diff --git a/.github/workflows/build.yml b/.github/workflows/build.yml
index 369932ab3e94..c5047e7acd0a 100644
--- a/.github/workflows/build.yml
+++ b/.github/workflows/build.yml
@@ -990,6 +990,7 @@ jobs:
             'node-express-esm-without-loader',
             'node-express-cjs-preload',
             'node-otel-sdk-node',
+            'node-otel-custom-sampler',
             'ember-classic',
             'ember-embroider',
             'nextjs-app-dir',
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.gitignore b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.gitignore
new file mode 100644
index 000000000000..686a0277246c
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.gitignore
@@ -0,0 +1,2 @@
+dist
+.vscode
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.npmrc b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.npmrc
new file mode 100644
index 000000000000..070f80f05092
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/.npmrc
@@ -0,0 +1,2 @@
+@sentry:registry=http://127.0.0.1:4873
+@sentry-internal:registry=http://127.0.0.1:4873
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/package.json b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/package.json
new file mode 100644
index 000000000000..3507981ff013
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/package.json
@@ -0,0 +1,31 @@
+{
+  "name": "node-otel-custom-sampler",
+  "version": "1.0.0",
+  "private": true,
+  "scripts": {
+    "build": "tsc",
+    "start": "node dist/app.js",
+    "test": "playwright test",
+    "clean": "npx rimraf node_modules pnpm-lock.yaml",
+    "test:build": "pnpm install && pnpm build",
+    "test:assert": "pnpm test"
+  },
+  "dependencies": {
+    "@opentelemetry/api": "^1.9.0",
+    "@opentelemetry/sdk-trace-node": "^1.25.1",
+    "@sentry/node": "latest || *",
+    "@sentry/opentelemetry": "latest || *",
+    "@sentry/types": "latest || *",
+    "@types/express": "4.17.17",
+    "@types/node": "18.15.1",
+    "express": "4.19.2",
+    "typescript": "4.9.5"
+  },
+  "devDependencies": {
+    "@playwright/test": "^1.44.1",
+    "@sentry-internal/test-utils": "link:../../../test-utils"
+  },
+  "volta": {
+    "extends": "../../package.json"
+  }
+}
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/playwright.config.mjs b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/playwright.config.mjs
new file mode 100644
index 000000000000..31f2b913b58b
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/playwright.config.mjs
@@ -0,0 +1,7 @@
+import { getPlaywrightConfig } from '@sentry-internal/test-utils';
+
+const config = getPlaywrightConfig({
+  startCommand: `pnpm start`,
+});
+
+export default config;
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/app.ts b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/app.ts
new file mode 100644
index 000000000000..cc7e98446706
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/app.ts
@@ -0,0 +1,50 @@
+import './instrument';
+
+import * as Sentry from '@sentry/node';
+import express from 'express';
+
+const PORT = 3030;
+const app = express();
+
+const wait = (duration: number) => {
+  return new Promise<void>(res => {
+    setTimeout(() => res(), duration);
+  });
+};
+
+app.get('/task', async (_req, res) => {
+  await Sentry.startSpan({ name: 'Long task', op: 'custom.op' }, async () => {
+    await wait(200);
+  });
+  res.send('ok');
+});
+
+app.get('/unsampled/task', async (_req, res) => {
+  await wait(200);
+  res.send('ok');
+});
+
+app.get('/test-error', async function (req, res) {
+  const exceptionId = Sentry.captureException(new Error('This is an error'));
+
+  await Sentry.flush(2000);
+
+  res.send({ exceptionId });
+});
+
+app.get('/test-exception/:id', function (req, _res) {
+  throw new Error(`This is an exception with id ${req.params.id}`);
+});
+
+Sentry.setupExpressErrorHandler(app);
+
+app.use(function onError(err: unknown, req: any, res: any, next: any) {
+  // The error id is attached to `res.sentry` to be returned
+  // and optionally displayed to the user for support.
