Transmission of bacterial infections from donor to recipient may occur with donor bacteremia. We describe a novel mechanism for transmission ofPseudomonasto multiple recipients through direct contamination of a donor innominate artery graft. Patient data were collected by chart review from the donor and the kidney, kidney-pancreas, heart, lung, and liver recipients. The donor was not bacteremic but hadP. aeruginosaisolated from routine tracheal cultures. Spillage of tracheal contents onto the innominate artery and subsequent contamination of intra-abdominal organs likely occurred. Vascular anastomotic infections with graft loss caused byPseudomonasoccurred in three patients (liver, kidney, and kidney-pancreas), and the lung patient developed severe pneumonia. AllPseudomonasisolates were identical by molecular typing. Donors may transmit bacterial infections to multiple recipients by mechanisms other than donor bacteremia. Although donor tracheal cultures are commonly positive, in certain settings antimicrobial treatment of recipients may be needed.