Short bowel syndrome (SBS) is a leading cause of intestinal failure, often requiring long-term parenteral nutrition (PN) for survival. While PN has significantly improved patient outcomes, complications such as catheter-related infections, metabolic imbalances, and liver disease can develop, necessitating alternative treatment strategies. Intestinal transplantation (ITx) has emerged as a life-saving intervention for select SBS patients with irreversible intestinal failure and severe PN-related complications. This chapter explores the indications, types, and outcomes of ITx, highlighting its evolution from an experimental procedure to an essential therapeutic option. Advances in surgical techniques, immunosuppressive therapies, and patient selection have improved posttransplant survival, yet challenges such as chronic rejection and long-term graft function remain. The decision to pursue ITx must be carefully considered, balancing the risks of lifelong immunosuppression against the potential for digestive autonomy. Early referral for transplant evaluation may enhance outcomes, reducing waiting list mortality and improving quality of life. This chapter underscores the importance of a multidisciplinary approach in optimizing the management of SBS and intestinal failure, ensuring timely intervention for patients most likely to benefit from transplantation.