Astral Codex Ten

Coalition To Modify NOTA

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Coalition To Modify NOTA

Article

Coalition To Modify NOTA is a recurring organization in the Astral Codex Ten archive, appearing 5 times across 5 issues between October 27, 2023 and October 13, 2025. The archive places it in contexts such as “Ned Brooks is starting a new push - the Coalition To Modify NOTA”; “Coalition To Modify NOTA is full of previous living kidney donors”; “my latest interest is Coalition to Modify NOTA, see here”. It most often appears alongside ACX Grants, 1DaySooner, Africa.

Metadata

  • Category: Organizations
  • Mention count: 5
  • Issue count: 5
  • First seen: October 27, 2023
  • Last seen: October 13, 2025

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

My Left Kidney
October 27, 2023 · Original source
So in late September 2023 - ten months after I started the process - I finally got fully cleared to donate, surgery set for October 12. VI. I knew, in theory, that anaesthetics existed. Still, it’s weird. One moment you’re lying on a table in the OR, steeling yourself up for one of the big ordeals of your life. The next, you’re in a bed in the recovery room, feeling fine. The operation - this thing you’ve been thinking about and dreading for months - exists only as a lacuna in your memory. Not even some kind of fancy lacuna, where you remember the darkness closing in on you beforehand, or have to claw yourself back into consciousness afterwards. The most ordinary of lacunas, like a good night sleep. There was no pain, not at first. The painkillers and nerve blocks lasted about a day after the surgery. By the time they wore off, it was more of a dull ache. The hospital offered me Tylenol, and I wanted to protest - really? Tylenol? After major surgery? But the Tylenol worked. Some people will have small complications (I am a doctor, pretty jaded, and my definition of “small” may be different from yours). Dylan Matthews wrote about an issue where his scrotum briefly inflated like a balloon (probably this is one of the ones that doesn’t feel small when it’s happening to you). I missed out on that particular pleasure, but got others in exchange. I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria - but that was fifteen seconds of intense pain. Then a week afterwards, just when I thought I’d recovered fully, I got bowled over by a UTI which knocked me out for a few days. But overall, I was surprised by the speed and ease of my recovery. A few hours after the surgery, I walked a few steps. After a day, I got the catheter out and could urinate normally again. After two days, I was eating “SmartGel”, a food substitute that has mysteriously failed to catch on outside of the immobilized-hospital-patient market. After three, I was out of the hospital. After four, I started easing myself back into (remote) work. After a week, I flew cross-country. . . . and then I got the UTI. If this section sounds schizophrenic, it’s because it’s a compromise between an original draft where I said nothing went wrong and it was amazing, and a later draft written after a haze of bladder pain. Just don’t develop complications, that’s my advice. Still, I recently heard from the surgeon that my recipient’s side of the surgery was a success, that my kidney was in them and going fine - and that put things back into perspective. To a first approximation, compared to the inherent gravity of taking an organ out of one person and putting it in a second person and saving their life - it was all easy and everything went well. When I look back on this in a decade, I’ll remember it as everything being easy and going well. Even now, with some lingering bladder pain, modern medicine still feels like a miracle. VII. In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need. This sentence fascinates me because of the hanging “would”. Would, if what? A natural reading is “would if someone needs it”. But there are 100,000 strangers on the waiting list for kidney transplants. Between 5,000 and 40,000 people die each year for lack of sufficient kidneys to transplant. Someone definitely needs it. Yet only about 200 people (0.0001%) donate kidneys to strangers per year. Why the gap between 25-50% and 0.0001%? Some of you will suspect respondents are lying to look good. But these are anonymous surveys. Lying to themselves to feel good, then? Maybe. But I think about myself at age 20, a young philosophy major studying utilitarianism. If someone had asked me a hypothetical about whether I would donate a kidney to a stranger in need, I probably would have said yes. Then I would have continued going about my business, never thinking of it as a thing real-life people could do. Part of this would have been logistics. I wouldn’t have known where to start. Do you need to have special contacts in the surgery industry? Seek out a would-be recipient on your own? Where would you find them? But more of it would have been psychological: it just wasn’t something that the people I knew did, and it would be weird and alienating for me to be the only one. This is going to be the preachy “and you should donate too!” section you were dreading all along, but I’m not going to make a lot of positive arguments. If 90% of the people who answer yes on those surveys are lying to feel good, then only 3 - 5% really want to donate. But bringing the donation rate from 0.0001% of people to 3 - 5% of people would solve the kidney shortage many times over. The point isn’t to drag anti-donation-extremists kicking and screaming to the operating table. The point is to reach the people who already want to do it, and make them feel comfortable starting the process. 