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The 759 cases of brain death declaration (BDD [Italian law, 6 hours of observation time]) that occurred in 190 Italian intensive care units (ICUs) between May and September 2012 were studied to quantify carbapenem‐resistant gram‐negative bacteria (CR‐GN) isolated in organ donors, to evaluate adherence to national screening guidelines, and to identify risk factors for CR‐GNisolation. Mandatory blood, bronchoalveolar lavage, and urine cultures were performed on the BDDday in 99% of used donors. Because results were rarely made available before transplant, >20% of transplants were performed before obtaining any microbiological information, and organs from 15 of 22 CR‐GNcases were used. Two (lung–liver) of the 37 recipients died, likely because of donor‐derived early CR‐GNsepsis. ICUstay >3 days (odds ratio [OR] = 7.49, P= .004), fever (OR= 3.11, P= .04), age <60 years (OR= 2.80, P= .06), and positive ICUepidemiology (OR= 8.77, P= .07) were associated with CR‐GNisolation. An association between single ICUand risk of CR‐GNwas observed, as a result of differences across ICUs (ICC= 29%; 95% confidence interval [CI] 6.5%‐72%) probably related to inadequate practices of infection control. Continuous education aimed at implementing priority actions, including stewardship programs for a rational use of antimicrobials, is a priority in healthcare systems and transplant networks. Improved awareness among ICUpersonnel regarding the importance of early CR‐GNdetection and timely alert systems might facilitate decisions regarding organ suitability and eventually save recipient lives. In this national study, the authors evaluate the risk factors for carbapenem‐resistant, gram‐negative bacteria isolation in brain dead organ donors and possibly related recipient deaths, suggesting that tailored surveillance cultures, timely information, and alert systems based on critical care personnel education and transplant network organization might facilitate and improve decisions regarding organ suitability.