Ethical leadership in health care helps to guide the administrator through difficult decisions, upholding the policy of the institution while putting patient care first. This case study presents an ethical dilemma encountered by the administrator regarding organ procurement in an unidentified person who dies within the hospital. The purpose of this report is to provide a comprehensive literature and concept review of the bioethical considerations of organ donation in an unidentified person, to review the current status of the Uniform Anatomical Gift Act (UAGA), and to provide a review of presumed versus informed consent. These are all aspects that shape ethical decision-making for the health care administrator. Forty-eight states have adopted UAGA legislation governing regulations regarding organ donation. In states where the legislation has been enacted, the authority to consent for organ donation is granted to the custodian of the body. In the case of persons who are unidentified, individual state regulations often grant custodianship to the hospital in which the patient died. Health care administrators may be called upon to consent for hospital procedures in cases of diminished capacity and the absence of a substitute decision maker. The health care administrator needs to be well-informed about the ethical framework for decision making in order to opine regarding organ procurement based on patient autonomy and uphold the current laws and hospital policy with beneficence and integrity.