Acclaimed documentarian Penny Lane’s (LISTENING TO KENNY G, HAIL SATAN?, NUTS!) newest film is CONFESSIONS OF A GOOD SAMARITAN, which made its world premiere at the 2023 SXSW Film Festival, winning The Hope Special Award. In the film, Lane documents the donation of one of her kidneys to an unknown recipient in need, exploring why this major surgery felt like such an obvious decision for her to make. She does so through confessional-style interviews, conversations with other altruistic donors, and explorations into the history and ethics of organ transplantation as well as what distinguishes someone as altruistic.
CONFESSIONS OF A GOOD SAMARITAN is directed by Penny Lane, produced by Gabriel Sedgwick, edited by Hannah Buck, and filmed by Naiti Gámez. We spoke with Lane from her home in Brooklyn about the challenges of making such a personal film, what she learned and didn't learn from the neuroscience of altruism, and the past and future of organ donation.
Science & Film: CONFESSIONS OF A GOOD SAMARITAN seems to be set mostly in real time, as events are transpiring, and I’m wondering how you approached that as a filmmaker as related to some of your other work? It is part desktop film, how did you come to that decision?
Penny Lane: It took four years to make this film. It always had this very unwieldy quality, and it's still there. It just kept branching out in different directions, and halfway through filming I was like, I gotta contain it somehow. So, the idea for the desktop element came about when I needed some sort of container.
Around the same time, I realized that I was going to have to use my diaries in the film, which wasn't something I had started out planning to do. There were two reasons. A lot of the narrative had already happened before picking up the camera which, by the way, is the classic documentary problem. I always told my students: we have serious act one problem in documentary, because by the time you pick up the camera, the beginning is over. That's how you knew to pick up the camera was that the adventure had begun. But in this case, it was really a challenge figuring out how to represent the totality of the experience of donating a kidney when I only started filming pretty far into the process. And then the second reason [I chose to use my diaries] was that I started to understand that the choice to put myself in the film wasn't going to be as simple as I'd wanted it to be, which was: I'll just be there a little bit and I'll help glue things together. I started to understand that I had created a protagonist and I needed to commit to that. The journey of that protagonist was very psychological.
I was inspired by Chloé Galibert-Laîné's film about THE PAIN OF OTHERS, which is a desktop film in a much more rigorous, short film and experimental film way. And I was like, I could do something like that – I could see that [desktop element] as being a container that I could try to put things inside of and it will allow me the freedom to jump between disparate elements in a way that feels intentional, and not just like everything but the kitchen sink has gone into this film. The other film that I've made that's as “everything but the kitchen sink” was NUTS! Every documentary technique is in that movie. This film is similar in the sense that it's like: what techniques are out there? Let's use them, there's so many! [The desktop element] ended up playing out well with the themes of the film, because so much of the film ended up being about isolation. The Penny character that I crafted – and it's very much crafted, and not just captured – she was a lonely person. That’s effectively true in some spiritual sense, but it's not like I showed that I even have friends. You wouldn't know that I hang out with people [laughs]. I was really trying to emphasize the modern condition. You see outside of my apartment building, and you see all the little windows, the individual people inside them, and it feels so modern to me. It just feels like New York, you know. So many people, but everyone's alone in their little window.
S&F: You've explored other niche communities in films like HAIL SATAN?, did you approach the altruistic donors you interview in this film in a similar vein?
PL: That is a good observation in the sense that the people who are part of the altruistic donor community are outsiders who can only relate to one another in certain kinds of ways. [For them it's like,] you have a moral intuition, an impulse, and a concept of what seems normal and rational in your head but somehow no one agrees with you except for this tribe. This relates to the satanists because one of the things I was interested in with the Satanic Temple was that there was a community of outsiders, and I very much related to them in that way.
I've always felt like, if there's ten people in a room, and there's a consensus forming, my instinct would be like, Oh, actually... I'm not capable of not being a devil's advocate. It's my basic personality [laughs]. What you see in CONFESSIONS OF A GOOD SAMARITAN is I don't necessarily feel like I fit in with other donors, either. They just seemed really happy, and I was not feeling that way. It was the week before my surgery, so I was freaking out, and they were all years out. They had the good sense to not film themselves throughout the whole process. They probably had found it frightening and depressing, but didn't remember because, you know, the warm glow of altruism had washed over the whole memory. I also filmed them with a glowing white background and I put myself in a dark studio. But yeah, I definitely felt like I didn't fit in with them either. And I've never been a joiner. There's a club called the "One Kidney Club" and they meet up and hang out, and I have no interest in going.
