<p>Severe aplastic anemia [SAA] is a serious illness characterized by pancytopenia with symptoms of hematopoietic failure and a hypocellular marrow. Both hematopoietic stem cell transplantation [HSCT] and immunosuppressive therapy [IST] with antithymocyte globulin [ATG] are the standard treatment options available. The process of HSCT can vary depending upon whether it is being offered for idiopathic AA or for inherited bone marrow failure syndromes [IBMFS]. For idiopathic AA, HSCT using a matched sibling [MSD] donor is the treatment of choice in patients below the age of 50 years. Alternate donor [matched unrelated donor and haplo-identical donor] transplants may be offered upfront in specific circumstances. Conditioning regimens used include a combination of Cyclophosphamide with ATG or Fludarabine with Cyclophosphamide and ATG. The preferred graft source is unmanipulated bone marrow [BM]; however, in low-income countries and in specific circumstances, the use of peripheral blood stem cells [PBSC] may be preferred. Graft-versus-host disease [GVHD] prophylaxis consists of a calcineurin inhibitor [CNI] – either Cyclosporine or Tacrolimus in combination with short course methotrexate. The overall survival after MSD transplants is close to 90% for patients aged 18 and below and 80% for patients aged &gt; 18 years. Outcomes of MUD and Haploidentical transplants are steadily improving and now nearing the outcomes of MSD transplants. For IBMFS, it is important to recognize them early since they will not improve with IST, donors need to be screened for the same genetic mutations, and doses of conditioning regimens needs to be modified in certain IBMFS. In addition, some of the IBMFS carry a risk of malignancies involving other organs and this risk does not reduce with HSCT. The survival outcomes of MSD and alternate donor transplants in IBMFS range between 75-90%. In conclusion, HSCT offers very good survival in both idiopathic AA and IBMFS. Early access to HSCT will help in further improving outcomes.</p>