Transplant medicine specialists are highlighting a critical gap in healthcare equity that could determine who lives or dies on organ waiting lists. The World Health Organization's new guidelines for GLP-1 medications like semaglutide and tirzepatide acknowledge obesity as a chronic disease requiring sustained treatment, but fail to adequately prioritize the 600,000 Americans who either await organ transplants or live with transplanted organs. These patients face a uniquely precarious position where excess weight can disqualify them from life-saving procedures or compromise transplanted organ function. The medical community argues that transplant candidates and recipients should receive explicit priority in the WHO's "highest need" framework for GLP-1 access. For transplant candidates, obesity often creates an impossible barrier - they're too sick to exercise intensively yet must achieve weight targets to qualify for surgery. Meanwhile, immunosuppressive medications required post-transplant frequently cause weight gain, threatening the longevity of their new organs. This represents more than an access issue; it's a matter of medical justice. Current healthcare systems often treat obesity management as elective rather than essential for transplant success. However, research demonstrates that weight optimization significantly improves transplant outcomes and reduces complications. The clinical evidence supporting GLP-1 therapies' cardiovascular and metabolic benefits makes them particularly valuable for this population, who already face elevated risks from their underlying conditions and medications. As healthcare systems implement WHO guidelines, the transplant community's advocacy underscores how treatment prioritization decisions reflect broader questions about healthcare equity and resource allocation in an era of expensive but transformative medications.