Transmission of bacterial infections from donor to recipient may occur with donor bacteremia. We describe a novel mechanism for transmission of Pseudomonas to multiple recipients through direct contamination of a donor innominate artery graft. Patient data were collected by chart review from the donor and the kidney, kidney-pancreas, heart, lung, and liver recipients. The donor was not bacteremic but had P. aeruginosa isolated from routine tracheal cultures. Spillage of tracheal contents onto the innominate artery and subsequent contamination of intra-abdominal organs likely occurred. Vascular anastomotic infections with graft loss caused by Pseudomonas occurred in three patients (liver, kidney, and kidney-pancreas), and the lung patient developed severe pneumonia. All Pseudomonas isolates were identical by molecular typing. Donors may transmit bacterial infections to multiple recipients by mechanisms other than donor bacteremia. Although donor tracheal cultures are commonly positive, in certain settings antimicrobial treatment of recipients may be needed.