For many patients who struggle to lose weight or quit smoking, their biggest obstacle is self-motivation. Instead of focusing on themselves, however, a better inspiration may be to do it for someone else — and even save their life.

According to the National Kidney Registry, only about 1% of people who register to donate are successful. An estimated 10%-44% get screened out because of their weight or smoking status.

“It is something that is mutable. It is addressable,” said Daniela Shuman, co-director of Project Donor, a nonprofit that aims to give ineligible donors the extra boost they need to shed pounds or quit smoking so they can qualify. “We’re identifying candidates who are highly motivated.”

The program — founded in 2023 by economist and “Freakonomics” author Stephen Levitt — channels that motivation by providing and paying for practical weight-loss tools including Weight Watchers or Noom subscriptions, scales and blood pressure monitors, and case managers who provide ongoing accountability and support. For potential donors who may have been rejected for smoking concerns, Project Donor also provides nicotine replacement therapy.

More than 1000 people have participated, and about half remain actively working toward their goals, Shuman said. One hundred seventy-eight have successfully donated organs, achieving a 17% donation rate that’s eight times the national average. Participants lose about 13 lb on average, and one person reported losing 102 lb. Postdonation follow-ups show that participants tend to keep the weight off.

Elizabeth Acosta, 50, of Edison, New Jersey, lost 17 lb in 3 months last year through Project Donor so she could donate part of her liver to save her boyfriend, Chris Chiucchi, who had end-stage liver failure.

“Somebody’s life was literally depending on me getting rid of the excess fat,” Acosta said. After a lifetime of battling weight issues and reaching her heaviest during the pandemic, she said it stopped being a question of whether she could get the weight off and started being a question of when.

Penn Medicine, the Philadelphia hospital where Chiucchi would have his operation, had said it could push his surgery until June of 2025. “But I was scared he wasn’t going to make it to June,” Acosta said. “I had been watching him, little by little, fall apart.”

Penn Medicine required donors to have less than 30% body fat, meaning Acosta needed to lose 15-20 lb to qualify. Through a pamphlet the hospital gave her, she found out about Project Donor. The program gave her access to Weight Watchers and a nutritionist, and in just 90 days, she met her goal. In May 2025, she donated 63% of her liver to Chiucchi, her now-fiancé.

The Science of ‘Prosocial Motivation’

Acosta’s success illustrates “prosocial motivation,” the drive to make changes that benefit others.

“You can bring benefits to other people on top of the health benefit you generate for yourself,” said Hengchen Dai, PhD, associate professor of management and organizations and behavioral decision making at UCLA.

Identity plays a big role, Dai said, particularly for people who see themselves as helpers. During the COVID pandemic, researchers found that people who were motivated by protecting others — not just following rules — showed significantly better adherence to masking and distancing. The impulse proved especially powerful when people identified strongly with humanity. Those who saw themselves as helpers of all people, not just their immediate community, maintained protective behaviors more consistently.

Neuroimaging studies reveal why. Prosocial decisions activate a network of brain regions including the anterior cingulate cortex (ACC), prefrontal cortex, and areas involved in reward processing. The ACC seems particularly important — it’s involved in both feeling others’ pain and making decisions to help them.

Research in rats shows that those who help have higher levels of oxytocin receptors (for the “love” hormone oxytocin) and increased empathy- and motivation-related brain regions, suggesting that social bonds drive prosocial behavior.

Perhaps most intriguingly, the vagus nerve — which connects the brain to the heart and gut and regulates key functions like heart rate, digestion, and the body’s stress response — appears to play a role. When activated by stimuli such as deep breathing, meditation, or acts of compassion, vagal activity inhibits the defensive “fight-or-flight” response and supports prosocial motivation and cooperation.

Research also shows that the positive effects of prosocial behaviors appear to produce lasting improvements in mental health and emotional well-being, suggesting that their psychological benefits persist even after the helping behavior ends.

Despite its strength, though, prosocial motivation is not a magic bullet. Emphasizing COVID vaccines’ protective benefit to others did not increase vaccination rates, Dai’s team found. This suggests it might work better for ongoing lifestyle changes than for one-time health decisions.

Context and relationship also matter. While Acosta’s intimate connection to her fiancé created a powerful personal motivation, abstract appeals to help strangers may carry less weight.

Project Donor’s approach also highlights the limits of prosocial motivation. Of the program’s 1027 participants, only 178 have donated. Successful donors also tended to have a lower starting BMI. The program is also likely most effective for people who are already highly motivated and face manageable health barriers. Participants with greater issues may need additional support, longer timeframes, or other motivational strategies.

Making Prosocial Motivation Work for Your Patients

The principle of prosocial motivation can extend to everyday health goals. Rachel Murphy, a 45-year-old mother of two in Kansas City, Missouri, found inspiration in her daughters.

“I’m just desperate to see them grow up,” Murphy said. As she learned more about aging and heart health, the importance of personal change became clear. “I just don’t want to be that person that — surprise — had a heart attack.”

Murphy illustrates a key point that healthcare providers should express to patients: Consider who else might benefit from their health changes. They may have kids who need them healthy, or workout partners who rely on them for accountability, or loved ones who want them to be around for a long time. Patients may even ask family members directly how their health affects them, and they might be surprised by their worries or hopes.

Doctors can also encourage patients to reframe their inner dialogue. Instead of telling themselves, “I need to work out,” they could instead say, “I’m exercising because I love my family and I want to be there for them.” The key is finding connections that feel personally meaningful. Adding this social element to goals costs nothing and may provide the extra push needed to maintain new routines.

Murphy’s changes have been gradual but consistent — she’s lost 20 lb since she started her health and fitness journey and feels more energetic. She has incorporated more whole foods into her diet and added resistance training.

She’s also careful about the message she sends to her daughters: “I’m trying not to say, ‘Oh, I’m trying to lose weight.’ It’s more that I want to be healthy, so that they see an active mom.”

For Acosta, what started as urgent weight loss to save her fiancé has become a sustained lifestyle change. Post-surgery, she continues walking 21,000 steps daily and has lost another 7 lb. “I take my recovery seriously,” she said. “I was healthy going in and I wanted to be healthy coming out.”