20-year-old me was in that category. The process of making him feel comfortable involved fifteen years of meeting people who already done it. During residency, I met a fellow student doctor who had donated. Later, I got involved in effective altruism, and learned that movement leader Alexander Berger - a guy who can easily direct millions of dollars at whatever cause he wants - had donated his personal kidney as well. Some online friends. Some people I met at conferences. And Dylan Matthews, who I kept crossing paths with (most recently at the Manifest journalism panel). After enough of these people, it no longer felt like something that nobody does, and then I felt like I had psychological permission to do it. (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint6.) So I’m mostly not going to argue besides saying: this is a thing I did, it’s a thing hundreds of other people do each year, getting started is as simple as filling out a form, and if it works for you, you should go for it7. When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month. But probably some of it was also the warm glow of having made a difference or something. That could be you! VIII. The ten of you who will listen to this and donate are great. That brings the kidney shortage down from 40,000 to 39,990/year. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors. But so far they haven’t been able to get together enough of a coalition to overcome the usual cabal of evil bioethicists who thwart every medical advance. My kidney donation “mentor”8 Ned Brooks is starting a new push - the Coalition To Modify NOTA - which proposes a $100,000 refundable tax credit - $10,000 per year for 10 years - for kidney donors. There would be a waiting period and you’d have to get evaluated first, so junkies couldn’t walk in off the street and get $100K to spend on fentanyl. No intermediate company would “profit” off the transaction, and rich people wouldn’t be able to pay directly to jump in line. It would be the same kidney donation system we have now, except the donors get $100,000 back after saving the government $1MM+. (the libertarian in me would normally prefer a free market, but “avoid taxes by selling your organs” also has a certain libertarian appeal) This came up often when I talked to other donors. They all had various motivations, but one of the things they cared about was being able to advocate for these kinds of systemic changes more effectively. I personally have been wanting to push this in an essay here for a while, but it seemed hypocritical to play up the desperate kidney shortage while I still had two kidneys. Now I can support NOTA modification whole-heartedly . . . full-throatedly? . . . it’s weird how many of these adverbs involve claims to still have all of your organs. This is also one of the answers to the question I asked in section IV: how do you balance acts of heroic altruism that everyone will love you for vs. acts of boring autistic altruism that will make everyone hate you, but which will accomplish more good in the end?) Coalition To Modify NOTA is full of previous living kidney donors, who are using the moral clout and recognition they’ve gotten to get attention and change the system in an unglamorous way. I find this an admirable way of squaring the circle: do the flashy heroic things to gain social capital, then spend the social capital on whatever’s ultimately most important. If you get one takeaway from this, let it be that those guys who bought the castle were good guys. Two takeaways, and it’s that plus modify NOTA. Three takeaways, and you should feel permission to (if you want) donate a kidney. You can sign up here.9 Feel free to email me at scott@slatestarcodex.com if you have questions about the process. 1Further perspective: I’m 38, which gives me a 2/million total chance of dying per day. So the likelihood that I would die during my kidney operation equals the likelihood that I would die during a randomly chosen two months of everyday life. 2Maybe, kind of. Our knowledge of how radiation causes cancer comes primarily from Hiroshima and Nagasaki; we can follow survivors who were one mile, two miles, etc, from the center of the blast, calculate how much radiation exposure they sustained, and see how much cancer they got years later. But by the time we’re dealing with CAT scan levels of radiation, cancer levels are so close to background that it’s hard to adjust for possible confounders. So the first scientists to study the problem just drew a line through their high-radiation data points and extended it to the low radiation levels - ie if 1 Sievert caused one thousand extra cancers, probably 1 milli-Sievert would