Stem cell-derived organoids are emerging as living therapeutics for repairing or replacing damaged tissues and organs, offering new opportunities for regenerative medicine. However, their clinical translation remains limited by immune rejection, insufficient functional integration, and low manufacturing throughput. In this review, we summarize recent advances in engineering organoids toward implantable living therapeutics by examining how hydrogel engineering, microfluidic chips, three-dimensional bioprinting, and synthetic biology overcome key translational barriers and facilitate the in vivo application of organoids. We further discuss the existing regulatory frameworks supporting the clinical translation of organoid-based therapies. Current evidence indicates that these bioengineering strategies enhance graft survival, tissue integration, and therapeutic efficacy through complementary mechanisms, including immunomodulatory signals, biomimetic microenvironments, hierarchical tissue architectures, and programmable cellular functions. Importantly, engineered organoids have been successfully applied to restore hair-bearing skin, repair colonic epithelial continuity, bridge critical-size bone defects, and correct metabolic disorders. Despite these advances, significant challenges remain in quality-control standardization, scalable manufacturing, regulatory harmonization, and long-term safety assessment. Future studies integrating artificial intelligence (AI) and intelligent living devices are warranted to facilitate high-fidelity manufacturing, quality inspection, real-time monitoring, and closed-loop therapeutic regulation in clinical practice. Collectively, engineered organoids represent a promising frontier for new-generation transplantation and regenerative medicine.