The topic of this paper is not only of concern to people interested in transplantation. The organization described stemmed from the experience of the earthquake in southern Italy in 1980, in which physicians of our transplant center participated only as surgeons. We feel that a tranaplant team could be useful in a mass casualty situation with the intent to help in the triage of the seriously injured, select patients with brain death, and transport selected donors to transplant centers.
The problem of triage in mass casualties is by itself a difficult and complex ethical and practical issue (1). The first hours after any disaster has occurred are crucial in dividing patients into different categories and in putting them into the care of specialized physicians, according to their primary lesions. Often severely traumatized people are discovered late and do not get the primary intensive assistance which will allow them to stabilize their clinical condition (2).
According to the type of disaster, the percentage of head trauma patients varies greatly, reaching its peak in case of earthquakes (approximately 4% of victims died of head trauma), air crashes and building destructions (3). It is reasonable to think that often head trauma is associated with multiple traumas and that in some cases (direct trauma of the most important organs, crush lesions, etc.) this may represent a contraindication to considering the patient as a donor. Generally, however, head trauma with brain death, even associated with different lesions but without metabolic, septic or cardiovascular alterations, must at least be considered for organ donation (4).