Hematopoietic SCT is now an established treatment modality with definitive indications for many hematological disorders. However, this line of treatment requires tremendous resources, and it becomes increasingly difficult for transplanters practicing in the developing world to reconcile the difference between what is possible and what is available. On the basis of 18 years of experience and more than 1300 transplants, this article will focus on special issues, which we think are important for hematopoietic SCT practices in developing countries, taking the program in Egypt as an example that may be applicable to other countries in the developing world. The SCT program in Egypt started in 1989 on a narrow scale. In 1997, the transplant rate increased dramatically with the opening of the SCT unit at the Nasser Institute. Our team is registered in the Center for International Blood and Marrow Transplant Research. The total number of transplants performed till June 2007 is 1362; 80% of the cases are allogeneic and 20% autologous. There are seven other centers in Egypt performing mainly autologous transplants.