{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:21:39Z","timestamp":1791890499060,"version":"4.3.4"},"reference-count":79,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,9,8]],"date-time":"2015-09-08T00:00:00Z","timestamp":1441670400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec><jats:label\/><jats:p><jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:p><jats:bold>Policy Points<\/jats:bold>:<\/jats:p><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The growing shortage of life\u2010saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Because community\u2010level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:boxed-text><\/jats:p><\/jats:sec><jats:sec><jats:title>Context<\/jats:title><jats:p>The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community\u2010level factors explain geographic variation in organ donor designation rates in Massachusetts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community\u2010level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent\u2010death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community\u2010level characteristics with organ donor designation rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner\u2010occupied housing, native\u2010born residents, and white residents had higher rates of organ donor designation (<jats:italic>p<\/jats:italic> &lt; 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R<jats:sup>2<\/jats:sup> = 0.52).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The findings suggest that community\u2010level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1468-0009.12139","type":"journal-article","created":{"date-parts":[[2015,9,9]],"date-time":"2015-09-09T05:37:30Z","timestamp":1441777050000},"page":"609-641","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Does Social Capital Explain Community\u2010Level Differences in Organ Donor Designation?"],"prefix":"10.1111","volume":"93","author":[{"given":"KEREN","family":"LADIN","sequence":"first","affiliation":[{"name":"Tufts University"},{"name":"Tufts University Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RUI","family":"WANG","sequence":"additional","affiliation":[{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AARON","family":"FLEISHMAN","sequence":"additional","affiliation":[{"name":"Transplant Institute Beth Israel Deaconess Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MATTHEW","family":"BOGER","sequence":"additional","affiliation":[{"name":"New England Organ Bank"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAMES R.","family":"RODRIGUE","sequence":"additional","affiliation":[{"name":"Harvard Medical School"},{"name":"Transplant Institute Beth Israel Deaconess Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,9,8]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"United Network for Organ Sharing.United Network for Organ Sharing Annual Report 2012.www.unos.org\/docs\/AnnualReport2012.pdf. 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