Purpose of reviewOrgans procured from donors with positive viral serology are currently underused. Defining the risk of transmission will enhance the use of such organs.Recent findingsRecent data point to the overall safety of using such organs. Prophylaxis and prevention of reactivation of the viruses have been looked at, and more studies are underway. However, one needs to define the criteria and the population suitable to receive organs from hepatitis-positive donors.SummaryIn this article, we attempt to get to the basics by discussing the antigens and antibodies as they relate to the transplant surgeons. Analysis of the current data from individual centers and the United Network of Organ Sharing database is used to delineate some guidelines. Judicious judgment will allow many of these organs with positive viral serology to be transplanted into appropriate recipients with minimal incremental risk.