Patients with primary brain tumors are often accepted as marginal organ donors given the rarity of extraneuronal metastases (ENM) from these tumors. Nonetheless, transmission of donor PBT to organ recipient is a recognized phenomenon. Systemic diversion of cerebrospinal fluid and craniotomy are occasionally identified as the cause of ENM. However, in the absence of cervical adenopathy or scalp, pelvic, or abdominal masses, such interventions do not justify exclusion from organ donation. Medulloblastoma, ependymoma, and anaplastic meningioma have increased metastatic potential. Patients with these tumors pose an increased risk of transmitting malignancy to the recipient. Conversely, with the exception of gliosarcoma, glioblastoma and other tumors of astrocytic and oligodendroglial origin only rarely metastasize. Such patients are of lower risk of tumor transmission. In addition to the usual vigilance employed by transplant surgeons, attention should be directed to craniotomy site and ipsilateral lymph nodes. In patients with shunts, the peritoneal cavity should be examined as well as shunt tract and tip.