Aims: To adapt the Global Living Guidelines for Cochlear Implantation in Adults to the Australian and New Zealand (ANZ) context, ensuring relevance across diverse service models. Methodology: The ANZ Hearing Health Collaborative (ANZ HHC), comprising over 70 stakeholders, conducted five structured workshops between 2023-2024. These focused on referral pathways, evaluation protocols, candidacy criteria, and outcome measures. Feedback from clinicians, researchers, and those with a lived experience of hearing loss informed the draft guidelines, which were refined through public consultation. Results: Finalised in mid-2025 with 80% stakeholder endorsement, the ANZ Living Guidelines recommend timely referral for adults with severe or greater hearing loss who derive limited benefit from hearing aids. They advocate for multidisciplinary candidacy assessment and outcome evaluation using both objective speech perception tests and patient-reported measures. Conclusion: The guidelines offer a unified, evidence-informed framework for adult cochlear implantation across ANZ. They aim to improve access, consistency, and quality of care, and serve as a foundation for policy, funding, and service planning. Ongoing implementation and evaluation will be essential to achieving system-wide improvements in hearing health.