The patient was a 55-year old Japanese man, who had a traffic accident and suffered cervical cord injury in Thailand. Although he received an emergency operation and intensive care, he had respiratory paralysis and received a tracheostomy. One month after the accident, he still needed to receive mechanical ventilatory support. He and his wife hoped to return to Japan. We were asked to transport the patient from Bangkok to Tokyo. With some help from an assistance company, we could transport the patient safely from Bangkok to Tokyo on a commercial airline under mechanical ventilatory support. We experienced the several regulations and difficulties in performing medical treatment and transportation of a critical patient in a commercial airline.