The global shortage of transplantable organs continues to limit access to life-saving transplan-

tation. Paediatric organ donation represents a valuable yet underutilised resource due to ethical

concerns, technical challenges and limited public awareness. En bloc kidney transplantation from

paediatric donors has emerged as a practical strategy to expand the donor pool while preserving

vascular integrity and nephron mass. We report a successful en bloc renal transplantation from

a 5-year-3-month-old donor weighing 14.5 kg into a 42-year-old adult recipient with end-stage

kidney disease secondary to hypertensive nephrosclerosis. Anaesthetic management focused on maintaining haemodynamic stability, optimising graft perfusion and balancing fluid administration gin a recipient with significant cardiovascular comorbidities. Continuous invasive haemodynamic monitoring and goal-directed fluid therapy were utilised throughout the procedure. Attention was
paid to maintaining adequate mean arterial pressure during vascular anastomosis and reperfusion
while avoiding fluid overload in the presence of diastolic dysfunction. Immediate urine output
following reperfusion indicated early graft function. The postoperative course was uneventful, and
the patient was transferred from the intensive care unit after two days. This case highlights the im-
portant role of anaesthetists in perioperative transplant management and underscores the need for
greater awareness and advocacy for paediatric organ donation.

Keywords: Paediatric organ donation, en bloc kidney transplantation, renal transplantation, anaes-
thesia, organ donation advocacy