Patients with a matched sibling donor and 40 years of age or younger in good condition should be transplanted as soon as possible with a bone marrow graft, conditioned with cyclophosphamide and ATG and treated with CSA and MTX as GvHD prophylaxis. Patients not eligible for HSCT should receive immediate IS treatment with ATG and CSA. This is a conservative but well established treatment algorithm. However, early donor search should be initiated in younger patients without a MSD. Deviations from this recommended approach should only be investigated in studies. Prognosis of aplastic anemia has greatly improved over the four last decades. Improvement in the outcome of treatment for severe aplastic anemia (SAA) was achieved with better cellular support and treatment of severe infections. Progress in the definitive treatment forms available, hematopoietic stem cell transplantation (HSCT)  and immunosuppressive treatment (IS) have also contributed to a better outcome. In this short review, we discuss indications and prognosis for matched sibling donor (MSD) transplantation, consider the optimal stem cell source, conditioning regimen, and immunosuppression and debate the effect of age on the outcome of treatment for SAA. Finally, we briefly mention the rare cases of syngeneic HSCT.