Research

Evidence a legislative aide can actually use.

We evaluate registration and authorization policy the way you'd evaluate any state-level intervention — carefully, quasi-experimentally, and with the uncertainty stated out loud.

Publications

manuscriptunder review2026

Mandatory Active-Choice Donor Registration and Deceased-Donor Organ Yield: A Quasi-Experimental Study of California's SB 1395

California's 2011 SB 1395 — the only U.S. law that requires every DMV applicant to make an explicit yes-or-no donor decision, with blank answers rejected — is a natural experiment in registry design. Using OPO-level OPTN/SRTR data (2006–2016), we compared California's four OPOs against neighboring passive-choice states. Both an augmented synthetic control and a difference-in-differences model associated active-choice architecture with higher organ yield (DiD ATT +0.216, P = .020), and the organ-specific effects followed the expected ischemia-tolerance order — heart > lung > liver > kidney — consistent with active choice cutting the consent delays that damage the most time-sensitive organs first.

Methods: Quasi-experimental design; augmented synthetic control (primary) and difference-in-differences (robustness) on OPO-level OPTN/SRTR data, 2006–2016; in-space placebo and wild-cluster-bootstrap inference.

Key finding

When California made the donor question mandatory, organ yield went up.

California's SB 1395 is the only U.S. law requiring every DMV applicant to answer the donor question — yes or no, no skipping. Comparing California's procurement organizations against neighboring opt-in states, active-choice registration was associated with higher deceased-donor organ yield (difference-in-differences ATT +0.216, P = .020). The effect was largest for the most time-sensitive organs — heart, then lung, then liver — exactly what you'd expect if the policy cuts the consent delays that damage organs fastest.

Associational estimate from a manuscript under peer review; confidence intervals and full methods in the paper.

Methods, in plain language

Why quasi-experimental designs are the right tool.

You can't randomize states into policies. So to know whether a registration reform actually worked, you have to reconstruct the counterfactual — what the state would have looked like without it. Here's how, without the jargon.

Treated state (actual) Synthetic control (counterfactual)

Illustrative schematic — not real estimates.

01
The problem with before-and-after
When a state changes its registration policy, you can't just compare the year before to the year after — donation rates move for a dozen reasons at once. You need to know what would have happened without the policy.
02
Building a synthetic control
We construct a ‘synthetic’ version of the state from a weighted blend of comparison states that tracked it closely before the change. The gap that opens up after the policy is the estimated effect.
03
Difference-in-differences
We cross-check by comparing the change in treated states against the change in untreated ones over the same window, netting out shocks that hit everyone. Two designs that fail in different ways are harder to fool than one.

History

Where we've been.

2026

OAI founded

Anvit Divekar launches the Organ Access Initiative in March 2026 to advocate for mandated-choice organ donor registration.

2026

First chapters launched

Georgia Tech, UCSD, Ohio State, and Fort Bend County chapters go active, spanning GA, CA, OH, and TX.

2026

AJPH paper submitted

Quasi-experimental study of California SB 1395 (active-choice registration) submitted to the American Journal of Public Health.

2026

National expansion

Five new chapters launch across CA, OH, KY, and IL — bringing OAI to 9 chapters across 6 states. International expansion in progress.

The literature behind the argument.

These papers shaped how we think about registration reform. None are paywalled where we've linked them.

Annals of Internal Medicine2008

Mandated choice for organ donation: time to give it a try?

Thaler, R.H. & Sunstein, C.R.

The originators of nudge theory argue that requiring a yes-or-no answer at license renewal would dramatically increase registration without coercion.

Read the paper ↗

Health Psychology2008

The gap between willingness and registration in organ donation: a nationwide survey

Siegel, J.T. et al.

Documents the 30-point gap between stated support for donation (~90%) and actual registration (~60%) and identifies registration friction as the primary cause.

NBER Working Paper2012

Active-choice informed consent in California organ donor registration

Kessler, J.B. & Roth, A.E.

Field experiment showing that forcing an explicit yes/no choice (rather than allowing the question to be skipped) significantly increases registration rates.

