The ongoing depletion of conventional fossil fuel reserves, coupled with escalating environmental concerns and the volatility of global oil markets, has intensified the search for cleaner and more sustainable energy alternatives for transportation. Among various low-emission fuels—such as biodiesel, ethanol, methanol, ammonia, hydrogen, and Compressed Natural Gas (CNG)—Liquefied Natural Gas (LNG) has emerged as a particularly viable option for Medium- and Heavy- Duty Vehicles (M&HDVs). LNG offers several advantages, including higher volumetric energy density, reduced tailpipe emissions, and compatibility with high-efficiency engine technologies. Its adoption is of strategic relevance to countries such as India, where transportation remains one of the largest contributors to Greenhouse Gas (GHG) emissions and is predominantly dependent on imported crude oil. The utilisation of LNG in M&HDVs has been identified as a means to simultaneously reduce GHG emissions and enhance national energy security. In this context, a comprehensive assessment is presented, encompassing LNG production pathways, distribution logistics, cryogenic storage technologies, and economic feasibility, as well as supportive government policies and international best practices. Key challenges, such as Boil-off gas (BOG) management, refuelling infrastructure gaps, cost parity with diesel, and engine retrofitting, have also been critically evaluated. Particular attention has been given to recent technological advancements and their potential to improve lifecycle emissions performance and cost-effectiveness. It is suggested that the integration of LNG into national energy and transportation strategies may yield substantial environmental and economic benefits, especially when supported by policy instruments, public–private investment models, and standardised regulatory frameworks. The findings indicate that LNG is poised to play a pivotal role in the decarbonisation of the freight and commercial transport sector, both in India and globally, thereby contributing to long-term sustainability objectives.