Organ transplantation is a critical medical intervention that saves countless lives globally, yet disparities in organ donation systems between developed and developing nations persist. This study examines the deceased organ donation systems in Nepal and the United States (U.S.), highlighting stark contrasts in efficiency, infrastructure, and public engagement. While the U.S. achieves 48.08 donations per million population (pmp) annually through a well-regulated framework under the Uniform Anatomical Gift Act (UGA), Nepal recorded only one brain-death donation in 2023 and none in 2024 despite significant governmental investment. Key differences include the U.S.'s centralized Organ Procurement Organizations (OPOs), computerized allocation via DonorNet, and robust public awareness campaigns, whereas Nepal relies on manual processes, lacks trained personnel, and has limited community engagement. 
 

To address these gaps, Nepal must implement urgent reforms: (1) enhancing public education and integrating donor registration into national identity cards, (2) training multidisciplinary teams, (3) establishing independent oversight for transparent allocation, (4) amending the Human Body Organ Transplantation Act (HBOTA) to expand transplantable organs and introduce donation after circulatory death (DCD) protocols, and (5) decentralizing authority to prevent conflicts of interest. By adopting lessons from the U.S. system—such as standardized protocols, technological integration, and trust-building measures—Nepal can develop an equitable, efficient, and sustainable organ donation framework to save more lives.