Organ transplantation is one of the greatest achievements of the 20th century. In Croatia the pioneering role in the treatment of end-stage renal disease was done by Department of Surgery in the Clinical Hospital Rijeka which cooperated closely with immunologists, nephrologists, transfusiologists and other specialists. The first hemodialysis in patient with acute renal insufficiency was done in 1962. The chronic dialysis began in October 1966 under the leadership of prof. Jerko Zec. Establishement of the dialysis was the basis for the program of kidney transplantation. The other preparations during several years were under leadership of prof. Vinko Frančišković. We learned the operative technics on dogs. Clinical and immunological problems were debated on regularly meetings. The author of this text stayed the first six months in 1969 at the Department of Nephrology in „Necker“ hospital in Paris. He arranged with the transplant surgeon Michel Lacombe a visit of professor Frančišković to Paris to see a kidney transplantation from living donor. Solid preparations resulted in the first kidney transplantation performed at the January 30th 1971. The mother gave her kidney to 34-year old son. The recipient died 14,5 year after transplantation with functional transplant. The first cadaveric transplantion was performed at the May 15th 1972. The donor was a woman injured in traffic accident. The diagnosis of death was based on cardiac arrest. The patient died after 6 months from miliary tuberculosis. Contrary to our wish to use cadaveric donor as much as possible, during many years we performed more transplants from living donor due to pressure of many patients from other regions of Croatia and others republics of Yugoslavia. Small number of cadaveric kidneys we gave to patients on waiting list toward rules of selection. For example, more than 20 patients from Slovenia received new kidney in Rijeka. We helped unselfishly to other centers in the beginning of their transplant activity. The beginning of transplantation programme undoubtedly has significant positive impact on development of medicine in the Rijeka and Croatia.