Tuberculosis occurred in two patients, each of whom received a kidney from the same cadaver donor whose cerebrospinal fluid cultures grew Mycobacteria following organ donation. Although the degree of immunosuppression and graft function were similar in the recipients, one died of disseminated tuberculosis. Kidneys contaminated with certain pathogens, including Mycobacteria, should not be transplanted. Transplant recipients with tuberculosis require prompt antituberculous therapy, and may require transplant nephrectomy for persistent evidence of urinary tract tuberculosis.