The Spillover Effect of Suspending Non-essential Surgery: Evidence from Kidney Transplantation 

M. Zhang, G. Wang, and T. Dai. Under Review after Major Revision.

Organ transplantation is a life-saving procedure for patients with end-stage organ disease, where delays can have serious, even life-threatening, consequences. Between March and April 2020, amid the COVID-19 pandemic, multiple states in the U.S. temporarily suspended non-essential surgery. Although these suspensions were not intended for essential surgery (e.g., deceased-donor kidney transplantation), the literature on service operations implies such suspensions may have either a positive or negative spillover effect, depending on whether hospitals maintain or reduce resources. Motivated by these divergent implications, we estimate the potential spillover effect of suspending non-essential surgery on deceased-donor kidney transplantation. Analyzing a dataset of all U.S. kidney transplant procedures, we observe a steep decline in transplant volume during the early months of the pandemic, with states suspending non-essential surgery experiencing steeper declines. Using a difference-in-differences approach, we estimate a 15% reduction in transplant volume due to state-level suspension of non-essential 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.