Purpose of Review <p>Deceased organ donation remains profoundly underutilized in low- and middle-income countries (LMICs) despite being the cornerstone of self-sufficient transplantation systems. Most LMICs—including India—still depend heavily on living donors because of gaps in legislation, infrastructure, and public acceptance. This review synthesizes global evidence and the Indian experience to identify actionable strategies that can expand deceased donation in resource-constrained settings.</p> Recent Findings <p>Major barriers include inconsistent brain-death determination, weak hospital-based organ retrieval and coordination networks, including limited linkage with centralized allocation systems, limited immunological and preservation facilities, cultural and religious misconceptions, and inadequate family counselling. Several LMICs, particularly India, have shown progress through state-level models (e.g., Tamil Nadu, Kerala, Gujarat) that emphasize trained transplant coordinators, sustained public awareness, and streamlined medico-legal clearances. Internationally, successful frameworks integrate professionalized donor coordination, mandatory brain-death reporting, transparent digital registries, and early adoption of donation after circulatory death (DCD) and machine perfusion. Emerging innovations such as green corridors, drone transport, and structured donor recognition programs further enhance organ utilization.</p> Summary <p>Achieving transplant self-sufficiency in LMICs requires a multi-pillar approach: ethical governance and transparent allocation systems; uniform brain-death and DCD protocols; robust retrieval and immunology infrastructure; continuous training of transplant professionals; and culturally sensitive public engagement. India’s mixed progress illustrates that context-adapted policies, coupled with long-term investments in capacity building and technology, can transform deceased donation from a marginal resource into a dependable, equitable lifeline.</p>