Organ transplantation has been widely accepted as a solution for end-stage organ failure. The limitation has been organ shortage. The intensivist plays a major role in the different stages of the donation process. This study investigated the knowledge and attitude toward organ donation and transplantation amongst intensivists in the major hospitals of Riyadh. The study was conducted in June 2002. Twenty-two intensivists in the intensive care units (ICUs)of 4 hospitals in Riyadh participated in the study. A questionnaire was distributed concerning knowledge and attitude on donation and transplantation. The information was tabulated and analyzed. Only 50% appreciated the high success rate of modern organ transplantation. One fourth did not know of the role of the Saudi Center for Organ Transplantation (SCOT). Most of the intensivists knew the Islamic view on transplantation. Many would be willing to allow donation from a deceased relative. However, only 13% carry donation cards. Most participants believed that the organ shortage was mainly due to family refusal to donate. Intensivists need to have better insight into the obstacles to donation that can be solved at the level of the hospital and the ICUs. Moreover, the communication gap between ICUs and SCOT needs to be bridged to optimize the use of all potential donors.