Short bowel syndrome is the clinical manifestation of a fundamental reduction in the functional intestinal absorptive surface area and malabsorption. The development of total parenteral nutrition has improved the natural course of this disease. Home parenteral nutrition‐related complications continue to generate significant morbidity and mortality for these patients. Small‐bowel transplantation is an alternative to home parenteral nutrition. There are significant risks of graft rejection and the potential complications oflong‐term immunosuppression. Small‐bowel transplantation is an option, but it should be reserved for patients no longer considered candidates for continued home parenteral nutrition.