The transmission of donor-related malignancies by organ transplantation is rare event but biological behaviour of malignant tumors developed by the transplanted patients is in general more aggressive than similar ones in non-transplanted population. This paper presents an analysis of our series of cases and a review of the literature to the point of the transmission of cancer from organ donors with primary central nervous system tumors. Patients with primary CNS neoplasms have been accepted for organ donation because these tumors very rarely spread outside the CNS. To our knowledge, after an extensive review of the literature, the CNS tumor transmission risk with transplantation may be estimated between a little more than 0% and 3%. In the light of available data and in accordance with our investigations we consider that patients with CNS tumors can be accepted as donors as long as the risk of dying on the waiting lists is significantly higher than the tumor transferral risk. Organ donors with benign or low-grade CNS tumor should be accepted unreservedly. Donors with high-grade tumors should be consider as "marginal donors" and their assessment can be based on the comparison and the balance between the risk of tumor transmission and the medical condition of the recipient.