The Spillover Effect of Suspending Nonessential Surgery: Evidence from Kidney Transplantation

Kidney transplantation is a life-saving procedure for patients with end-stage kidney disease. A delay in kidney transplantation has serious, even life-threatening, consequences. This study examines the impact of suspending nonessential surgery on deceased-donor kidney transplantation. Between March and April 2020, amid the COVID-19 pandemic, multiple states in the United States temporarily suspended nonessential surgery. Although these suspensions were not intended for deceased-donor kidney transplantation, because it is an essential surgery, the literature on service operations implies such suspensions may have either a positive or a negative spillover effect, depending on whether hospitals maintain or reduce resources. Motivated by these divergent implications, we estimate the potential spillover effect of suspending nonessential surgery on deceased-donor kidney transplantation. Analyzing a data set of all U.S. kidney transplant procedures, we observe a steep decline in transplant volume during the early months of the pandemic, with states that suspended nonessential surgery experiencing steeper declines. Using a difference-in-differences approach, we estimate a 13% reduction in transplant volume due to state-level suspension of nonessential surgery. This negative spillover effect is particularly pronounced in low-efficiency transplant centers with long cold ischemia times (CITs) but less so in high-efficiency centers, suggesting CIT is a key indicator of operational resilience against disruptions. Our mediation analysis reveals more than 40% of the spillover effect is attributable to changes in healthcare employment. This study indicates that in future public health crises, policymakers should adopt nuanced strategies to secure the healthcare workforce essential for supporting critical services, especially in centers with longer CITs. This paper was accepted by Jayashankar Swaminathan, operations management. Funding: This work was supported by the Johns Hopkins Bloomberg School of Public Health Hopkins Business of Health Initiative seed grant, “COVID-19 and the Business of Health”. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.03624 .