Choosing a surrogate to make medical decisions for a patient is an emotionally challenging task. In hospital settings, it is estimated over 86% of life saving medical decisions have been made by a surrogate (Swigart, Lidz, Butterworth, & Arnold, 1996). For the marginalized populations of lesbian, gay men, bisexual, and transgender persons (LGBT), decisions are especially difficult, compounded by issues of discrimination, lack of legal support, level of relationship commitment,, and complicated disclosure to family and medical professionals (Riggle, Rostosky, Prather, & Hamrin, 2005). Limited research has been presented regarding environmental and social factors that impact the choice of a surrogate decision-maker for a LGBT individual. This in-depth literature review will examine factors influencing individual surrogate choice, identify obstacles and gaps in the literature findings, and explore services required by the LBGT population.