To establish a state-of-the-art organ transplantation program in Libya. Since August 2004, fifty kidney transplants have been performed. Forty-nine patients received kidneys from living-related donors and 1 husband from his wife. Donor selection was based on human leukocyte antigen (HLA) compatibility. Renal failure was due to chronic-glomerulonephritis in most patients, diabetes in 5 adults, systemic lupus erythematosus in 2 adults, and congenital anomalies in 2 children. Sixteen patients matched the HLA of their donors, 28 matched 1 haplotype and 6 did not match any. Immunosuppression was accomplished with methyl-prednisolone and basiliximab. Maintenance therapy was with mycophenolate mofetil, cyclosporine and prednisone. The latter was completely discontinued 1 month after transplantation. In patients with resistant hypertension, unilateral native nephrectomy was carried out during transplantation. Donor nephrectomy was performed through an open mini-incision using a Thompson retractor. 49 patients are alive and well and 48 of them have had functioning kidneys for 10-to-22 months. Three patients had acute rejections that were successfully treated with methylprednisolone (n=1) or methylprednisone (n=2). All 46 patients and 2 pediatric recipients have excellent renal function and are living normal lives. In Libya, establishing an active and successful transplant program with early steroid withdrawal has brought many benefits to patients and their families and great savings to the government. Our program hopefully will provide a model for similar programs in Asia and Africa and encourage local governments to legalize organ procurement from cadaveric donors.