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Complex medical scenarios such as organ transplantation often bring up complex ethical issues for the medical practitioner. Knowledge about evidence-based medical evaluation and management combined with adhering to fundamental principles of medical ethics will go a long way in protecting the interests of all the stakeholders. Here, we discuss a complex scenario faced by our kidney transplantation team about offering transplantation for a patient with severe left ventricular dysfunction and how we used a framework of ethical principles in clinical decision-making.