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Living donor kidney transplantation began in Ethiopia at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in September 2015. At the request of the Federal Democratic Republic of Ethiopia Ministry of Health, preparations for recovery of organs from deceased donors (DD) began in November 2015.AaBET Hospital (AH), the trauma center associated with SPHMMC, was selected as the site to initiate DD. Collaborations with the University of Michigan (UM), University of Barcelona’s Donation and Transplantation Institute (DTI), and Hospital do Rim (HR) in Sao Paulo, Brazil, were established. Six areas of planning were identified: (1) engaging experienced collaborating institutions to support and train Ethiopian personnel, (2) updating Ethiopia’s brain death (BD) laws, (3) designing a program for professional and public education, (4) establishing BD protocols at AH and SPHMMC, (5) training physicians and staff in the management of potential donors and recovery of DD organs, and (6) training faculty and staff to organize, lead, and operate a hospital-based organ procurement organization (OPO).Training of four SPHMMC surgeons in kidney transplantation by UM kidney transplant surgeons began in July 2015. Teams from UM and the DTI made site visits in March 2016 to assess the feasibility of establishing DD at SPHMMC and AH. Beginning that month, working groups were established at SPHMMC and AH to guide the DD development process. In September 2016, two surgical fellows from SPHMMC traveled to the HR for training that included DD management and organ recovery. Two AH faculty members and a SPHMMC administrator enrolled in DTI master level courses in November 2016 for training in DD and OPO administration. An additional site visit by faculty from DTI and UM in January 2017, focused on protocol development, staff recruitment and training, and legislation. Timelines and prototype BD protocols and legislative language will be presented, as will perspectives on the imperative for establishing brain death protocols, even in the absence of active DD.Pragmatic BD definitions and protocols are necessary for the operation of modern hospitals. DD under conditions of restrained resources is possible and practical. Successful introduction of these practices requires methodical planning and preparation, and critical support and leadership by hospital administration and governmental agencies.