Resource recovery and reuse from domestic wastewater has become an important subject for the current development of sanitation technologies and infrastructures. Different technologies are available and combined into sanitation concepts, with different performances. This study provides a methodological approach to evaluate the sustainability of these sanitation concepts with focus on resource recovery and reuse. St. Eustatius, a small tropical island in the Caribbean, was used as a case study for the evaluation. Three source separation-community-on-site and two combined sewerage island-scale concepts were selected and compared in terms of environmental (net energy use, nutrient recovery/reuse, BOD/COD, pathogens, and GHG emission, land use), economic (CAPEX and OPEX), social cultural (acceptance, required competences and education), and technological (flexibility/adaptability, reliability/continuity of service) indicators. The best performing concept, is the application of Upflow Anaerobic Sludge Bed (UASB) and Trickling Filter (TF) at island level for combined domestic wastewater treatment with subsequent reuse in agriculture. Its overall average normalised score across the four categories (i.e., average of average per category) is about 15% (0.85) higher than the values of the remaining systems and with a score of 0.73 (conventional activated sludge – centralised level), 0.77 (UASB-septic tank (ST)), 0.76 (UASB-TF - community level), and 0.75 (ST - household level). The higher score of the UASB-TF at community level is mainly due to much better performance in the environmental and economic categories. In conclusion, the case study provides a methodological approach that can support urban planning and decision-making in selecting more sustainable sanitation concepts, allowing resource recovery and reuse in small island context or in other contexts.