Kidney transplant surgery is for thinking surgeons who enjoy being part of a multidisciplinary transplant team. Good ones recognize the small margin for error and avoid difficulties by careful preparation and anticipation of potential pitfalls. Progressively, their role has gained in significance and is now the most important variable in kidney graft loss in the first 6 months after transplantation. Deceased organ donation is complex, expensive, and insufficient in numbers to meet the demand for kidney transplantation. Living donor surgery is therefore a procedure of necessity. Laparoscopic approaches have obvious benefits to the patient but are not operations for the beginner. There are few remaining stalwarts of the open nephrectomy procedure. Because of the limited length of the donor ureter, kidney transplant procedures involve placement of the donor kidney into a heterotopic position with vascular anastomoses to the iliac vessels. No two procedures are the same. Observation of the transplanted kidney changing from a flaccid and pale appearance to one that is firm and pink, and within seconds of removing vascular clamps, is an unforgettable experience for the first timer. Even better is the sight of urine, minutes later. Good transplant centres select their new surgeons carefully!