+  res.statusCode = 500;
+  res.end(res.sentry + '\n');
+});
+
+app.listen(PORT, () => {
+  console.log('App listening on ', PORT);
+});
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/custom-sampler.ts b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/custom-sampler.ts
new file mode 100644
index 000000000000..cbaaac57c8ea
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/custom-sampler.ts
@@ -0,0 +1,31 @@
+import { Attributes, Context, Link, SpanKind } from '@opentelemetry/api';
+import { Sampler, SamplingResult } from '@opentelemetry/sdk-trace-node';
+import { wrapSamplingDecision } from '@sentry/opentelemetry';
+
+export class CustomSampler implements Sampler {
+  public shouldSample(
+    context: Context,
+    _traceId: string,
+    _spanName: string,
+    _spanKind: SpanKind,
+    attributes: Attributes,
+    _links: Link[],
+  ): SamplingResult {
+    const route = attributes['http.route'];
+    const target = attributes['http.target'];
+    const decision =
+      (typeof route === 'string' && route.includes('/unsampled')) ||
+      (typeof target === 'string' && target.includes('/unsampled'))
+        ? 0
+        : 1;
+    return wrapSamplingDecision({
+      decision,
+      context,
+      spanAttributes: attributes,
+    });
+  }
+
+  public toString(): string {
+    return CustomSampler.name;
+  }
+}
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/instrument.ts b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/instrument.ts
new file mode 100644
index 000000000000..bba794d9f027
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/src/instrument.ts
@@ -0,0 +1,30 @@
+import { NodeTracerProvider } from '@opentelemetry/sdk-trace-node';
+import * as Sentry from '@sentry/node';
+import { SentryPropagator, SentrySpanProcessor } from '@sentry/opentelemetry';
+import { CustomSampler } from './custom-sampler';
+
+Sentry.init({
+  environment: 'qa', // dynamic sampling bias to keep transactions
+  dsn:
+    process.env.E2E_TEST_DSN ||
+    'https://3b6c388182fb435097f41d181be2b2ba@o4504321058471936.ingest.sentry.io/4504321066008576',
+  includeLocalVariables: true,
+  debug: !!process.env.DEBUG,
+  tunnel: `http://localhost:3031/`, // proxy server
+  skipOpenTelemetrySetup: true,
+  // By defining _any_ sample rate, tracing intergations will be added by default
+  tracesSampleRate: 0,
+});
+
+const provider = new NodeTracerProvider({
+  sampler: new CustomSampler(),
+});
+
+provider.addSpanProcessor(new SentrySpanProcessor());
+
+provider.register({
+  propagator: new SentryPropagator(),
+  contextManager: new Sentry.SentryContextManager(),
+});
+
+Sentry.validateOpenTelemetrySetup();
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/start-event-proxy.mjs b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/start-event-proxy.mjs
new file mode 100644
index 000000000000..4650bf6ecc67
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/start-event-proxy.mjs
@@ -0,0 +1,6 @@
+import { startEventProxyServer } from '@sentry-internal/test-utils';
+
+startEventProxyServer({
+  port: 3031,
+  proxyServerName: 'node-otel-custom-sampler',
+});
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/errors.test.ts b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/errors.test.ts
new file mode 100644
index 000000000000..18d14cd12080
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/errors.test.ts
@@ -0,0 +1,29 @@
+import { expect, test } from '@playwright/test';
+import { waitForError } from '@sentry-internal/test-utils';
+
+test('Sends correct error event', async ({ baseURL }) => {
+  const errorEventPromise = waitForError('node-otel-custom-sampler', event => {
+    return !event.type && event.exception?.values?.[0]?.value === 'This is an exception with id 123';
+  });
+
+  await fetch(`${baseURL}/test-exception/123`);
+
+  const errorEvent = await errorEventPromise;
+
+  expect(errorEvent.exception?.values).toHaveLength(1);
+  expect(errorEvent.exception?.values?.[0]?.value).toBe('This is an exception with id 123');
+
+  expect(errorEvent.request).toEqual({
+    method: 'GET',
+    cookies: {},
+    headers: expect.any(Object),
+    url: 'http://localhost:3030/test-exception/123',
+  });
+
+  expect(errorEvent.transaction).toEqual('GET /test-exception/:id');
+
+  expect(errorEvent.contexts?.trace).toEqual({
+    trace_id: expect.any(String),
+    span_id: expect.any(String),
+  });
+});
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/sampling.test.ts b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/sampling.test.ts
new file mode 100644
index 000000000000..cb374ec8d440
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tests/sampling.test.ts
@@ -0,0 +1,149 @@
+import { expect, test } from '@playwright/test';
+import { waitForTransaction } from '@sentry-internal/test-utils';
+
+test('Sends a sampled API route transaction', async ({ baseURL }) => {
+  const transactionEventPromise = waitForTransaction('node-otel-custom-sampler', transactionEvent => {
