Organ transplantation represents one of modern medicine’s most significant achievements, with transplant anesthesiology emerging as a critical subspecialty in this field. This chapter introduces the specialized domain of transplant anesthesiology, highlighting its unique challenges and essential contributions to successful transplantation outcomes. Transplant anesthesiologists navigate complex physiological terrain in patients with end-stage organ dysfunction while managing unpredictable scheduling and time-sensitive procedures. This chapter details the anesthesiologist’s multifaceted role across the perioperative continuum—from preoperative risk stratification and patient optimization to intraoperative management of hemodynamics, coagulation, metabolic derangements, and reperfusion syndrome. It examines the evolution of transplant anesthesiology alongside advancements in surgical techniques and immunosuppression, the organizational frameworks supporting this subspecialty, and current challenges including the increasing use of extended criteria donors and the growing complexity of transplant recipients. This chapter emphasizes that expertise in transplant anesthesiology significantly impacts graft and patient outcomes, underscoring its essential position within the multidisciplinary transplant team.