Nigeria's organ donation and transplantation systems remain underdeveloped, yet they hold great potential to address the nation's escalating healthcare challenges. This commentary provides a comprehensive overview of the current state of organ donation and transplantation in Nigeria, highlighting historical milestones, legal frameworks, and the pressing issues that hinder progress, including organ trafficking, cultural barriers, and inadequate healthcare infrastructure. Additionally, it reviews the disparities in access to transplantation services and the critical role of socioeconomic factors in this divide. The commentary offers a forward-looking approach, presenting key recommendations for policy reform, infrastructure development, and public education. Implementing these strategies would be pivotal in ensuring equitable access to organ donation services while setting a precedent for medical innovation in West Africa. Ultimately, this paper underscores the need for government action, international collaboration, and community engagement to create a robust and ethical organ donation framework in Nigeria.