Informed Consent Liver Donor Living Donor Research

Videos and Assessments Improve Informed Consent for Living Liver Donors

I’ve written about the A2ALL Study before, and these results arise from those centers:



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).


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).
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.

Freeman J, Emond J, Gillespie BW, Appelbaum PS, Weinrieb R, Hill-Callahan P, Gordon EJ, Terrault N, Trotter J, Ashworth A, Dew MA, Pruett T, & the A2ALL Study Group (2013). Computerized assessment of competence-related abilities in living liver donors: the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. Clinical transplantation PMID: 23859354