S&F: But when you talk to the neuroscientist, there's a sort of affirmation that maybe there is something biologically connecting you with this community. Why did you want to go the hard science route in terms of relating or not to this community of altruistic donors?
PL: When I started out, I didn't know that there was a neuroscientist who studied the brains of altruistic donors. That wasn't in my original conception. But I did know that I wanted to do the history of transplantation; I had done tons of research into that, so there was already a science angle in the film. But the science of altruism, it would have been like a cinematic crime not to explore it. There was this psychological mystery that was the whole point of the movie – the only reason I made this movie was because I was haunted, I didn't understand what was happening in my head, what was happening in their heads [those of altruistic kidney donors] and why everyone doesn’t see this [donating a kidney] in the same way. Finding out that there was a psychologist who literally studies this, it's such an amazing discovery, and then to find out that she's like, a movie star and so good on camera was a whole other level of luckiness. But I kind of knew going into it, because I'd read her book, that when we started filming, it wasn't going to solve anything. The brain scans are fascinating, but ultimately, you're like, okay, I have no idea what to do with this. It's not like if your amygdala is big, you're empathetic. These are averages, these are populations. It tells you something, but it's such a huge anticlimax in the film. I even kept in the joke: I was like, I guess I can go home now. I don't know what it means. It only adds to the mystery, it doesn't get you much traction in the mystery.
Still from CONFESSIONS OF A GOOD SAMARITAN
S&F: I thought you handled it really well, in the sense that you keep in the line where the scientist says a brain scan is like a photo. It's a representation of something at a period of time...
PL: And at this moment in your life, right? We don't have historical data on the size of my amygdala. Did it get bigger over time? Does that ever happen?
S&F: How did you find out about her work in the first place?
PL: I would have found her anyway because I would have been googling and she's pretty well known, but I actually met her at a science retreat. I met her at a retreat in Woods Hole that the National Academy of Sciences produces. Once a year, they get together 12 scientists and 12 documentary – film, video, journalism – people. I met her there and we hit it off, and we were like best buds the whole weekend. It was only on the last day when she did her mini presentation, and I was like, are you fucking kidding me? So I became aware of her early in the process of making the film, but it wasn't like finding her was the beginning of it. I was at that time much more on the bioethics side of things, how our ethical intuitions have changed alongside the technological possibility of transplantation and looking at that from a science perspective. I hadn't thought about the idea of doing the hard science of altruism because I didn't know that was a thing.
S&F: How have our ethics regarding transplantation changed alongside technological advancements?
PL: The example I give in the film is the example of the first successful human-to-human transplant between identical twins. At the time, it was pretty much the consensus view that this was unethical; you should not cut open a healthy person and make them endure all the risks of surgery, even if it means saving the life of their twin. That case was an outlier. The idea that you would do that was shocking, controversial, and people didn't like the idea. Imagine that reaction at each stage of development [of organ transplantation technology]. As the immunosuppression got better, now it's mothers and sons, and now it's cousins, and now it's close friends, and now it's strangers. And now it's what, pigs? Which is not not an ethical question. There is an ethical revulsion until it becomes normal, and you see the good outcomes – the guy who was going to die being happy and alive at age 50. So, to me, it felt really important to show that because it's easy to look at our current ethics and think we've always had this ethics. That's so completely not true.
S&F: In the film, you make it clear that TV and broadcast media played a huge role in popularizing organ donation.
PL: I wouldn't have had the idea to give a kidney to a stranger on my own. It would never have crossed my mind if I hadn't seen news stories. I probably heard about it three times before it clicked and I was like, I want to do that.
S&F: So how do you feel about the inevitability of your film in that lineage?
PL: I feel mixed, like everything else. But guess what, life is fucking tragic. There's no perfect utopian outcome because, let's say one in 1,000 people who are living donors die. And that's a number that, as you see in the film, is contestable. It depends on how you ask the question, and what the data set is. I really struggled with that part of the film because, I've got my surgeon and his white lab coat saying one on 1,000, the kidney advocates say one in 10,000, and those are really different fucking numbers. I'm just like, thank God I'm not an advocate or a surgeon. I'm just giving you the people's numbers and hoping that you can sort it out yourself.
There's never been an altruistic kidney donor who's died. That hasn't happened yet. But that's only because there's so fucking few of us. So, let's say my film was wildly successful and was on every television in America, and everyone watched it and next year, there are 2,000 people who give kidneys. One of them is going to die! There's going to be an altruistic donor who dies if people like me are successful in raising awareness and encouraging people to do it. And so of course I feel mixed feelings about that. That's why I'm Googling: When are the CRISPR pigs going to be ready? I don't think that's an ethical free pass either, certainly not. But I am loathe to think that human beings should be doing what I did if there are better alternatives available. No human being should be a living organ donor. It's too risky, right?