cause one extra cancer. This is called the Linear Dose No Threshold (LDNT) model, and has become a subject of intense and acrimonious debate. Some people think that at some very small dose, radiation stops being bad for you at all. Other people think maybe at low enough doses radiation is good for you - see this claim that the atomic bomb “elongated lifespan” in survivors far enough away from the blast. If this were true, CTs probably wouldn’t increase cancer risk at all. I didn’t consider myself knowledgeable enough to take a firm position, and I noticed eminent scientists on both sides, so I am using the more cautious estimate here. 3I told them I had an aunt who died of radiation-induced cancer. It’s true, but I feel grubby for bringing her into this; I thought doctors would be more likely to listen to an emotional story than cold logic. 4EAs have been debating the exact effectiveness of kidney donations for a long time. You can find good skeptical arguments by Jeff Kaufman and Derek Shiller, and good arguments in favor by Alexander Berger and Tom Ash. 5Outside of Philosophy 101 thought experiments, there’s a nonprofit that will often reimburse you for lost wages from your donation. 6Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons. 7But here are some practical points you might not already appreciate: You shouldn’t have to pay much money. If, like me, you need to travel (eg to New York), kidney related charities will reimburse your travel costs (in theory, I haven’t yet proven this, and a few costs were illegible and I decided not to submit them).
Inline links: polls, 5,000, 40,000, Manifest journalism panel, 6, filling out a form, 7, usual, 8, the, here, 9, 1, 2, Linear Dose No Threshold, this claim, 3, 4, Jeff Kaufman, Derek Shiller, Alexander Berger, Tom Ash, 5, 6, 7
Quests And Requests
November 03, 2023 · Original source
I’m inspired by this. Also, I’m a medium-level celebrity. So far I’m having trouble finding good leverage points (my latest interest is Coalition to Modify NOTA, see here), but I bet people who actually know this space could find better ones.
Inline links: here
Sometimes you have a good idea for political change (again, I’ll bring up the Coalition to Modify NOTA). Probably some people disagree with it, but not too many people, and it’s not some issue like abortion where everyone thinks about it all the time and is at total loggerheads. It’s just some good idea that there should be a law about, but there isn’t. What’s the strategy for turning it into law?
Inline links: Coalition to Modify NOTA
ACX Grants Results 2024
February 10, 2024 · Original source
Elaine Perlman, $50,000, to lobby for changes in the laws around kidney donation. I discussed this further in part VIII here: there’s a severe shortage of organs, and the easiest way to solve it is to let the government give people tax breaks for organ donation. Elaine works with the Coalition To Modify NOTA, a group of doctors, donors, recipients, and others who are fighting to turn this into law via the End Kidney Deaths Act.
Inline links: here, Coalition To Modify NOTA
ACX Grants 1-3 Year Updates
June 18, 2025 · Original source
Minnesota and Virginia also have legislation to enable cities to implement land value taxes. We are monitoring these efforts. There are a few other cities we are operating in. We have helped another organization prepare for a meeting in Tennessee by doing impact analysis of land value taxes in the city. We have presented to city officials in the City of South Bend who have expressed support for land value taxes. Finally, we are in conversation with a State Senator in Colorado who is a champion of land value taxes. Meanwhile, we have soft launched and developed the OpenAVMKit, which uses a unified schema to do assessment accuracy reports and automated valuation methods for any property tax data given. Valuation of land is the key binding constraint to successful implementation of land value taxes. We plan to be the leaders in this space with strong benchmarking capabilities and a repo that can enable the open-source community to make the best automated valuation methods. Along with these efforts, we have expanded the movement. We have posted to the Progress and Poverty Substack growing the subscriber base to around 5,000 subscribers. We have spoken to over 25 local advocates interested in working on land value taxes in their local communities. Yet, there is a long way to go. We need to start earning income through technical assistance contracts as our grant funding expires. We need to continue pushing for a state to implement, and we need to be prepared to tell the success story for when they do. 65: EN’s Work On Bacteriophage Therapy Our project is aimed at pioneering phage therapy in Nigeria, where limited resources/infrastructure have historically held back research in this field. Starting from the ground up, we are establishing the foundational systems needed to support a robust phage research ecosystem. So far, we’ve isolated 34 bacteriophages targeting Pseudomonas aeruginosa, an essential step toward building a comprehensive phage bank. This began with collecting a wide range of clinical Pseudomonas isolates, which