Objective To review the role of heme oxyenase-1 in organ transplantation and explore the potential applications targeted on overexpression of heme oxyenase-1 gene.Data sources The data cited in this review were mainly obtained from the articles listed in Medline and PubMed,published from January 1996 to December 2008.The search terms were "heme oxygenase-1" and "transplantation".Study selection Articles regarding the role of heme oxyenase-1 in organ transplantation and its protective role in transplants were selected.Protective effects of heme oxygenase-1 overexpression using a gene transfer approach against ischaemic reperfusion injury during transplantation were widely explored.Results Local heme oxygenase-1 overexpression in the graft ameliorates the ischaemic reperfusion injury.This is due to removal of heme, a potent prooxidant and proinflammatory agent, but also because of generation of biologically active products.Conclusions Overexpressive heme oxygenase-1 activity is associated with tissue protection in the setting of graft,ischaemic reperfusion injury.Gene therapy is attractive to us; but a long way from general application.In terms of heme oxygenase-1, the gene promoters are polymorphic.Although individualization is an important principle during clinical application, it is difficult to put into practice.