Read the paper ↗

European Journal of Health Economics2012

Presumed consent vs. mandated choice in organ donation: a meta-analysis

Bilgel, F.

Finds mandated choice produces registration and donation rates comparable to opt-out systems while preserving individual autonomy — the key trade-off in policy design.

Collaborate with us.

We work with academic researchers, organ procurement organizations, and policy staff. If our methods or data are useful to you — or yours to us — reach out.

Get in touch

Mandatory Active-Choice Donor Registration and Deceased-Donor Organ Yield: A Quasi-Experimental Study of California's SB 1395

Why quasi-experimental designs are the right tool.

Treated state (actual) Synthetic control (counterfactual)

Illustrative schematic — not real estimates.

01
The problem with before-and-after
When a state changes its registration policy, you can't just compare the year before to the year after — donation rates move for a dozen reasons at once. You need to know what would have happened without the policy.
02
Building a synthetic control
We construct a ‘synthetic’ version of the state from a weighted blend of comparison states that tracked it closely before the change. The gap that opens up after the policy is the estimated effect.
03
Difference-in-differences
We cross-check by comparing the change in treated states against the change in untreated ones over the same window, netting out shocks that hit everyone. Two designs that fail in different ways are harder to fool than one.

Where we've been.

2026

OAI founded

Anvit Divekar launches the Organ Access Initiative in March 2026 to advocate for mandated-choice organ donor registration.

2026

First chapters launched

Georgia Tech, UCSD, Ohio State, and Fort Bend County chapters go active, spanning GA, CA, OH, and TX.

2026

AJPH paper submitted

Quasi-experimental study of California SB 1395 (active-choice registration) submitted to the American Journal of Public Health.

2026

National expansion

Five new chapters launch across CA, OH, KY, and IL — bringing OAI to 9 chapters across 6 states. International expansion in progress.

The literature behind the argument.

These papers shaped how we think about registration reform. None are paywalled where we've linked them.

Annals of Internal Medicine2008

Mandated choice for organ donation: time to give it a try?

Thaler, R.H. & Sunstein, C.R.

The originators of nudge theory argue that requiring a yes-or-no answer at license renewal would dramatically increase registration without coercion.

Read the paper ↗

Health Psychology2008

The gap between willingness and registration in organ donation: a nationwide survey

Siegel, J.T. et al.

Documents the 30-point gap between stated support for donation (~90%) and actual registration (~60%) and identifies registration friction as the primary cause.

NBER Working Paper2012

Active-choice informed consent in California organ donor registration

Kessler, J.B. & Roth, A.E.

Field experiment showing that forcing an explicit yes/no choice (rather than allowing the question to be skipped) significantly increases registration rates.

Read the paper ↗

European Journal of Health Economics2012

Presumed consent vs. mandated choice in organ donation: a meta-analysis

Bilgel, F.

Finds mandated choice produces registration and donation rates comparable to opt-out systems while preserving individual autonomy — the key trade-off in policy design.

Mandatory Active-Choice Donor Registration and Deceased-Donor Organ Yield: A Quasi-Experimental Study of California's SB 1395

Why quasi-experimental designs are the right tool.

The problem with before-and-after

Building a synthetic control

Difference-in-differences

Where we've been.

OAI founded

First chapters launched

AJPH paper submitted

National expansion

The literature behind the argument.

Mandated choice for organ donation: time to give it a try?

The gap between willingness and registration in organ donation: a nationwide survey

Active-choice informed consent in California organ donor registration

Presumed consent vs. mandated choice in organ donation: a meta-analysis

Collaborate with us.

Mandatory Active-Choice Donor Registration and Deceased-Donor Organ Yield: A Quasi-Experimental Study of California's SB 1395

Why quasi-experimental designs are the right tool.

The problem with before-and-after

Building a synthetic control

Difference-in-differences

Where we've been.

OAI founded

First chapters launched

AJPH paper submitted

National expansion

The literature behind the argument.

Mandated choice for organ donation: time to give it a try?

The gap between willingness and registration in organ donation: a nationwide survey

Active-choice informed consent in California organ donor registration

Presumed consent vs. mandated choice in organ donation: a meta-analysis

Collaborate with us.