Expanding the toolbox of the biology and electronics mutual conjunction is a primary aim of bioelectronics. The organic electrochemical transistor (OECT) has undeniably become a predominant device for mixed conduction materials, offering impressive transconduction properties alongside a relatively simple device architecture. In this review, we focus on the discussion of recent material developments in the area of mixed conductors for bioelectronic applications by means of thorough structure–property investigation and analysis of current challenges. Fundamental operation principles of the OECT are revisited, and characterization methods are highlighted. Current bioelectronic applications of organic mixed ionic–electronic conductors (OMIECs) are underlined. Challenges in the performance and operational stability of OECT channel materials as well as potential strategies for mitigating them, are discussed. This is further expanded to sketch a synopsis of the history of mixed conduction materials for both p- and n-type channel operation, detailing the synthetic challenges and milestones which have been overcome to frequently produce higher performing OECT devices. The cumulative work of multiple research groups is summarized, and synthetic design strategies are extracted to present a series of design principles that can be utilized to drive figure-of-merit performance values even further for future OMIEC materials.