We propose a framework for building patient-specific treatment recommendation models, building on the large recent literature on learning patient-level causal models and inspired by the target trial paradigm of Hernan and Robins. We focus on safety and validity, including the crucial issue of causal identification when using observational data. We do not provide a specific model, but rather a way to integrate existing methods and know-how into a practical pipeline. We further provide a real world use-case of treatment optimization for patients with heart failure who develop acute kidney injury during hospitalization. The results suggest our pipeline can improve patient outcomes over the current treatment regime.