We address issues connected with international river basin management and the EU Water Framework Directive (WFD). By creating a register of River Basin Districts established under the WFD, we show that the number and area of international River Basin Districts are significant. Further, we present an assessment of international cooperation and water quality in 14 international river basins in the Baltic Sea Drainage Basin. Our results indicate that the WFD is a push forward for international river basin management in the region. However the WFD in general, and the principle of river basin management in particular, may be hard to implement in river basins shared between EU Member States and countries outside the EU. According to the study, Vistula, Pregola, and Nemunas appear to be the international basins within the Baltic Sea Drainage Basin in greatest need of intensified cooperation with regard to the state of the water quality.