Clan culture weakens organ donation willingness—based on empirical evidence from China

The persistent global shortage of human organs underscores the urgent need to increase organ donation rates, making the identification of effective strategies a critical area of academic and policy enquiry. This study examines how clan culture—characterised by strong collective norms and hierarchical kinship structures—influences individual decisions to donate organs in China. Using the density of ancestral halls as a proxy for clan culture, we analyse data from 2226 participants across 276 prefecture-level cities in China. The results reveal that clan culture, as an informal institution, significantly weakens individuals’ willingness to donate organs. This association varies with the surrounding informal institutional environment: it is weaker where public discourse on organ donation is more active and where higher education is more prevalent, and stronger where religious activity is more widespread. These patterns point to a substitutive/complementary structure among informal institutions, in which some provide alternative sources of legitimacy while others reinforce the same bodily-integrity norms. By integrating clan-based cultural dynamics into the discourse on organ donation, this study contributes to a deeper understanding of how sociocultural contexts shape health-related behaviours and offers theoretical insights for designing culturally responsive organ donation campaigns.