Uterus transplantation (UTx) raises questions on how to assess the need for UTx in needs-based healthcare systems, and this is the focus of this chapter. I will identify different needs in the situation, characterize these as direct or indirect (where treatment has to be targeted to those with direct needs) and analyze how such a complex of needs should be handled in priority setting. The main conclusions are: only the needs of existing individuals should be taken into account; we have reasons not to combine the needs of different individuals but to allow the greatest need to trump all other needs involved in the situation; what is the greatest need has to be decided on a contextual basis, distinguishing between pre-pregnancy and during pregnancy needs; in the latter case, even if the fetus has greatest need, the woman should have the last say in whether this should be allowed to trump other needs.