India ranks third, after the United States and China in organ transplantation and has made significant progress in building capacity for rare transplants in addition to enhancement of relatively common transplants of kidney, liver, and heart. Despite the establishment of an organized system in the country for organ procurement from deceased donors, distribution and transplantation to needy patients, bridging the wide gap between transplants requirement and availability of organs continues to be a huge challenge. An estimated 2 lakh people die due to renal failure every year in India while around 9,000 kidney transplants are done with only about 10% of kidney transplants from deceased donors and 90% from living donors. Official data paints a similarly gloomy picture of a huge gap between organ donation and demand in respect of liver transplants and heart transplants. While over 2 lakh people die from liver failure or liver cancer every year in the country, timely liver transplants can save about 25,000 to 30,000 patients but around 2,000 liver transplants are done due to unavailability of donors and high costs. In sharp contrast to Western countries in which decease donors account for about 90% of the transplant, living donors account for about 80% of transplantation which speaks volumes about the low level of awareness on deceased organ donation despite the existence of the required legal framework. Recommendation by the Parliamentary Standing Committee, on Health and Family Welfare, for the continuation of the National Organ Transplant Programme (NOTP) till 2026 is expected to increase deceased organ donation and augment transplant infrastructure over the next four years. Key objectives of MOTP include organizing an efficient mechanism for organ and tissue procurement/retrieval especially from deceased donors and their distribution for transplantation, promoting deceased organ and tissue donation including pledging for the same, and spreading awareness about various aspects of organs and tissue transplantation among the public at large. Establishing and maintaining a national registry of organ and tissue donation and transplantation and developing an effective transport system for rapid and safe transportation of organs and tissues within and across the cities, as envisaged in strategies for the programme is critical to achieving the desired objectives. Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs and Tissues Act and has revolutionized the concept of organ donation after death. NOTP Guidelines explain that organ donation is practically possible in the situation of Brain stem death a victim of a road traffic accident or cerebrovascular accidents etc., where the brain stem is dead and a person cannot breathe on his own but can be maintained through a ventilator, oxygen, fluids etc., to keep the heart and other organs working and functional. After natural cardiac death, only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 8-9 organs, including vital organs such as kidneys, heart, liver, pancreas, lungs, small intestine and many types of tissues like cornea, skin, heart valves, bones etc., can be donated. The establishment of the National Organ and Tissue Transplant Organization (NOTTO) in New Delhi, five Regional Organ and Tissue Transplant Organizations (ROTTOs) and sixteen State Organ and Tissue Transplant Organizations (SOTTOs) have helped build the ecosystem for the promotion of organ donation in the country. From a deceased donor, the heart can be transplanted within 4-6 hours, lungs within 4-8 hours, liver within 12-15 hours, pancreas within 12-24 hours, kidneys within 24-48 hours and intestine within 6-10 hours which requires a smooth communication between the apex body and regional and state transplant organisation to ensure that donated organs are quickly and safely transported and transplanted on those patients who need them most urgently. The number of persons who have pledged for organ and/or tissue donation with NOTTO swelling to more than 14 lakhs speaks volumes about the growing awareness of organ donation and awareness about the legal framework of Brain Stem death will encourage family members of Brain-stem dead to donate the organs to save lives of many. A person legally in possession of the deceased person including a parent, spouse, son/ daughter or brother/sister can sign the consent form to give consent for the removal of organs. Awareness campaign for whole body donation or organ donation after one's death for transplantation and medical training and research has gained ground in the country. The awareness needs to be scaled up to the next level through a special focus on the importance of brain-stem death in organ transplantation. Strengthening the implementation of the NOTP at state levels for infrastructure development, the building required human resources and advocacy requires making organ donation a popular social movement. Preventing and controlling the diseases which cause organ failure should also be prioritized to reduce the demand for transplantation so that the gap between demand and availability of organs for transplant can also be reduced.