In a mechanically ventilated patient who is brain‑dead with no advance directive on file, from whom is organ donation consent most appropriately obtained?

• A. Closest family member
• B. Attending physician only
• C. Hospital ethics committee
• D. The patient’s legal guardian (if any)

Answer: (A)

When a patient is brain-dead and cannot express wishes, someone must stand in as the decision-maker for organ donation. In the absence of an advance directive, the responsibility falls to the person who is legally authorized to make medical decisions for the patient, typically the closest family member or next of kin. This surrogate responsibility is why the consent for organ donation is most appropriately obtained from the closest family member—their role is to reflect the patient’s values and preferences and to authorize donation when no directive exists. The physician informs and supports the family, but the actual consent is provided by the surrogate. A hospital ethics committee isn’t the source of consent, and a legal guardian would only have authority if one exists. Therefore, approaching the closest family member first aligns with who is legally and ethically empowered to make this decision for a patient who cannot decide for themselves.