How Families Become Able to Assume Surrogate Decision-Making Responsibility in Donation After Brain Death: An Interpretive Qualitative Study.

Donation after brain death requires families to assume surrogate decision-making responsibility while coping with sudden loss and uncertainty. The aim of this study was to explore how family members became able to assume this responsibility. Semi-structured interviews were conducted 3-7 years after donation with four family members who had participated in organ donation discussions in Japan. Data were analysed using Krippendorff's qualitative content analysis. Families described being assigned responsibility before feeling ready, regaining orientation through sustained interaction with healthcare professionals, developing moral authorisation to decide despite uncertainty and integrating the decision into their lives over time. These findings suggest that surrogate decisional agency develops through relational and temporal processes rather than through information provision alone. Relational continuity, sensitive timing and post-decision support may help critical care nurses support families facing surrogate decision-making.