The notion of rationing healthcare is taboo: People naturally feel no one should limit the resources spent extending human life, particularly theirs or their loved ones’. Transplantation can transform organ recipients’ lives, but must be rationed by access to the far-too-small supply of donated organs, making it a microcosm of ethical dilemmas in rationing healthcare. Operations research techniques can maximize the number of life years gained from transplantation or redistrict geographic allocation units to distribute organs more fairly across large countries like the United States. Paired kidney exchange, in which a living kidney donor who is incompatible with the intended recipient exchanges organs with another incompatible pair, uses graph algorithms for maximum weight matching to select the best combination of exchanges. Beyond the sophistication of methods, the real challenge is to help decision-makers scrutinize how "fair" and "optimal" can be defined. I will share my experiences as a computational scientist in the transplant community.