This study examined how families’ understanding of brain death affected their decision to donate their loved one’s organs. Little more than half reported receiving an explanation of brain death. Most respondents, even those who had chosen to donate their loved one’s organs, could not demonstrate a clear understanding. Few reported hospital or organ procurement organization staff used visual aids to clarify or reinforce the ideas presented. Before making organ donation requests, a physician should provide a consultation on brain death and the severity of the donor’s injury. Healthcare providers should be familiar with common misconceptions and assess the family’s understanding of brain death. To ensure this communication happens, a clear protocol has been provided at the end of the article.