Maintenance and replacement are considered as a crucial process in the medical equipment life cycle management. However, most of the healthcare sectors, especially private hospitals, are still facing conflict in deciding whether to maintain or replace medical equipment, due to poor planning in the organization. Previous studies have found that irregular maintenance, poor equipment planning, and management are the main problems that often occur with medical equipment in hospitals. Thus, this study aims to identify decision-making criteria for medical equipment maintenance and replacement, to evaluate the important decisionmaking criteria for medical equipment maintenance and replacement, and to develop decision-making framework for medical equipment maintenance and replacement focusing on Malaysian private hospitals. This study has been conducted in three phases namely: identifying the criteria through systematic literature review (SLR); semi-structured interviews using qualitative approach; and pairwise survey using Analytical Hierarchy Process (AHP). From SLR, we found 15 criteria for medical equipment maintenance and replacement. While in the interview phase, we have refined the findings from SLR and concluded that there are only nine decision-making criteria for maintenance and replacement of medical equipment. In the last phase, the analysis from AHP pairwise survey has found that the consensus indicator (CI) was low with 59% while high consistency ratio (CR) was more than 10%.