*Purpose: Non-directed kidney donors can initiate living donor chains that end to patients on the deceased donor waitlist. While many studies of paired exchange practices focus on the whole population of transplant recipients, the characteristics and outcomes of chain end recipients may differ from other paired exchange recipients due to their history on the kidney wait list.

*Methods: In this retrospective cohort study we compared 748 National Kidney Registry (NKR) chain end recipients to controls from the NKR and the Scientific Registry of Transplant Recipients between February 2008 and June 2019.

*Results: : Compared to other living donor recipients, chain end recipients were more often older, black, publicly insured, and spent longer on dialysis. Black patients received chain end kidneys at a rate approaching that of receiving deceased donor kidneys (31% vs 33%, p=0.2). Chain end donors were older and had slightly lower glomerular filtration rates and higher Living Kidney Donor Profile Index (LKDPI) scores. There were 127 (17%) of chain end kidneys with a LKDPI<0, meaning they were predicted to outperform any deceased donor kidney. Chain end blood type O donors had similar characteristics to other O donors in NKR. There was a similar cumulative incidence, but an increased adjusted hazard, of graft failure among chain ends compared to other living donor recipients. No difference in mortality was seen after adjusting for recipient, donor, and transplant factors. Compared with deceased donor recipients, NKR chain end recipients had lower graft failure (5 year: 6.9% vs 12.5%, p<0.001) and mortality (5 year: 7.2% vs. 14.4%, p<0.001).

*Conclusions: These findings demonstrate high donor quality at chain end. Sharing non-directed donors among a multicenter network may improve the diversity of recipients who benefit from living donation.

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