The success of solid organ transplantation has paradoxically led to the progressive shortage of donor organs. The increasing demand and relatively static supply has led to the use of expanded criteria donors. This article reviews the recent literature on the use of expanded criteria donors in renal, pancreatic, heptatic, and cardiac transplantation. The available data suggest that, whereas expanded criteria donor organs are associated with outcomes inferior to those achievable with optimal donor organs, there are ways of improving the outcomes associated with their use. The other important issue to consider is that the outcomes of transplantation with these organs may in fact be superior to those associated with not undergoing transplantation.