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Existing research on organ donation has generally focused on message types but ignored how people’s innate preference, perceived similarity, affects the effectiveness of organ donation messages. To examine this issue, this study conducted a 2 (perceived similarity vs no perceived similarity) X 2 (sympathy vs pride) between-subjects factorial experiment to examine how perceived similarity affects emotional appeals in organ donation messages. The results revealed that regardless of emotional appeals, perceived similarity drives people’s intention to promote organ donation campaign and being an organ donor. Furthermore, no matter exposed to which type of emotional appeal message, perceived similarity induces both more sympathy and pride, which indicates a mixed altruistic and egoistic motivation in organ donation intention. These findings offer important theoretical and applied implications for future research.