we are now characterizing alongside the phages through genome sequencing and phenotypic assays including studies on phage stability across pH, temperature, and salinity ranges. Our long-term goal is to develop a phage-based hydrogel for treating diabetic wounds. On the regulatory front, we have secured approval from the Attorney General to register our nonprofit organization, the Centre for Phage Biology and Therapeutics. Additionally, we’re expanding into vaccine development; following a research stay in Prof. Roderick's lab at the University of Waterloo, we have initiated the design of a phage-based universal Salmonella vaccine aimed at covering all major serotypes—an urgent need underscored by Africa’s reliance on external vaccine sources during the COVID-19 pandemic. I have signed an MTA agreement with Roderick to use his phage-based vaccine platform patents to enable us to design vaccines against any common disease affecting us. This is only the beginning, but we are proud to be laying the scientific and institutional groundwork for homegrown phage innovation in Africa. Emergent Ventures funded EN before we did and deserves a lot of credit here also. 66: Create An Artificial Kidney For an implantable artificial kidney, the first essential component is a hemofilter designed to emulate the glomerulus. Critical requirements for this hemofilter include high permeability (to maximize flow for a given area), selectivity (specifically, the retention of albumin), and robust blood compatibility (ensuring sustained function over time). Our initial strategy focused on using negative surface charge to reduce fouling. I began by testing polyelectrolyte (PE) coatings on 24nm pore membranes featuring a negative terminal charge, similar to the glomerular barrier. These initial static tests, assessing platelet adsorption in whole blood, yielded positive outcomes for some polyelectrolytes, indicating potentially desirable blood compatibility. However, static test setups are not truly representative of dynamic in-vitro conditions and don't provide data on key parameters like permeability, fouling progression, or changes in membrane selectivity. To address these limitations, I designed and built a blood filtration setup. This system sustains human whole blood in circulation for 20 minutes, allowing us to analyze all the aforementioned parameters, as well as platelet activation markers. This has resulted in a fairly high-throughput system for evaluating any surface coating. I'm pleased to report this setup has been accepted for presentation at this year's European Society for Artificial Organs (ESAIO) conference. I am also currently working on a full manuscript, as I believe this system offers a viable way to partially replace animal experiments in our early-stage research, requiring only 1.2ml of human blood per run. Working with a PhD student (hired to support both this research and work on membrane substrates), we have continued testing these PE coatings, alongside PEG coatings, on our membranes. Here, we're finding that optimization of the coating layer is crucial. With the current PE coatings, we observe a permeability drop of about an order of magnitude compared to the base membrane, making them unsuitable for an implantable device in their present form. This is likely due to the specific nature of the initial PE layer, which we can modify. We also suspect there may be ingress of PE into the pores, meaning we're not achieving just a surface coating (our goal), but rather a very thick coating, which would explain the flux loss. Optimizing the coating process to control penetration depth is now a primary focus of my ongoing work. I am currently aiming for a flux of 20ul/min (as this is cap introduced by the protein gel layer anyway) but for it to be at this 'steady state' permeability without drop in permeability. I am also imaging the membranes after contact with SEM to see if there is indeed any platelet adsorption etc. Tugrul has the dubious honor of maybe being "the only person to climb a 4000m peak with severe kidney failure". To raise money and awareness for his artificial kidney project, he is running Climb Against Time, where he will climb 41 mountains over 4000m (13000 ft) this summer. He is looking for donors and climbing partners. 67: Add Tardigrade Genes To Human Cells The goal of this one was to make hybrid cells that are more resilient for research and certain medical applications. They report: The grant was to synthesize vectors for the expression of humanized tardigrade proteins that can be targeted to different areas of the cell. All the vectors were designed, generated, and transposed into human cells. The proteins all localize successfully (e.g. they match the designed target), with one exception (we are still working on validating it). We've done some stress testing with the trangenic cells, but haven't reached firm conclusions yet. We've further generated some multigene designs but have not yet transposed them into cells, but should shortly. We're hoping to submit a manuscript on the first round later this year. 68: Teach Forecasting To EU Policy-Makers The original project didn't work out, but our grantee (who still prefers to remain anonymous) is now working with an EU think tank pursuing the same agenda, and has been teaching forecasting workshops to policy-makers for the past two months. 