By now you've undoubtedly heard that Facebook allows people to share their organ donor status. A friend of mine adjusted her information on the day of the announcement to reflect her donor status and someone quipped, "What did you donate?" Snark potential aside, it's a wonderful way to bring the donor community together and to raise awareness about organ donation overall. With over 100,000 people waiting for an organ donation and only 14,144 organ transplants in 2011, the prospects look grim for many—which has unfortunately driven a robust black market trade in body parts.

There is much to consider here regarding ownership and ethics. But there is also something to be said about social pressure, too. A 2010 survey (1) conducted by Donate Life America revealed the following reasons why people might not consider becoming an organ donor:

  • 52% of respondents were open to the idea that doctors may not try as hard to save their lives if their wish to be organ donors is known
  • 61% are open to the idea that it is possible for a brain dead person to recover from his or her injuries
  • 8% believe that organ or tissue donation is against their religion

These beliefs are unfounded:

  • If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ, eye, and tissue donation can only be considered after you are deceased.
  • While you can recover from comas, brain death is permanent and irreparable.
  • All major religions in the United States support organ, eye, and tissue donation.

Still, these ideas persist. The percentage of people who report believing that emergency personnel may not work as hard to save their lives or that they can recover from brain death remains high (pdf). What Facebook has done is launch a massive campaign to shift perception—after all, if you're friends are doing it, friends whom you've vetted (hopefully—we'll overlook that girl you met at the bar who swore she knew you in elementary school and then looked you up on Facebook a few days later) and opted to follow and share personal information with, then how bad could it be?

There's science behind the mechanisms of social pressure. If you think of behaviors as viruses, you can see that they're more powerful—or contagious—when passed between people who have contact with each other—and we're more likely to have contact with each other if we're friends. However, some network structures are better suited to this than others. Networks characterized by "long-ties"—where members have fewer overlapping connections and links appear to be more randomized—were believed to have a farther reach because they could transfer information to more unique members. But research has found that networks where members have a great deal of overlap between connections and interests—clustered networks—there are higher rates of behavior adoption because members can receive multiple signals that reinforce certain patterns (pdf).

In randomized networks, behavior is treated like a simple contagion where single contact is enough to pass the behavior on. But if you think about it, the challenge there is fairly illustrated by the Telephone Game: the message might be clear initially, but it gets diluted as it travels down the line. The same is true of behavior: the farther away you get from the original actor and the relationship you share, which provides a strong reason for why you might adopt the behavior, the less compelling it becomes to emulate and adopt her actions.

Behavior change is far from simple; it requires repetition. Within the clustered network frame, social behavior is regarded as a complex contagion, requiring multiple points of contact before "infection" can occur. In 2003, researchers Nicholas Christakis and James Fowler gave us a good example of the power of clustered networks by tracing obesity, smoking cessation, and happiness through the Framingham network—a fortuitous byproduct of a medical study that collected information on personal contacts, which allowed the participants' social networks to be mapped years later, and for researchers to trace the spread of certain behaviors. Christakis and Fowler found that:

  • If a person became obese, the likelihood his friend would also become obese was 171%.
  • When smokers quit, their friends are 36% more likely to also quit. (Although this effect diminishes as the separation between contacts grow, and loses its efficacy at four degrees of separation.)
  • Happy friends increased the likelihood of an individual being happy by 8%.

Framingham demonstrated that your contacts matter and that what they do is of great importance. Our networks help us establish a sense of what's acceptable—right down to expanding waistlines. The more social reinforcement we receive that certain actions are appropriate, the more likely we are to adopt those actions ourselves.

Facebook is clearly a clustered network. Part of the work done by Christakis and Fowler was to reproduce the measure of happiness in the Framingham network with a Facebook sample, and the results were strikingly similar. So if people start sharing their status as organ donors, it helps normalize the behavior, and minimizes the damaging effect of the misconceptions that hinder sign-ups. Peer pressure, in this form, can be powerful. It can convince you to do things you might not otherwise consider because you're afraid or it goes against what you think believe. Peer pressure can shift the social mindset.

But it's still peer pressure. And haven't we been taught that this is a negative thing?

There's already been an article asking why Mark Zuckerberg hasn't indicated that he's an organ donor. Should he have to? Or will he have to in order to be accepted? Silly question? Replace Zuckerberg with Joe Smith or Jane Doe and ask it again. How will we view people who fail to publicly comply with a greater social norm of the network? Do we freeze them out?

This is different from sharing a political or religious affiliation or music group or favorite because it's a status that's meant to cross boundaries. While very few people will argue that becoming an organ donor is a bad thing, it still remains a choice, and now it's become a choice that we can be judged on. For example, in the Framingham study smokers mingled freely with nonsmokers in 1971 and they were distributed evenly throughout the network. However, by 2001 as groups of smokers quit, those who persisted were socially isolated. What if we required people to list their status as smokers or non-smokers—how would our networks shift as a result of this information?

If organ donor status becomes a part of the basic set of information a person can share on Facebook—it's not, but let's consider the possibility—how would this missing piece of information color your interaction? Does it frustrate you to not know this bit about your connection? Will you think twice about connecting with them? And if it's not the organ donor status that does it, then what will? Knowing whether the person was bullied or was a bully as a child? Whether he as high blood pressure?

At the very least, this allows a community of donors who might not have otherwise known each other to find and connect with others who have made this very important commitment. This is a concerted effort to harness the potential power of a clustered network. Still, it's not a network that exists in isolation. There's no telling what will happen as a result of making this information public and no telling how far it will actually reach, but the impact of external factors, such as media attention, on network behaviors can't be discounted. We'll just have to watch and see. In the meantime, do you plan to share your status as an organ donor?

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1. Unfortunately, I couldn't find the original survey that I had linked when I previously discussed these data, but you can view the original press release with the stats above here (pdf).


Centola, D. (2010). The Spread of Behavior in an Online Social Network Experiment Science, 329 (5996), 1194-1197 DOI: 10.1126/science.1185231

Christakis, N., & Fowler, J. (2007). The Spread of Obesity in a Large Social Network over 32 Years New England Journal of Medicine, 357 (4), 370-379 DOI: 10.1056/NEJMsa066082

Christakis, N., & Fowler, J. (2008). The Collective Dynamics of Smoking in a Large Social Network New England Journal of Medicine, 358 (21), 2249-2258 DOI: 10.1056/NEJMsa0706154

Rosenquist, J., Fowler, J., & Christakis, N. (2010). Social network determinants of depression Molecular Psychiatry, 16 (3), 273-281 DOI: 10.1038/mp.2010.13


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