The critical organ shortage has driven a paradigm shift in utilizing deceased donors with infectious diseases, transforming many historical absolute contraindications into relative ones through advanced diagnostics and targeted therapies. While universally fatal or untreatable infections like active rabies, prion diseases, untreated disseminated fungal infections, or multidrug-resistant sepsis remain absolute contraindications, most infections now undergo rigorous risk-benefit analysis. Groundbreaking management strategies, particularly the advent of direct-acting antivirals (DAAs), enable the routine and safe use of hepatitis C viremic donors, achieving >95% cure rates in recipients. Similarly, refined protocols allow hepatitis B core antibody-positive donors with nucleos(t)ide analogue prophylaxis, and carefully selected HIV-positive donors for HIV-positive recipients under specific protocols (e.g., HOPE Act). Enhanced nucleic acid testing (NAT), rapid pathogen identification, and tailored prophylaxis (e.g., for CMV, endemic fungi, Chagas disease, toxoplasmosis) further mitigate risks from bacterial, parasitic, and other viral infections. This evolution mandates multidisciplinary evaluation, stringent donor screening, pathogen-specific recipient management protocols, and comprehensive informed consent, significantly expanding the donor pool without compromising recipient outcomes through individualized risk assessment and vigilant post-transplant monitoring.