The reported annual incidence of ESRD in the Kingdom is 100-120 patients per million population. The first dialysis unit in Saudi Arabia was set up in 1971 and since then rapid advances have been made in the Kingdom in the field of renal replacement therapy. There are currently 103 centers offering dialysis to about 4500 patients. The National Kidney Foundation was established in 1985 to implement a cadaveric organ transplant program and to co-ordinate the renal care facilities in the Kingdom. This center was renamed as Saudi Center for Organ Transplantation (SCOT) in 1993 in order to encompass transplantation of organs other than the kidney as well. A real impetus was given in the year 1982 with the approval handed over by Islamic scholars on the concept of brain-death and organ transplantation. From 1979, when the first renal transplant was performed till end of 1994, more than 1600 renal transplants have been performed in 13 transplant centers in Saudi Arabia. Also, 49 liver, 57 heart, 45 heart valve, 121 cornea, 4 pancreas, 4 lung, and 100 bone marrow transplants have been performed in the Kingdom. Despite these achievements, there is still a large gap between demand and supply and efforts are ongoing to improve the donor pool and bridge this gap.