Introduction: Kidney transplant is the preferred treatment for patients with end-stage kidney disease. Previously, there were no transplant services in Rwanda, and the National Medical Referral Board recommended those who could be supported for referral abroad, primarily in India. In aggregate, 67 Rwandans were supported by the Government of Rwanda for a period of seven years for kidney transplantation, for a total cost of 804,000 USD, excluding travel and living costs.  In 2023, Rwanda’s Ministry of Health partnered with several US medical schools to implement living donor kidney transplantation and launch renal transplant surgery and nephrology fellowship programs. In May 2023, the first kidney transplants were successfully performed at the King Faisal Hospital Rwanda (KFH), a multispecialty quaternary hospital providing specialized healthcare services. 
Methods: An interdisciplinary, project-based approach was undertaken to establish the systems, workforce, and partnerships to launch the program. This included revising the legal framework for organ donation, implementing a five-year health workforce development plan across the whole transplant team, conducting financial analysis and bundled tariff cost, and strengthening the clinical infrastructure at KFH.
Potential recipients were evaluated by designated nephrologists, transplant surgery fellows, nurses, and social workers, and potential donors were evaluated by designated nephrologists, transplant surgery fellows, a psychiatrist, and a donor advocate. Pairs were medically approved by the KFH transplant team in collaboration with US colleagues. Medically approved pairs were reviewed by the National Transplant Committee to verify compliance with Rwandan regulations.
Results: Our kidney transplant program included a multidisciplinary team of transplant surgeons, nephrologists, pathologists, psychiatrists, nurses, anesthesiologists, and social workers. The average duration of preoperative evaluation was 55 days, divided into 4 phases, including medical, surgical, immunological, and administrative. 85 candidate pairs have been evaluated since the beginning of the program. Of those, 45 pairs were approved for transplantation, and 20 living donor kidney transplants were successfully performed. Fellowship programs in nephrology and renal transplant surgery were launched through the University of Rwanda to equip local physicians with the skills needed to comprehensively manage the transplant program.
Conclusion: Rwanda will continue to offer renal transplant surgery regularly, with the aim for Rwandan professionals to comprehensively manage this program in two years. By engaging in this comprehensive, project-based approach with health workforce development and clinical service accessibility at the forefront, living donor kidney transplant is projected to be a sustainable service in Rwanda that will have a significant impact on the livelihood of its population.