The field of stem cell transplantation has witnessed major advances in recent years with exponential increase in the indications and number of transplants worldwide. Although several centers are now performing allogeneic hematopoietic stem cell transplantation in the Kingdom of Saudi Arabia (KSA) and the Middle East region the availability of this procedure for eligible patients is still limited. The current activities of the stem cell transplant programs in the KSA specifically at the King Faisal Specialist Hospital and Research Center with the indications and outcome will be presented. Special issues related to transplantation in the Kingdom will be reviewed and discussed including issues related to donor availability and donor and recipient compatibility, and the potential for alternate donor program. The patterns of diseases observed in the KSA and the Middle East region are slightly different and the status of transplant candidates before transplantation is different from what is observed in Western Europe and North America particularly patients transplanted for bone marrow failure syndromes and Aplastic anemia. Specific observation regarding the incidence of graft versus host disease and its relation to the genetically homogeneous community will be presented. The pattern of infections post transplantation is also different including high seropositivity for cytomegalovirus, as well as, both hepatitis B and C viruses. Collective effort is needed regarding bone marrow transplantation in the area through the collaboration of the different centers.