"Donor-acquired sarcoidosis" is defined as the development of sarcoidosis in presumably naïve (non-sarcoidosis) transplant recipients who have received tissues or organs from donors who were not known or suspected to have active sarcoidosis. In reviewing the literature up until September of 1999, we found four publications describing a total of eight organs or tissues donated by subjects with sarcoidosis. These are the basis for this review. We draw upon these cases to discuss etiologic considerations for sarcoidosis, and suggest that donor-acquired sarcoidosis strengthens the view that sarcoidosis is caused by a transmissible agent, perhaps of infectious origin. Since not all recipients of organs from donors with active sarcoidosis develop sarcoidosis, host factors also appear to be important in disease pathogenesis. Less credence is ultimately given to external or environmental factors. Issues underlying host tolerance as a possible explanation for the reported absence of mortality or loss of allograft function during the limited periods of observation are also discussed.