When transplant surgeons switched between different organ types in consecutive surgeries, one-year mortality rates in patients increased by 14.8 percent, according to new Virginia Tech research. The findings suggest that scheduling and workflow changes could help reduce these risks – and the implications may extend beyond medicine.
We were surprised by how large the effect was – the performance gap from a single switch was comparable to a meaningful share of the experience gap between newer and more seasoned surgeons.”
Jiayi Liu, assistant professor in the Pamplin College of Business Department of Business Information Technology
Her research, recently published in Nature Human Behaviour, analyzed over 300,000 transplant surgeries from 2007-19 and provides causal evidence that task switching – transitioning between cognitively different procedures – can affect patient outcomes.
In modern work, task switching is everywhere, yet its mental toll is notoriously hard to measure. In the real world, people usually switch tasks because they are already distracted or overwhelmed, which blurs the data. Organ transplants, however, provides an environment to isolate exactly how switching tasks impacts performance.
Liu’s research found that not all switches were equally costly. The penalty was negligible when surgeons switched between similar procedures, but increased sharply when the switch required a fundamentally different surgical approach. “Most schedules are organized by urgency or convenience, but our findings suggest a more effective principle: grouping tasks by cognitive similarity and giving surgeons longer stretches of focused time on one type,” Liu said.
The study also found that recovery time matters. A one-day interval between procedures reduced the switching penalty, suggesting that recovery time helps surgeons reset before the next operation.
“We found a striking pattern. When a switch occurs on the same day, the mortality rate for those patients rises sharply – from about 4.5 percent to 7.2 percent,” Liu said. “If you have even a night to rest between surgeries, the switching cost is much lower, and with two days in between, the effect is essentially gone.”
Switching costs were also influenced by the experience level of a surgeon. Liu found that surgeons with greater cumulative experience in a given organ type, as well as those who maintained a more balanced portfolio across multiple organ types, were less affected by switching. This suggests that both depth and breadth of experience may be protective when switching is unavoidable.
Technology also may help reduce switching costs. Scheduling tools, including those powered by artificial intelligence, could be designed to minimize high-risk transitions by spacing out resources and reducing overwork. Additionally, technology could serve as a buffer between surgeries – simulation platforms, such as virtual reality, can help surgeons refresh their procedural knowledge before entering the operating room.
The analysis used data from the Scientific Registry of Transplant Recipients, a national organ transplant database, to track surgeon activity over 13 years. Liu worked with Yiwen Jin, an assistant professor at the University of Calgary, and Joel T. Adler, a transplant surgeon and assistant professor at the University of Texas at Austin. Using detailed registry data, the team reconstructed each surgeon’s sequence of procedures to identify when switches between organ types occurred. The analysis showed switches occur in more than 15 percent of cases, indicating that switching is a regular part of surgical practice.
The study was motivated by learning how transplant surgery actually works. “Most people expect surgeons to specialize in a single organ – but many transplant surgeons perform kidney, liver, and pancreas transplants, switching types depending on what arrives,” Liu said. “That raised a natural question: could those transitions carry a hidden cost?”
If task switching can affect the performance of highly trained surgeons in high-stakes situations, it likely matters in other demanding professions as well – anywhere experts face frequent transitions between cognitively different tasks. Liu hopes this study is a first step toward recognizing these hidden costs and inspiring changes that better support surgeons and their patients in practice.
Liu, J., et al. (2026). Causal evidence of task-switching costs in organ transplantation. Nature Human Behaviour. DOI: 10.1038/s41562-026-02459-8. https://www.nature.com/articles/s41562-026-02459-8
This article was originally published on news-medical