The shortage of organs for transplant is a universal problem. The World Health Organization is urging every nation to seek self-sufficiency regarding their organ procurement program. Reaching self-sufficiency inevitably requires the provision of a well-developed deceased-donor organ procurement program. Most countries represented by the Middle East Society for Organ Transplantation still rely on living-donor organ donations. Some of these countries have been relatively successful in promoting deceased-donor donation as well. In our region, deceased-donor organs are recovered exclusively from patients who have been declared brain dead. However, with improvements in preventive and therapeutic interventions, the pool of potential brain dead donors is rapidly shrinking. This should, therefore, stimulate our interest in developing a program for recovering organs after cardiac death. However, increasing the pool of donors, even to optimal levels, may still not be enough to meet the growing demand. More resources must be invested in reducing the demand for organs. This is especially true in our region, where primary care programs aimed at slowing or containing disease progression that may lead to organ failure are lacking. This problem is compounded by limited access to such programs and, for that matter, limited access to even the most basic primary care. Continued efforts to increase the supply of donor organs must be pursued. At the same time, we must work to more effectively treat the diseases that could lead to end-stage renal disease and the increased demand for donor organs. A comprehensive approach to the problem of donor organ shortages in countries in the Middle East also must consider the relatively limited financial resources that are available.