*Princess*
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You have one liver available for transplant, but two patients with equal medical need. One is an ex-alcoholic mother with two young children, the other a 13 year old with an inborn liver abnormality. How would you decide to whom it should be given?

I read this on a website for past interview questions, what would you say? It is soo hard to decide!!
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modini
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#2
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Whoever's higher up on the transplant list
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H.JJJ
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^ what modini said.. but if it was only considering those two and nobody else on the list.. the 13 year old, has his/her life ahead of them. also you could say the mother damaged her liver by drinking so how do we know she would turn to drink again and damage this one? the kid was born with the disfunction which doesnt make it their fault
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Donald Duck
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I'd just pick the highest one on the list, assuming the mother is really an ex-alcoholic.
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gyrase
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The liver can be split into two.
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AJ-24
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#6
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(Original post by *Princess*)
You have one liver available for transplant, but two patients with equal medical need. One is an ex-alcoholic mother with two young children, the other a 13 year old with an inborn liver abnormality. How would you decide to whom it should be given?

I read this on a website for past interview questions, what would you say? It is soo hard to decide!!
Well - as everyone else has said, who ever is higher up the list

Orrrr "flip a coin" ... lame as it sounds its entirely fair (assuming the coin is) and it'll help you decide. After all, if the choice for me was "50% chance of getting a liver ... or NO liver .. its an obvious choice".

Orrr the evolutionary standpoint that the mother has already reproduced, so ya kno.

I still like the coin idea though
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*Princess*
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(Original post by modini)
Whoever's higher up on the transplant list
And who decides who is highest on the transplant list?
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beccy.
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oo isnt the best thing to say in an interview that you would consult your team?!
and then say whoever you think deserves it most for whatever reason but that youd be willing to listen to arguments otherwise and weigh up the pros and cons of each etc. cos there is no right answer to that kinda question..
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*Princess*
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(Original post by beccy.)
oo isnt the best thing to say in an interview that you would consult your team?!
and then say whoever you think deserves it most for whatever reason but that youd be willing to listen to arguments otherwise and weigh up the pros and cons of each etc. cos there is no right answer to that kinda question..
That sounds like a good idea because it shows you are a team player etc, any med students/people with offers care to shed some light on this?
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gyrase
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(Original post by *Princess*)
And who decides who is highest on the transplant list?
Erm ... whoever was put on the list for liver transplant first gets the liver ...
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nexttime
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is she a good mother to her children? how young are they, and do they have good alternative care arrangements?

its not so much about the mother's life, that is clearly (imo) not as important as the child's. what is more important is whether the children will have their lives ruined by the loss of their mother.
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willowtree
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this 13 year old girl has survived with a dodgy liver for 13 years. Is the other patient an emergency? If so then give her this liver and the 13 yearold can wait another few weeks.
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*Princess*
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(Original post by nexttime)
is she a good mother to her children? how young are they, and do they have good alternative care arrangements?

its not so much about the mother's life, that is clearly (imo) not as important as the child's. what is more important is whether the children will have their lives ruined by the loss of their mother.
Yes, i was thinking along those lines too- like how much of an impact does the mother have on the children's daily lives? But, wouldn't that sound really harsh as it seems like you are neglecting the fact the mother should be given the transplant for the sake of solely her living, rather than for the sake of her being there for her children (if that makes any sense?)

I guess im just really scared that im going to sound really cold-hearted and overly logical/ devoid of emotions at interview (if i get one- i haven't even applied yet!)
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*Princess*
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(Original post by gyrase)
Erm ... whoever was put on the list for liver transplant first gets the liver ...
So it is like a first come first serve basis, rather than a priority arrangement type system?
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Suspect
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They won't really be judging you on which one you pick- more the reasoning you use and the ideas you come up with.
You'd be best off thinking out loud- mentioning all the stuff thats already been mentioned here (like team decisions, quality of life etc) so they can ask you questions on it.
In a real interview this could also lead on to discussions about limited resources in the NHS and could be an opportunity to bring up all the recent discussions about an opt-out transplant scheme so bear that in mind when you're trying to prepare.
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gyrase
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Ok I guess I was concentrating too much on the scientific side of the liver transplant. The first come first serve basis doesnt apply to liver transplants that much as it does to kidney transplants as the latter are more common.

The mother has a responsibility of her children, if denied the liver transplant and the decision leads to her death, the decisions of the medical staff is fully to blame. Consequently, what will happen to the children after losing their mother will also be because of the Doctor's decision to who gets the liver. Children will most likely go to foster care/relatives.
Another aspect here is that the mother is an ex-alcholic which she may relapse to again, so a transplant wouldnt be *deserved* if its taken bad care of. Given that she has children and responsibility, most likely she wouldnt retreat back to drinking. I would also like to know the status of the father in this situation if available.

The 13 yr old teenager is a congenital liver abnormality case so if the medical team decide the liver should go to the mother, the medical staff can't be fully blamed if the child does decease because the child was likely to die from an abnormal liver anyway as oppose to the mother who would die due to no transplant.

The age is the key feature here and there isnt a right answer unless more patient history is given. Personally, I would say the mother should recieve it.
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nexttime
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(Original post by *Princess*)
Yes, i was thinking along those lines too- like how much of an impact does the mother have on the children's daily lives? But, wouldn't that sound really harsh as it seems like you are neglecting the fact the mother should be given the transplant for the sake of solely her living, rather than for the sake of her being there for her children (if that makes any sense?)

I guess im just really scared that im going to sound really cold-hearted and overly logical/ devoid of emotions at interview (if i get one- i haven't even applied yet!)
yeah i had an interview at cardiff that i thought went really well, and ended up getting rejected. this could have been because of a number of reasons, of course, but i think me being too 'cold' may have been something to do with it.

i think at the end of the day you can only make decisions based on your own logic, and if that comes accross as uncaring, then there is nothing you can do. Just think alloud, consider both sides (including emotional involvements, i guess), and make the best decision you think is available.
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Renal
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(Original post by gyrase)
Ok I guess I was concentrating too much on the scientific side of the liver transplant. The first come first serve basis doesnt apply to liver transplants that much as it does to kidney transplants as the latter are more common.
Well it does. People in liver failure die - rapidly. People in kidney failure don't, well, not as quickly because they get plumbed up for dialysis sharpish. Hence, a punter wanting a kidney can wait for the best(ish) match to come up, the liver punter has to be a bit more flexible and take what they're given.
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gyrase
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(Original post by Renal)
Well it does. People in liver failure die - rapidly. People in kidney failure don't, well, not as quickly because they get plumbed up for dialysis sharpish. Hence, a punter wanting a kidney can wait for the best(ish) match to come up, the liver punter has to be a bit more flexible and take what they're given.
I dont kno, but if it was a first come first serve basis then the question of who should get the liver is redundant.

I certainly wish people would donate more, as dialysis is costly.
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zzzzzoe
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the one who needs it most desperately for medical reasons? (unless ones higher on the transplant list?)

haha sorry, im not even a medic!
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