S&F: I guess, yeah.
PL: I tried so hard to think about, how do you present the risks in context? What does it mean to say one in 1,000? Even one in 10,000? Is it riskier to drive your car to work every day? Is it riskier to have a child? There are all these things you can try to compare it to but ultimately, we're such bad risk analysts, it doesn't really matter [laughs]. I guess what I'm saying is if the bioethical and medical community has decided, as a group, this is okay, then who am I to argue with them? I don't know how to analyze those risks. People who give kidneys are often inspired to give a part of their liver. That's a common trajectory. That's a much more dangerous surgery. I'm like, is that too dangerous? Why do I feel like that's too dangerous and giving a kidney isn't? Is it just that I've absorbed the popular understanding of risk? Or do I really have some internal risk meter?
I'm not interested in telling people what to do, or giving the hard sell. I also don't think it's going to work with this because I've never met one altruistic kidney donor who started out being like, absolutely not, and then heard some argument and changed their mind. I've never met that person. The most I can do is to say, this is a thing, you can do it, it's probably easier than you think it is, but by the way, it was harder than I thought it would be. I don't know what the fuck I was picturing by the way, like what did I think it was going to be, a tonsillectomy? Christ, it was a major surgery. I don't know why I didn't foresee the amount of terror. Maybe I was just naive. But that's part of what makes me feel proud and satisfied, it wasn't easy. If there is anything you should be allowed to feel proud about, it probably should be this. Yet again, this is the complication of the project. I know, because I was around during Bad Art Friend, that people don't necessarily love it when you do a good thing and then are perceived to be bragging about it. That was part of my big reticence in doing this project. But then again, the word bragging is used in a very loose way; just saying that you did it would qualify.
I can tell any potential future kidney donors who might be thinking that [donating a kidney] is a good way to get attention and get people to like you that this is not your move. I can post, "I got a Guggenheim" and I will get 1,000 likes. And I can then post: “next week I'm going into surgery to give a kidney to a stranger,” and I'll get ten likes and then five people will be like, what the fuck is wrong with you? You can only imagine the things people are saying behind your back so, it wasn't exciting to me to put myself in that position. Even though again, I feel like, what else should you feel pride for? It feels taboo to even say that to you that I feel prideful for having done it.
There's something in psychology called do-gooder derogation, it's mostly been studied in relationship, interestingly, to vegans, where there's a sizable amount of the population that is going to react very negatively [to this choice]. In my non-scientific, casual observance, it's one of ten. Most people do not react negatively but the people who do have such a big impact on your psyche, it's so upsetting. It's very clearly seen as some kind of ethical threat. I understand that and appreciate that. I remember before I was vegan, I thought vegans were the worst. I've been on both sides. Now that I am vegan, I'm like, gee, I've never once tried to convince anyone to be vegan. I've never once lectured someone about their food consumption. And yet, a number of people will still react pretty negatively to me.
Part of what I liked about [being an altruistic donor] was that it was a moral challenge, not only to myself, but to the people around me. That was part of what I enjoyed about the topic and enjoyed about the film, even though again, I didn't love the idea of putting myself at the center of it. But it had to be me because was I going to meet another altruistic donor and subject them to the level of horrible questioning and doubt that I put myself through? No! I was not going to do that.
S&F: This is going too far afield but I'm weirdly thinking of the CURB YOUR ENTHUSIASM episode where he gives the donation anonymously...
PL: Amazing, I tried to put it in.
S&F: What are you working on next?
PL: I've been working for quite a while on an observational film about a beauty pageant system in America that's called Mrs. America, for married women. It's the alternative to Miss America. Most people don't even know this, but you have to be single to be in Miss America. So, if you're married, you can be Mrs. America. I've been inside that system, making this very, very intense observational film for about a year. And then I'm also working on a film about children's music. I'm not intending to be in or even close to in either one of these movies. I'm not saying never, I would never say never. But the challenges of eliminating that distance between author and subject were very real. And they weren't emotional. Artistically it felt impossible most days because I usually have a really good, clear sense of character. Like, which aspects of Kenny G's character matter to this film? That's a very important part of the director's job. You're interviewing someone and they're going on and you know already that this isn't relevant. But for this film it was like, I'm like rambling on about my grandmother, is this relevant? I think it was part of what made the film take so long to make was I had to rely on my creative collaborators way more than usual, which is already a lot, because I had no perspective ever, and I probably still don't.
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