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Navigating challenges in recipient selection for end-chain kidneys.

Neetika Garg1, Carrie Thiessen2, Jacqueline Garonzik-Wang2

  • 1Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|November 3, 2024
PubMed
Summary
This summary is machine-generated.

End-chain (EC) kidneys are increasingly used in kidney paired donation transplants. This study discusses ethical approaches for selecting recipients for these kidneys, highlighting the need for more research on their utilization and outcomes.

Keywords:
end-chain kidneysethicskidney paired donationliving kidney donor transplantationoutcomespaired kidney donationrace

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Area of Science:

  • Nephrology
  • Transplantation
  • Organ Donation

Background:

  • Kidney paired donation (KPD) and voucher donation are increasing KPD transplants.
  • End-chain (EC) kidneys are a growing proportion of KPD transplants in the US.
  • Limited data exist on EC kidney quality and utilization.

Purpose of the Study:

  • To discuss ethical recipient selection approaches for EC kidneys.
  • To address the lack of established algorithms for EC kidney allocation.
  • To consider ethical principles of utility, justice, and respect for persons.

Main Methods:

  • Discussion of three potential recipient selection strategies: adherence to the Kidney Allocation System, utility maximization, and priority for high-risk candidates.
  • Review of ethical principles guiding organ allocation.
  • Examples from the authors' center's experience.

Main Results:

  • EC kidneys offer opportunities for recipients without living donors.
  • No current data or algorithms guide recipient selection for EC kidneys.
  • Ethical considerations are crucial for equitable allocation.

Conclusions:

  • EC kidneys represent a significant and growing portion of KPD transplants.
  • Further research on EC kidney utilization and outcomes is essential.
  • Considerations for EC kidney allocation are relevant to other donation scenarios.