China's growing healthcare system, serving over 1.4 billion people, has witnessed remarkable progress in organ transplantation, including among pediatric patients. This review provides a comprehensive overview of pediatric transplantation in China, summarizing national trends, regulatory frameworks, clinical outcomes, and ongoing challenges. Data were obtained from the Report on Organ Donation and Transplantation in China (RODTC) between 2015 and 2024. Pediatric patients were defined as those under 18 years of age. Following the 2015 reforms establishing voluntary citizen donation as the only legitimate organ source, China has developed a robust national regulatory and ethical framework under the National Health Commission. The China Organ Transplant Response System (COTRS) ensures transparent allocation, with a 2018 policy granting priority to pediatric recipients and mandating that organs from donors under 18 be preferentially allocated to pediatric patients. From 2015 to 2024, pediatric kidney, liver, and lung transplants increased 4.9-, 2.1-, and 7.5-fold, respectively; pediatric heart transplantation increased 2.5-fold from 2019 to 2024. In 2019, child donors represented 8.20% of deceased donors. Leading indications included non-ischemic cardiomyopathy for heart, bronchiolitis obliterans for lung, biliary atresia and metabolic liver disease for liver, and glomerulonephritis for kidney transplantation. Reported survival rates were favorable, with 5-year patient survival of 70.0% for heart and 95.5% for kidney transplants. Major transplant centers are concentrated in Shanghai, Guangzhou, Zhengzhou, and Beijing. Four national registries ensure lifelong follow-up and quality monitoring. Pediatric organ transplantation in China has advanced rapidly under strengthened ethical oversight and allocation reforms prioritizing children. Despite significant growth, challenges remain in data accessibility, regional disparities, and donor shortages. Continued policy refinement, registry expansion, and regional collaboration-particularly with Hong Kong and Macao-are essential to further improve access and outcomes for pediatric transplant recipients.

The authors declare no conflicts of interest.