Renal transplantation is standard therapy for children with end stage renal disease (ESRD). Successful renal transplantation improves the well-being and nutrition as well as growth and development of infants and children. Renal transplantation is thus the goal of treatment of children with ESRD. Multidisciplinary inputs from the pediatric nephrologist, transplant surgeon, urologist, anesthetist, immunologist, dietician and social worker are imperative in providing optimum care to the transplant recipient. Children are usually excellent candidates for renal transplantation. Most transplant centers are able to perform the procedure once the child has achieved a weight of 810 kg. A multidisciplinary team should carefully evaluate the option of transplantation in children with multiple congenital anomalies and severe mental retardation with input from ethicists and informed input from parents.