Medical image segmentation models face significant challenges when deployed across different clinical environments, prompting the need for effective unsupervised domain adaptation (UDA) methods. A new approach, termed SHAPE, addresses the limitations of existing UDA techniques by incorporating structure-aware hierarchical alignment and plausibility evaluation. This enables the model to better account for global anatomical constraints and prevent the formation of implausible segmentations. By aligning features in a semantically aware manner, SHAPE improves distributional fidelity and enhances the overall performance of medical image segmentation models1. The development of SHAPE has significant implications for the deployment of medical imaging models in diverse clinical settings, allowing for more accurate and reliable segmentations. This, in turn, matters to practitioners as it can lead to improved patient outcomes and more effective treatment decisions, highlighting the importance of continued research in this area.