The binding constraint in Indian transplantation has not been surgical skill but coordination. An organ retrieved in one city has only hours of viability, and if the matching recipient sits on a list that another hospital cannot see, the organ is wasted. Fragmented lists also create the conditions for queue-jumping, which in turn erodes the public trust on which deceased donation depends — families consent when they believe the organ will go to whoever needs it most. A single national register addresses both problems at once: it raises utilisation by widening the pool of possible matches, and it makes allocation auditable. The outcome-tracking component is quieter but equally important, because India has had very little systematic data on how transplant recipients fare afterwards, without which no one can say which centres or protocols actually work.