Sustainability transformations are characterized by complex system dynamics, including abstraction, non-linearity and uncertainty, which are often challenging to comprehend due to psychological barriers and misconceptions. Serious games offer a promising tool to both explore and communicate such dynamics, as they simplify complex mechanisms and enable more tangible understanding through simulations of real-world problems. This study examines how existing serious games related to sustainability transformations translate politico-economic structures and ecological patterns into game design. Furthermore, we explore how leverage points can be integrated into serious games, drawing on Donella Meadows' systems thinking approach. The review follows the PRISMA framework and encompasses 170 selected papers from Scopus and EBSCO databases. Findings of qualitative analysis reveal how existing serious games related to sustainability transformations mirror ecological, economic and political structures and show possible ways to address leverage points via game design. Subsequently, we discuss how serious games can be used as educational and research tool to both explore and teach the root causes of unsustainability as well as possible interventions. Further research is needed to evaluate how serious games can contribute to enhance understanding of system dynamics and analyze human–system interactions. We outline approaches for future research efforts and discuss questions of validity when using serious games for research purposes.