American Samoa is to get a private dialysis clinic.
The government run LBJ Dialysis Clinic is currently filled and the hospital has no immediate plans to expand.
New dialysis patients have limited options - they either seek treatment off island or die from lack of treatment.
This has prompted a group of business people and medical professionals to begin the process of setting up and operating a private dialysis clinic.
The managing director is Chris Fisher, who is from California but who has has strong local family links to American Samoa.
"It's important that local people have an ownership interest in the clinic. Local ownership inspires trust, family connections and a genuine stake in community health and preventative health."
"We want to work together with the CKD clinic to prevent chronic kidney disease and to serve patients who require dialysis," Mr Fisher said.