Assam has expanded its capacity to retrieve and transplant organs from donors to a network of 12 hospitals, but the majority of these are concentrated in Guwahati, and only three hospitals with the facilities are beyond the state capital. The state urgently building capacity in more hospitals elsewhere is critical to making life-saving transplants of organs accessible for needy patients across the state. Bridging the widening gap between availability of donated organs and the number of needy patients continues to be a monumental challenge, with non-availability of critical infrastructure shortcomings being the key factor. It is heartening to know that more and more people have pledged their organs for donation, but disappointingly, the low number of transplants or donated organs paints a grim picture. There is no room for complacency over the organ donation pledge so long as awareness of the importance of cadaveric transplant of brain-dead donors remains low. While a living donor can donate only a kidney or a part of the liver, it is possible to transplant multiple organs of a brain-dead donor or patients with sudden cardiac death to save several lives. As cadaveric donations significantly increase the availability of organs for transplant for wait-listed patients, laying more emphasis on building awareness of it is crucial to ensure that pledges also lead to an increase in actual transplants after their death. The window for retrieval and safe transportation of retrieved organs being narrow, the network of hospitals equipped with retrieval and transplant facilities having an excellent coordination and efficient system to complete the process swiftly is vital to make awareness on organ donation result-orientated. In the case of living donors, there is an inherent risk to life and health that is not there in the case of cadaveric organ donations. The biggest challenge, however, in raising awareness on cadaveric organ donations is convincing the family members to overcome emotional barriers and consent to organ retrieval from brain-dead donors. The government and the NGOs engaged in building awareness on organ donations collaborating to raise awareness on cadaveric organ donations can significantly increase the availability of organs for transplants. The state government must ensure that organ retrieval and transplant is not gripped by the chicken and egg dilemma, and expansion of the network of hospitals with approved facilities must be pushed along with building awareness on organ donations by both living and brain-dead donors. The medico-legal complexities involved in organ donations, more particularly in cadaveric organ donations to non-blood relation recipients, are another area that needs focused attention from all stakeholders. Simplifying the documentation procedures can play a crucial role in converting the organ donation pledges into actual life-saving transplants. Hospitals and NGOs raising a team of volunteers to help the family members of brain-dead donors in the documentation process is essential, as family members are gripped by trauma and are not in a mental state to undergo the complex technical procedure involved in organ donations. The state government incentivising the NGOs working in the health sector and running organ donation awareness campaigns with fund and infrastructure support can bring about a transformative change in organ donation and transplants. Psychological counsellors being a part of such a trained team of professionals and volunteers is crucial to take care of the emotional trauma of relatives and other family members of brain-dead donors so that they can cope with the trauma of loss and find emotional strength to give consent for organ retrieval. Stories of family members of brain-dead donors overcoming trauma and consenting to retrieval of organs for transplants in needy patients need to be spread, in which media can play an effective role. Encouraging them to lead awareness campaigns can help more people to overcome the trauma or give consent to retrieval of brain-dead donors, as their personal stories will have stronger emotional appeal and be more persuasive than theoretically explaining the importance of cadaveric donations. The network of approved hospitals, the transport department, and the police department having strong coordination can go a long way in identifying organ donors who have met with a serious road accident and been declared brain dead by doctors. The use of digital technology to quickly disseminate the information from a centralised database can help hospitals and NGOs to approach family members of such donors to request retrieval of organ donations for transplants as wished by the donors. Explaining the brain-dead condition of a patient by medical experts is crucial to help family members realise that the condition of the donor is irreversible. If the awareness of the brain-dead condition among the general public increases, securing the consent by hospital authorities for organ retrieval from a donor can be easier. The state government adopting a multipronged approach of expanding organ retrieval and transplant capacity and building awareness on cadaveric organ donations will help save the lives of many needy patients in Assam. The cadaveric organ donation in Assam needs a stronger policy push.