It should come as no surprise that 1.5 million Afghans as refugees in Iran have no choice but using Iran's healthcare systems. Afghan refugees afflicted with end-stage renal disease (ESRD) are a case in point. As a result Iran has Afghan refugees needing renal transplantation. Although Iran has no renal transplantation waiting list, some refugees may wait for renal transplantation for several years. Iranian model of organ transplantation limits organ transplantation of foreigners to Iranian to limit the possible black market of organ retrieval from low socio-economic class refugees. As a result, an organ harvested from a foreigner brain death can only be allocated to a donor of their homeland. In our unique experience an Afghan brain death was occurred in Iran in 2007.There were 2 Afghans with end stage renal disease who had been waiting for kidney transplantation for a long time. Although it was suitable for organ harvest, no access was possible to any family members who could sign consent form. As a result, organ procurement unit of Masih Daneshvari hospital started a difficult work through a contact with Ministry of foreign affairs, and then with Embassy of the Islamic Republic of Iran in Afghanistan, got involved in finding the family of the brain death patient. In one day, in a village, family was found, and was invited for consent. Consent was achieved and organ donation was done. This is a new approached ethics of international collaboration for kidney transplantation in refugees. This report not only sheds light on the characteristics of Iranian transplantation system, but also highlights the impact of timely decisions of an organ procurement unit in special cases.