Abstract: Tissue engineering aims to construct bioactive tissues/organs substitutes to achieve precise repair and functional reconstruction. 3D bioprinting has introduced a transformative manufacturing paradigm. However, conventional bioinks often fail to adequately balance printability with biological functionality, limiting their ability to replicate the complex microenvironment of native tissues. Decellularized extracellular matrix (dECM) bioink, derived from natural tissues, preserves tissue-specific 3D architectures and intrinsic biological cues, thereby providing a highly biomimetic microenvironment that supports cell adhesion, proliferation, and differentiation. These properties, combined with low immunogenicity and print compatibility, earn it the title of an ideal bioink, enabling it to overcome the imbalance between printing performance and biological function in traditional inks and successfully link 3D bioprinting with tissue engineering. This review systematically examines the integration of dECM bioinks with 3D bioprinting: the standardized pathway from tissue decellularization and quality control to application is first outlined. Next, current advancements in bioprinting technologies are then introduced, the limitations of traditional bioinks are analyzed, and the bridging role of dECM bioinks is elucidated. Building on this framework, the latest applications and key achievements of dECM bioinks are critically reviewed, with emphasis on two major frontiers: in vivo tissue regeneration and in vitro applications, including organ modeling as well as drug screening. Finally, critical bottlenecks such as printing precision, batch consistency, and clinical translation challenges are addressed, with corresponding future directions suggested to advance clinical translation.