Willingness to pledge as an organ donor after death in Malaysia increased from 26 donors to 39 donors in 2009 compared with the previous year. However, this is still a relatively low number, translating to a donation rate of 1.38 per one million people. The aim of this study was to determine the proportion of receiving information about organ donation, willingness to donate, refusal factors for organ donation and reasons for refusal. We used data from organ donation module from the National Health and Morbidity Survey (NHMS) 2006, a nationwide cross-sectional study by the Institute for Public Health. Data were analyzed using SPSS ver. 19 and Stata Ver. 11 for descriptive and inferential statistics. They were 34,208 respondents in this study. About 69.6% (95%CI: 68.65-70.15 respondents who ever received information on organ donation and the proportion of those who pledged as organ donors was 1.5% (95%CI: 1.40-1.70). Pledge for organ donor was less likely among Malays (aOR=3.45, p<0.001), those with no formal education (aOR=3.93, p=0.001) and those with monthly incomes less than RM1000 (aOR=1.87, p=0.001). Main reasons for not pledging were fear (39.4%), against their religion (10.5%) and uncertainty because of religion (10.9%). Study revealed receiving information alone won't encourage organ donation. Therefore, awareness and in-depth knowledge is necessity to create positive perception on pledging for organ donation.