If a person who has no family is in a coma in San Francisco, and need a brain surgery who decides on the surgery?
If the patient literally has no next of kin, it would be usual for the court to appoint a power of attorney, this may be a lawyer or a doctor, depending on the circumstances and critical needs of the patient. The POA would be required to act in the patient’s best interests. If they have next of kin but they are just not in the USA, they will need to be informed first.