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Patients with diabetes are not infrequently faced with considering the possibility of organ transplantation, both as a therapy to manage diabetes itself as well as a therapy to manage complications of diabetes. Healthcare providers must be aware of the outcomes and advances in kidney, pancreas and islet transplantation in order to effectively advise and guide patients through the process of transplant evaluation.Recently, it has become clear that an aggressive approach to kidney transplantation should be taken in patients with diabetes with kidney failure, including early referral and consideration of ‘expanded donor criteria’ donor kidneys. Pancreas transplantation has become increasingly successful and may offer a subset of these patients a survival advantage, but the timing of pancreas transplantation remains in question. The field of islet transplantation continues to evolve, and offers significant benefits of resolution of hypoglycemia unawareness and improved glycemic control with less procedural complications.Kidney transplantation must be recognized by all healthcare providers as the treatment of choice in individuals with diabetes and renal failure. Advances in both pancreas and islet transplantation now demonstrate significant benefits for specific populations, and can be considered for subsets of patients with type 1 diabetes.