The article explores the rules and criteria used for the allocation of donor organs in Singapore. Organs are extremely scarce, so hard decisions have to be made about who receives them. Based on an analysis of documents and interviews done with local program directors, both the admission to a waiting list for transplant and the final recipient selection are covered. The observed practices appear remarkably similar to those predominant in several Western countries until recently, when they had to be modified there following public criticism. It remains to be seen whether Singapore can sustain its much stricter standards in the future.