Because of the importance of family in American Indian culture, immediate and extended family members should be informed of an impending death. A family-centered approach is recommended for conveying serious medical information and explaining issues such as autopsy and organ donation. Organ donation may be viewed as a desecration of the body. The entire family may be included when making decisions and signing documents. Due to the misuse of signed documents throughout the history of the American Indian, some Indian patients may be unwilling to sign informed consents, advance directives, and durable power of attorney forms. Patients may perceive verbal agreement as sufficient.