title: Computerized assessment of competence-related abilities in living liver donors: the Adult-to-Adult Living Donor Liver Transplantation Cohort Study.
abstract: BACKGROUND
  Despite its importance, determination of competence to consent to organ donation varies widely based on local standards. We piloted a new tool to aid transplant centers in donor assessment.
  
  
  METHODS
  We assessed competence-related abilities among potential living liver donors (LDs) in the nine-center A2ALL study. Prospective LDs viewed an educational video and were queried to assess Understanding, Appreciation, Reasoning, and ability to express a Final Choice using the MacArthur Competence Assessment Tool for Clinical Research, adapted for computerized administration in LDs ("MacLiver"). Videotaped responses were scored by a clinical neuropsychologist (JF).
  
  
  RESULTS
  Ninety-three LDs were assessed. Mean (standard deviation; domain maximum) scores were as follows: Understanding: 18.1 (2.6; max = 22), Appreciation: 5.1 (1.0; max = 6), Reasoning: 3.1 (0.8; max = 4), and Final Choice: 3.8 (0.5; max = 4). Scores did not differ by demographics, relationship to the recipient, eligibility to donate, or eventual donation (p > 0.4). Higher education was associated with greater Understanding (p = 0.004) and Reasoning (p = 0.03).
  
  
  CONCLUSIONS
  Standardized, computerized education with independent ratings of responses may (1) alert the clinical staff to potential donors who may not be competent to donate and (2) highlight areas needing further assessment and education, leading to better informed decision making.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908-0203, USA. jf4z@virginia.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Freeman
authors.forename: Jean
authors.initials: J
authors.lastname: Emond
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: Robert
authors.initials: R
authors.lastname: Weinrieb
authors.forename: Peg
authors.initials: P
authors.lastname: Hill-Callahan
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: James
authors.initials: J
authors.lastname: Trotter
authors.forename: April
authors.initials: A
authors.lastname: Ashworth
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Timothy
authors.initials: T
authors.lastname: Pruett
mesh_terms: D000328:Adult; D032882:Comprehension; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007258:Informed Consent; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D010353:Patient Education as Topic; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012984:Software; D009927:Tissue and Organ Procurement
keywords: MacArthur Competence Assessment Tool for Clinical Research; comprehension; ethics; informed consent; living donation; transplantation