For many patients experiencing organ failure, transplantation may be the only opportunity to improve their quality of life and to extend life expectancy. Organ shortage is an important problem for Italian and international procurement organizations. A review of donor and organ suitability is necessary to expand the donor pool. The suitability of donors at risk for HIV infection, as well as other marginal individuals, must be carefully evaluated before rejecting them. For donors with a social history considered to be at risk for HIV infection, laboratory testing is necessary to establish the actual HIV infection risk. It is important to consider every organ available for transplantation, even those considered to be marginal or coming from marginal donors. The only condition that we must always consider is that the organs be of acceptable quality and, above all, not expose patients to unacceptable risks.