Suppose you’re a surgical consultant in charge of assigning organs on a transplant list, and a liver becomes available. Your hospital currently has two patients that urgently need the transplant; a 14 year old girl, and a 33 year old man with two infant children who is a regular drinker.
This is a pretty dire situation, because whatever your choice, someone is going to die and you might feel you like you have indirectly condemned them. However, without treatment, it is likely that both patients will die anyway, and therefore it is important that the chance to treat someone be seized.
The very first thing to do is work out which of the patients are a biological match for the transplanted organ. If either of them isn’t, that ends the dispute immediately. Mechanical factors could also be considered - meaning whether the size and shape of the donor liver would suit each patient and whether the procedure would be substantially more difficult in either of them, for example if one of them had hemophilia.
In the UK, only around 1% of organ donors die in circumstances where their organs can be safely donated to another person.
There are then an enormous number of circumstantial factors that could then be assessed. For example, the father patient has a history of drinking, although the question does not say to excess. Might the teenage girl be more responsible with the liver and avoid heavy drinking? Demonstrate to the interviewer that you are aware that many of these social elements can be important in making the choice.
Perhaps the most important concept is that of Quality of Life (QoL). Which of the patients stands to gain the most with regards to long-term prognosis as a result of the transplant procedure? This is difficult to measure, but the Quality-adjusted Life Year is the most commonly used method. Essentially you’d wish to know which patient would live the largest number of years with the highest level of health - the girl has longer to potentially live, but would this necessarily be in the same health state as the father if something went awry during the operation?
Is it right that a heavy drinker should get a liver transplant over a non-drinker? These questions are very important for systems with constrained resources such as the NHS.
You may also consider the social impacts of your choice. The parents of the teenager are likely to suffer very badly emotionally if she were to die, due to her not having lived a full life, which would seem a great injustice. Conversely, the QoL for the two infant children would also likely be negatively affected by the lack of their father if he were to die.
Your interviewers will not expect you to choose ‘the right answer’ in these scenarios, as very often (if not always) the questions are designed such that one does not exist. Avoid jumping to a conclusion very quickly, as it’s all about how carefully you can assess the situation and consider as many factors as possible. Do choose an answer and provide solid reasoning to back it up, but always communicate that there are valid arguments on both sides.