For some time, it has been widely accepted that patients with primary brain tumours are suitable organ donors. Cases of tumour transmission from donor to recipient have been reported. There are increasing opinions that organs from such donors should no longer be transplanted unless in exceptional circumstances. The author has recently reported the largest experience in the literature of transplanting organs from primary brain tumour donors and confirmed the exceedingly low risk of tumour transmission. Because of the ever-increasing shortage of cadaveric organ donors and a significant waiting list mortality for many organ transplantations, dismissal of primary brain tumour donors should not be taken lightly. In this article, the evidence available to date is reviewed. A logical approach to the use of patients with primary brain tumours as potential organ donors is discussed.