69: Platform For Single-Cell Imaging They ended up unable to accept this grant and returned the money. 70: Open Source Polygenic Predictor For EA/IQ They have an update here. They think they have a predictor that can explain 12% of variance in intelligence, and they’re working on validating it and creating an easy-to-use website. 71: Improve Flu Vaccines The grant mainly funded agent based modelling to demonstrate the benefit of pre-existing immunity to pandemic influenza if and when a future pandemic occurs (academic publication will result). The original proposal was to attempt to influence the WHO influenza strain selection process. After attending WHO meetings and a global influenza conference, I believe this is not feasible. Stakeholder feedback was the potential short term negative effect on vaccine hesitancy is believed to outweigh the less tangible future benefit. Given the conservative nature of decision makers, pandemic vaccines are likely to remain research only. There are still green shoots of research into pandemic preparedness/prevention that I am continuing to work on. I'm working under the "Australians for Pandemic Prevention" brand of Good Ancestors, another group that ACX funded in 2024. 72: Scenario Analysis For Developing World Agricultural Programs In addition to the research and analysis funded by the grant, I’ve learned to code with LLMs and have built an MVP of the project. The app is being considered for further development by staff at a large international organization. 73: Further C’s Political Career C’s political career is going well, but he continues to think it wouldn’t be strategic to give more information publicly at this time. Lessons Learned I'm most impressed with our lobbying/advocacy organizations. In particular, Good Ancestors has gotten the Australian government to sign onto an international AI safety declaration, partner with various x-risk-related organizations, and (possibly) extend charity tax deductions to some EA causes that previously didn't have it - I think this on its own goes a substantial way to paying back the cost of all ACX Grants. Coalition to Modify NOTA has a kidney donation bill in front of Congress that the (very illiquid) prediction markets give a 45% chance of passing; if it works, it could save thousands of lives. The Georgists are partly responsible for bills making land value taxes slightly easier to implement in a handful of states. Good Science Project seems to have significantly improved science. Are lobbying organizations a better bet than other types of nonprofit (within the constraints of ACX Grants)? I'm not sure. It could just be that lobbyists are (naturally) better at playing themselves up and sounding successful than (for example) scientists, or that politicians are good at people-pleasing and make people feel heard and encouraged in a way that might not change overall policy later. Also, I recently talked to some grantmakers who funded a lobbying organization that superficially seems excellent, but they expressed concern it was net negative (!) by taking away oxygen and spotlight from potentially more effective orgs. So I am encouraged but wary. Animal welfare organizations were another standout success. Again, I don't know how to think about this - while I think our grantees were exceptional, there's also an issue where the scale of animal welfare challenges is so great, and work on them so neglected, that lots of organizations can save a million chickens here, or a million fish there, without particularly making a splash. On the one hand, this is exactly what effective altruism should be doing - exploring grants that are very high in linear utility even if they don't feel satisfying. On the other, they're unsatisfying - and also hard to assess retroactively. How many chickens should a good animal welfare grant save? Any realistic number will both be overwhelmingly large in absolute terms and far too small in relative terms. I'm most ambivalent about our science grants. Many of them say they are successful and can point to published papers which explain the science they did. But it's hard to judge whether anything useful has changed based on the science getting done. I know it's important to fund basic research and not just last-mile technology startups, but it's hard for a mini-grants program like this one to evaluate these kinds of abstract interventions. One disappointing result was that grants to legibly-credentialled people operating in high-status ways usually did better than betting on small scrappy startups (whether companies or nonprofits). For example, Innovate Animal Ag was in many ways overdetermined as a grantee - former Yale grad and Google engineer founder, profiled in NYT, already funded by Open Philanthropy - and they in fact did amazing work. On the other hand, there were a lot of promising ACX community members with interesting ideas who were going to turn them into startups any day now, but who ended up kind of floundering (although this