Are All Low GCS Patients Potential Organ Donors? Insights From a Policy-Driven Brain Death Evaluation Framework

Accurate identification of potential organ donors is essential for optimizing transplant opportunities.In Turkey, the 2025 update of the national Healthcare Quality Standards (SKS) introduced a mandatory brain death evaluation for all ICU patients with a Glasgow Coma Scale (GCS) ≤6. While intended to prevent missed donor opportunities, this policy may lead to unnecessary evaluations of patients with reversible conditions, creating an increased workload and resource strain on critical care teams. This study aimed to evaluate the clinical yield and practical implications of mandatory brain death evaluations in ICU patients with a GCS score of ≤6 following the implementation of this policy-driven framework.

We conducted a retrospective observational analysis of 395 adult ICU patients with GCS ≤ 6 at admission between January and September 2025. Patients were stratified by primary diagnosis (neurological vs non-neurological). The first GCS (at referral) and final GCS (end of ICU follow-up) were recorded, and confirmed brain death cases identified. Differences between groups were analysed using appropriate statistical tests.

Among 395 patients, 17 (4.3 %) were declared brain dead-all from the neurological group. Despite inclusion of non-neurological etiologies (including postoperative, metabolic, and respiratory diagnoses), none proceeded to brain death. The non-neurological cohort showed significant GCS recovery (eg, postoperative mean GCS improved from 3.13 to 12.76, p < .001).

The use of GCS ≤ 6 as a universal screening criterion for brain death evaluation in ICU patients is overly sensitive but lacks specificity. To optimise donor identification and resource utilisation, referral criteria should incorporate additional neurological and clinical filters.