Kidney transplantation is the best treatment for patients with kidney failure. However, over 25% of kidney transplants in Canada fail within 10 years due to both rejection and other causes of injury. Currently, doctors rely on an old blood test called creatinine to monitor the health of the kidney organ, but it is known that this practice can lead to missed opportunities for treatment, as creatinine becomes abnormal mainly in the later stages of kidney damage. In recent years, a new blood test called donor-derived, cell-free DNA (dd-cfDNA) has been shown to detect kidney organ injury before creatinine becomes abnormal. Currently, this test is only performed by central laboratories in the United States, making the technology too costly and not accessible to Canadian patients. To overcome these barriers, we will bring together the resources of health authorities, laboratories, and vendors of the dd-cfDNA test to implement this technology locally in BC and Alberta. In Activity 1 of the project, we will ensure local transplant laboratories can achieve the same level of test performance as provided by central US laboratories. In Activity 2 we will formally launch the test for clinical use in BC and Alberta to guide the management of patients. To confirm the expected benefits of testing, we will assess real-world quality indicators such as the time it takes to perform the test, whether all patients can have equal access to testing when needed, and the impact of testing on care. In Activity 3 we will conduct a comprehensive economic assessment to make sure we apply the test in the most cost-efficient manner. Supported by national leaderships and patient partners, we will share our approach and findings broadly with other transplant centers to help accelerate the diffusion of this new technology in Canada to improve patient care.