Introduction: With the enormous medical and surgical advances in the transplantation field, there now exists a growing number of transplant patients who present for a variety of reconstructive and cosmetic procedures. This study examines the surgical outcome of organ transplantation patients who required reconstructive surgery using free tissue transfer. Methods: A multi-center retrospective study was designed to determine medical and surgical complications in organ transplant patients who had free flaps performed for a variety of surgical defects. Chart review was performed in this subset of patients. Results: Five independent medical centers participated in the study. Twenty-one (n=21) transplant patients received organs (e.g. heart, kidney, pancreas) and were placed on life-long immunosuppressive agents. Subsequently, free tissue transfer technique was utilized to reconstruct lower extremity wounds, head and neck oncologic defects, post-mastectomy defects, and a traumatic thumb defect. There were no flap losses. Post-operatively, medical complications encountered included acute renal rejection with full recovery. Surgical complications included hematoma and partial skin graft loss. Impaired wound healing was not observed. Conclusions: In the properly selected patient, free tissue transfer can be performed safely in organ transplant patients. Delayed wound healing from immunosuppressive agents was not evident. Surgical and medical complications were uncommon.