Worldwide, thousands of orchid species are harvested from the wild. Widespread legal and illegal unsustainable trade has contributed to the decline of many species. However, there is also evidence of long-term, sustainable wild harvest of some orchid species that contribute to local livelihoods and cultural traditions. There is a clear need to help guide harvesters and resource managers towards sustainability. However, there is currently no appropriate framework to guide local harvest decisions, which is especially problematic given huge data limitations, variations in on-the-ground capacity to monitor and manage resources, and considering that the potential for sustainable harvest is context-specific. We reviewed the literature on orchid harvest, ecology and demography; assessed information on the life history of 27 harvested species; and drew on our experience with diverse orchid taxa to identify characteristics expected to influence harvest sustainability. We identified 23 characteristics within four themes: abundance and distribution; species traits related to growth and reproduction; local management practices; and demand. We selected 12 characteristics for which information was available for many species and observable in the field, and used an iterative process to develop a decision-making dichotomous key. The key identifies if and how the harvest of a given population at a given time can be conducted more sustainably, offering sets of considerations that harvesters and managers can use and adapt to local contexts. Critical research gaps include techniques for partial plant harvest and for augmentation; and investigation into the traits and protocols that have permitted long-term persistence and that can increase current sustainability.