Kidney transplantation (KTx) is the best treatment option in patients with chronic kidney disease (CKD). Health-economics data favour the KTx in comparison with any type of dialysis procedure, but the multidisciplinary approach and required high level of organisational infrastructure are frequent impediments for its availability in the majority of developing countries. A living donor kidney transplant (LDKTx) programme has been developed in the Republic of Macedonia since 1977 but without a real continuum in the following years. There was a great success with 15 cadaveric kidneys transplanted (1987-1989) followed by an average of 13.5 KTx per year in the period 1996-2011. Because of the scarce organ donation and transplant activities in the majority of Balkan countries the question remains what could be done in order to enable organ transplantation as the basic human right for the best treatment option in patients with CKD. In addition to the possible increase in the number of LDKTx, prerequisites for a deceased donor (DD) programme would be the creation of an official waiting list of candidates for DD transplantation, organizational and infrastructural networking and raising public awareness on the number of potential deceased donors through permanent media presentation. Our involvement in the South-eastern Europe Health Network (SEEHN) initiative and the support from the newly created Regional Health Development Centre (RHDC) on Organ Donation and Transplant Medicine established in Croatia (Zagreb) was shown as successful for improvement of the KTx programme. At the very first professional meeting (27-28 May, 2011 in Skopje, Macedonia), the organ donation and transplantation needs of each country within the SEE geographical region were addressed and action plans for further steps on how to proceed were established. Hence, the number of professionals (including vascular surgeons) involved in KTx was increased along with the substantial increase in the reimbursement per transplant procedure at the Urology Department. Nowadays, we are pleased to report 24 successfully performed LDKTx in 2012, and in 2013 for 7 months 28 transplantations, awaiting 40 KTx at the end of the year. Prospectively, we should initiate the deceased donor programme, even in order to sustain the already established high number of transplantation per month/year, since the potential for LDKTx may be exhausted. We also hope to be supportive for regional collaboration and transplantation of CKD patients from the neighbouring countries (Albania and Kosovo), and eventually to establish regional networking in deceased donor procurement, exchange and allocation practice.