A review of current and future district cooling (DC) technologies, operational, economic, and environmental aspects, and analysis and optimization methodologies is presented, focusing on the demands of cooling-dominated regions. Sustainable energy sources (i.e., renewable, waste/excess electricity and heat, natural/artificial cold) and cooling/storage technology options with emphasis on heat-driven refrigeration, and their integrations in published DC design and analysis studies are reviewed. Published DC system analysis, modeling, and optimization methodologies are analyzed in terms of their objectives, scope, sustainability-related criteria, and key findings. The current and future development of DC in the Gulf Cooperation Council (GCC) region, a major developing cooling-dominated market, is examined more specifically in terms of current and future energy sources and their use, and economic, environmental, and regulatory aspects, with potential technical and non-technical solutions identified to address regional DC sustainability challenges. From the review of published DC design and analysis studies presented, collective research trends in key thematic areas are analyzed, with suggested future research themes proposed towards the sustainability enhancement of DC systems in predominantly hot climates.