The better repair of human tissue is an urgent medical goal and in order to achieve a safe outcome there is a parallel need for sensitive, non-invasive methods of assessing the quality of the engineered tissues and organs prior to surgical implantation. Optical coherence tomography (OCT) can potentially fulfil this role, that has the capability to visualise the microstructures and tissue properties in real time at cellular resolution. The current status of OCT as an advanced imaging tool in clinical medicine, developmental biology and material science will be reviewed and the parallels to the engineering of living tissue and organs discussed. Results will be also presented for tissue engineering bioreactors with in situ OCT imaging. The data suggest that OCT can be utilised as a real time, non-destructive, non-invasive tool to critically monitor the morphology of tissue-engineered constructs during their fabrication and growth.