Hepatitis B virus (HBV) is a highly infectious blood-borne pathogen that can be transmitted by a solid organ allograft and result in substantial morbidity and mortality. Recent advances in the management of HBV infection prompt a reappraisal of the approach to the management of allograft recipients from cadaver donors previously exposed to HBV, because of the on-going shortage of organ donors. This report reviews current knowledge regarding the risk of HBV transmission by an organ from cadaver donors testing positive for markers of HBV infection and makes recommendations for the evaluation, treatment, and surveillance of the allograft recipients.