+    return transactionEvent?.contexts?.trace?.op === 'http.server' && transactionEvent?.transaction === 'GET /task';
+  });
+
+  await fetch(`${baseURL}/task`);
+
+  const transactionEvent = await transactionEventPromise;
+
+  expect(transactionEvent.contexts?.trace).toEqual({
+    span_id: expect.any(String),
+    trace_id: expect.any(String),
+    data: {
+      'sentry.source': 'route',
+      'sentry.op': 'http.server',
+      'sentry.origin': 'auto.http.otel.http',
+      url: 'http://localhost:3030/task',
+      'otel.kind': 'SERVER',
+      'http.response.status_code': 200,
+      'http.url': 'http://localhost:3030/task',
+      'http.host': 'localhost:3030',
+      'net.host.name': 'localhost',
+      'http.method': 'GET',
+      'http.scheme': 'http',
+      'http.target': '/task',
+      'http.user_agent': 'node',
+      'http.flavor': '1.1',
+      'net.transport': 'ip_tcp',
+      'net.host.ip': expect.any(String),
+      'net.host.port': 3030,
+      'net.peer.ip': expect.any(String),
+      'net.peer.port': expect.any(Number),
+      'http.status_code': 200,
+      'http.status_text': 'OK',
+      'http.route': '/task',
+    },
+    origin: 'auto.http.otel.http',
+    op: 'http.server',
+    status: 'ok',
+  });
+
+  expect(transactionEvent.spans?.length).toBe(4);
+
+  expect(transactionEvent.spans).toContainEqual({
+    span_id: expect.any(String),
+    trace_id: expect.any(String),
+    data: {
+      'sentry.origin': 'auto.http.otel.express',
+      'sentry.op': 'middleware.express',
+      'http.route': '/',
+      'express.name': 'query',
+      'express.type': 'middleware',
+    },
+    description: 'query',
+    parent_span_id: expect.any(String),
+    start_timestamp: expect.any(Number),
+    timestamp: expect.any(Number),
+    status: 'ok',
+    op: 'middleware.express',
+    origin: 'auto.http.otel.express',
+  });
+
+  expect(transactionEvent.spans).toContainEqual({
+    span_id: expect.any(String),
+    trace_id: expect.any(String),
+    data: {
+      'sentry.origin': 'auto.http.otel.express',
+      'sentry.op': 'middleware.express',
+      'http.route': '/',
+      'express.name': 'expressInit',
+      'express.type': 'middleware',
+    },
+    description: 'expressInit',
+    parent_span_id: expect.any(String),
+    start_timestamp: expect.any(Number),
+    timestamp: expect.any(Number),
+    status: 'ok',
+    op: 'middleware.express',
+    origin: 'auto.http.otel.express',
+  });
+
+  expect(transactionEvent.spans).toContainEqual({
+    span_id: expect.any(String),
+    trace_id: expect.any(String),
+    data: {
+      'sentry.origin': 'auto.http.otel.express',
+      'sentry.op': 'request_handler.express',
+      'http.route': '/task',
+      'express.name': '/task',
+      'express.type': 'request_handler',
+    },
+    description: '/task',
+    parent_span_id: expect.any(String),
+    start_timestamp: expect.any(Number),
+    timestamp: expect.any(Number),
+    status: 'ok',
+    op: 'request_handler.express',
+    origin: 'auto.http.otel.express',
+  });
+
+  expect(transactionEvent.spans).toContainEqual({
+    span_id: expect.any(String),
+    trace_id: expect.any(String),
+    data: {
+      'sentry.origin': 'manual',
+      'sentry.op': 'custom.op',
+    },
+    description: 'Long task',
+    parent_span_id: expect.any(String),
+    start_timestamp: expect.any(Number),
+    timestamp: expect.any(Number),
+    status: 'ok',
+    op: 'custom.op',
+    origin: 'manual',
+  });
+});
+
+test('Does not send an unsampled API route transaction', async ({ baseURL }) => {
+  const unsampledTransactionEventPromise = waitForTransaction('node-otel-custom-sampler', transactionEvent => {
+    return (
+      transactionEvent?.contexts?.trace?.op === 'http.server' && transactionEvent?.transaction === 'GET /unsampled/task'
+    );
+  });
+
+  await fetch(`${baseURL}/unsampled/task`);
+
+  const promiseShouldNotResolve = () =>
+    new Promise<void>((resolve, reject) => {
+      const timeout = setTimeout(() => {
+        resolve(); // Test passes because promise did not resolve within timeout
+      }, 1000);
+
+      unsampledTransactionEventPromise.then(
+        () => {
+          clearTimeout(timeout);
+          reject(new Error('Promise should not have resolved'));
+        },
+        () => {
+          clearTimeout(timeout);
+          reject(new Error('Promise should not have been rejected'));
+        },
+      );
+    });
+
+  expect(promiseShouldNotResolve()).resolves.not.toThrow();
+});
diff --git a/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tsconfig.json b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tsconfig.json
new file mode 100644
index 000000000000..8cb64e989ed9
--- /dev/null
+++ b/dev-packages/e2e-tests/test-applications/node-otel-custom-sampler/tsconfig.json
@@ -0,0 +1,10 @@
+{
+  "compilerOptions": {
+    "types": ["node"],
+    "esModuleInterop": true,
+    "lib": ["es2018"],
+    "strict": true,
+    "outDir": "dist"
+  },
+  "include": ["src/**/*.ts"]
+}