also describes Manifold, one of our standout successes). One thing I still don't understand is that Innovate Animal Ag seemed to genuinely need more funding despite being legibly great and high status - does this screen off a theoretical objection that they don't provide ACX Grants with as much counterfactual impact? Am I really just mad that it would be boring to give too many grants to obviously-good things that even moron could spot as promising? Someone (I think it might be Paul Graham) once said that they were always surprised how quickly destined-to-be-successful startup founders responded to emails - sometimes within a single-digit number of minutes regardless of time of day. I used to think of this as mysterious - some sort of psychological trait? Working with these grants has made me think of it as just a straightforward fact of life: some people operate an order of magnitude faster than others. The Manifold team created something like five different novel institutions in the amount of time it's taken some other grantees to figure out a business plan; I particularly remember one time when I needed something, sent out a request to talk about it with two or three different teams, and the Manifold team had fully created the thing and were pestering me to launch a trial version before some of the other people had even gotten back to me. I take no pleasure in reporting this - I sometimes take a week or two to answer emails, and all of the predictions about my personality that this implies would be correct - but it's increasingly something that I look for and respect. A lot of the most successful grants succeeded quickly, or at least were quick to get on a promising track. Since everything takes ten times longer than people expect, only someone who moves ten times faster than people expect can get things done in a reasonable amount of time. In almost every case where I thought to myself “this is a cool idea, but I don’t know how it’s going to really pay off, as opposed to reaching a cool intermediate accomplishment and then stagnating”, this was a correct criticism, and I should have taken it more seriously. But I can’t rule out that these were good in vague and hard-to-measure ways that I should take more seriously. This one is really self-serving, but in general when people were good communicators (or even bloggers) and wowed me with the writing-composition of their application, they turned out to be a good bet. And when people were hard to understand and annoying to communicate with, even if their ideas seemed good, they were less likely to pan out. Overall Thoughts The total cost of ACX Grants, both rounds, was about $3 million. Do these outcomes represent a successful use of that amount of money? Very naively, startups originating from ACX Grants have about $50 million in value1. If ACX Grants is equivalent to a pre-seed funder, and pre-seed funders usually get ~5%, then if we were VCs we would have a portfolio worth $2.5 million. About 1/5 of ACX Grants were attempting to be market-valued startups, so if we assume the charitable portion did about as well as the startup portion, then the charity portion is “worth” $10 million. There’s some reason to expect this is too high, since much of the startup value came from one successful outlier. But there’s another reason to expect this is too low, since we were aiming at charity rather than market cap, and any actual market cap that our grantees got was an unexpected side effect. I’m treating this as a sanity check rather than as a real number. It’s harder to produce Inside View estimates, because so many of the projects either produce vague deliverables (eg a white paper that might guide future action) or intermediate results only (eg getting a government to pass AI safety regulations is good, but can’t be considered an end result unless those regulations prevent the AI apocalypse). Because we tend towards incubating charities and funding research (rather than last-mile causes like buying bednets), achieved measurable deliverables are thin on the ground. But here are things that ACX grantees have already accomplished: Improved the living/slaughter conditions of 30 million fish.
Inline links: Progress and Poverty Substack, Climb Against Time, here, 1
ACX Grants Results 2025
October 13, 2025 · Original source
Elaine Perlman, $94K, to continue lobbying for kidney donation incentives. Elaine works with Waitlist Zero and the Coalition To Modify NOTA to promote the End Kidney Deaths Act, which offers valuable tax credits to kidney donors. They estimate this bill could save 100,000 lives over the next decade, and save the government $50 billion/year (dialysis is very expensive, Medicare currently covers it, and transplantees would no longer need it). Since our previous grant last year, the EKDA has been cosponsored by 29 members of Congress, discussed in the Journal of the American Medical Association, and profiled in the LA Times. The prediction markets are down to only 25% chance it gets passed this year, but I’m optimistic about 2026 - 2027
Inline links: End Kidney Deaths Act, Journal of the American Medical Association, the LA Times, 25% chance it gets passed this year