Expansion of the donor pool has led to reconsideration of selection criteria to obtain the largest number of grafts without compromising recipient outcomes. This reconsideration concerns the utilization of donors with malignancies. Herein we have analyzed the outcomes, survivals, and risks of cancer transmission among patients who received a liver transplant from a donor with a genitourinary malignancy. Six of 363 patients (1.5%) who underwent transplantation at our center received an organ from a donor with a genitourinary cancer which was detected prior to the surgical harvest. Donors affected by low-grade renal cell carcinoma (Fuhrman grade 1 or 2) or low-grade intraprostatic prostate carcinoma (Gleason score <or= 6) were classified as "standard risk" and utilized pending informed consent. Four of 6 patients (66.6%) succumbed, but none consequent to a neoplastic disease. The mean follow-up was 12 +/- 8.1 months; in no patient was there evidence of transmission of a donor malignancy. Despite a relatively high risk of liver metastases among patients with genitourinary neoplasms, the risk of tumor transmission to a liver recipient is low. It seems to be safe to utilize these donors for patients with a high risk of succumbing on the waiting list.