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Belson Rugwizangoga,1,2 Jean Berchmans Niyibizi,3 Marie Claire Ndayisaba,2 Emile Musoni,1,2 Felix Manirakiza,1,2 Annette Uwineza,1,2 Lisine Tuyisenge,4 Martin Nyundo,5 Theobald Hategekimana,5 Gervais Ntakirutimana2 1Department of Clinical Biology, University of Rwanda, Kigali, Rwanda; 2Department of Pathology, University Teaching Hospital of Kigali, Kigali, Rwanda; 3Department of Public Health, University of Rwanda, Kigali, Rwanda; 4Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda; 5Department of Surgery, University Teaching Hospital of Kigali, Kigali, RwandaCorrespondence: Belson Rugwizangoga PO Box 655, Kigali, Rwanda, Tel +250-78-854-6597Email b.rugwizangoga@ur.ac.rw; belson777@gmail.comPurpose: In most low- and lower middle-income countries (LMICs), minimally invasive tissue sampling (MITS) is a relatively new procedure for identifying the cause of death (CoD). This study aimed to explore perceptions and acceptance of bereaved families and health-care professionals regarding MITS in the context of MITS initiation in Rwanda as an alternative to clinical autopsy.Methods: This was a qualitative phenomenological study with thematic analysis. Participants were bereaved relatives (individual interviews) and health-care professionals (focus-group discussions) involved in MITS implementation. It was conducted in the largest referral and teaching hospital in Rwanda.Results: Motivators of MITS acceptance included eagerness to know the CoD, noninvasiveness of MITS, trust in medics, and the fact that it was free. Barriers to consent to MITS included inadequate explanations from health-care professionals, high socioeconomic status, lack of power to make decisions, and lack of trust in medics. Health-care professionals perceived both conventional autopsy and MITS as gold-standard procedures in CoD determination. They recommended including MITS among hospital services and commended the post-MITS multidisciplinary discussion panel in CoD determination. They pointed out that there might be reticence in approaching bereaved relatives to obtain consent for MITS. Both groups of participants highlighted the issue of delay in releasing MITS results.Conclusion: Both health-care professionals and bereaved relatives appreciate that MITS is an acceptable procedure to include in routine hospital services. Dealing with barriers met by either group is to be considered in the eventual next phases of MITS implementation in Rwanda and similar sociocultural contexts.Keywords: minimally invasive tissue sampling, perceptions, acceptance, low- and lower middle–income countries