• Reframes organoids along a continuum from in vitro disease models to transplantable therapeutic systems. • Establishes a unified engineering framework that governs microenvironment design across organoid development, maturation, and translational application. • Identifies vascularization and immune tolerance as a coupled bottleneck for organoid transplantation and distills design principles for perfusable, immunomodulatory graft niches. Organoids are moving from self-organized three-dimensional (3D) cultures toward engineered living systems with translational intent. Yet most platforms still rely on static, poorly defined matrices and limited control over architecture, maturation, and batch reproducibility. Clinical translation exposes scale dependent constraints This review reframes organoid translation as an engineering continuum that links controllable variables across three stages: in vitro microenvironment engineering, engineering enabled in vitro translational workflows, and in vivo clinical translation. We summarize how engineered microenvironments provide quantitative control over stiffness, geometry, and transport to improve reproducibility during organoid construction. We then discuss engineering enabled workflows that introduce dynamic conditioning and functional benchmarking to bridge in vitro performance with translational requirements. For in vivo application, we highlight vascularization and immune compatibility as a coupled bottleneck and define functional integration as measurable system level contribution rather than structural persistence alone. Together, these strategies outline a scale aware and clinically aligned engineering framework for organoid translation.
Liao et al. (Sun,) studied this question.