Multi-organ involvement and failure in selected accident cases with acute radiation syndrome observed at the Mayak Nuclear Facility

Mayak Production Association (Mayak PA) in the Southern Ural is the first Russian nuclear facility of plutonium production for weapons. Due to the lack of knowledge and experience in operating nuclear facilities, 19 radiation accidents including criticality accidents occurred and 59 individuals developed acute radiation syndrome (ARS) during commissioning and development of Mayak PA (1948–1958). Severe accidents that occurred at this facility are reviewed, and the initial symptoms and clinical courses of ARS in victims are discussed from the perspective of multi-organ involvement and failure.