Designing sustainable underground metro lines in dense urban environments is a highly challenging task that requires the collaboration of numerous stakeholders and consultants to make crucial decisions influenced by several factors. While it is impossible to address every issue influencing the decision-making process, identifying key factors and their interdependencies is essential for optimal design. This study focuses on six critical aspects of the reference design of metro systems: (1) track alignment, (2) tunneling strategy, (3) station typology, (4) operations and maintenance, (5) procurement strategy, and (6) environmental aspects. Amongst these aspects, we identify track alignment as the primary driving factor that influences the other factors. We analyze the decision between shallow and deep alignments as an engineering choice that necessitates balancing conflicting factors and constraints. Our contribution lies in mapping these factors and their dependencies, thus offering policymakers, project managers, and designers a framework to navigate the design process. Our discussion also provides guidance to public agencies in tendering for design teams more efficiently. Drawing from lessons learned by experienced design managers, this study aims to fill the gap in the literature by offering a generalist perspective on metro design.