Advancements in transplantation offer promising treatment options for a variety of diseases. Organ donation, an essential part of organ transplantation, may be performed at hospitals even if the facility is not a transplant center; therefore, perioperative nurses should be aware of developments in transplantation and the implications for patient care at their facilities. Considerations for organ transplant protocols include the type of documentation required, the elements of the transplant OR time out, and the use of intraoperative anti-rejection medications. Considerations for organ donation protocols include issues specific to a deceased donor, a living donor, or a donation after cardiac death. Newer developments in the transplant OR include laparoscopic kidney donation and transplantation, kidney paired donation transplantation, other living donor procedures, and transplantation procedures using robotic technology.