As a result of the increasing number of transplants being facilitated by kidney paired donation, and newer initiatives such as voucher donation, end-chain kidneys now constitute a considerable proportion of kidney paired donation transplants in the United States. Data on end-chain kidneys are limited. They may be lower in quality compared to non-end chain living donor kidneys. However, they can provide unique opportunities for recipient candidates without living donors. There are no data or algorithms available to guide recipient selection for end-chain kidneys accepted by a transplant center. Considering the ethical principles of utility, justice, and respect for persons that underlie organ allocation, we discuss three potential approaches for recipient selection: 1) adherence to the Kidney Allocation System, 2) utility maximization and 3) priority to high-risk candidates, along with examples from our own center's experience. Similar considerations are also relevant to selection of recipients for non-directed donor organs, and to out-of-sequence allocation for deceased organ donors. Since end-chain kidneys represent an increasingproportion of kidney paired donation-facilitated living kidney donor transplantation in the United States, and will likely get more medically and surgically complex over time, ongoing research on their utilization and outcomes is needed.

中文翻译：

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个人观点：应对末端链肾受体选择的挑战。


由于肾脏配对捐献促进了越来越多的移植，以及代金券捐赠等新举措，末端链肾现在在美国肾脏配对捐献移植中占了相当大的比例。关于末端链肾的数据是有限的。与非末端链式活体供体肾脏相比，它们的质量可能较低。但是，他们可以为没有活体供体的受赠候选人提供独特的机会。没有数据或算法可用于指导移植中心接受的末端链肾的受者选择。考虑到器官分配的基础效用、正义和尊重人的道德原则，我们讨论了选择受体的三种可能方法：1） 遵守肾脏分配系统，2） 效用最大化和 3） 优先考虑高风险候选人，以及我们自己中心经验的例子。类似的考虑也与非定向供体器官的受者选择以及已故器官供体的无序分配有关。由于在美国，末端链肾在肾脏配对供体促进的活体肾脏供体移植中所占的比例越来越大，并且随着时间的推移，医学和手术可能会变得更加复杂，因此需要对其利用和结果进行持续研究。