contains a detailed discussion of altruism and self‐regard as well as a conversation on the distinctions between commodities and precious goods. Additionally, Flescher includes methodological reflections on the role of advocacy in academic scholarship and on using anecdotes as data in ethical arguments. His sections on altruism would have been stronger with more attention to ecological and evolutionary perspectives. Nonetheless, this book is a needed and timely piece on how practical and applied ethics can be a source of orienting questions in religion and science.