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The Murder of Nicholas Green: Organ Donation 20 Years Later

2014; Elsevier BV; Volume: 64; Issue: 4 Linguagem: Inglês

10.1053/j.ajkd.2014.08.007

1523-6838

Reg Green, Giusy De Rosa, Andrea Scarabelli, Luca Salvatore De Santo, Franco Citterio, Natale Gaspare De Santo,

Child Welfare and Adoption

A Father’s Story 1Section was adapted from The Nicholas Effect: A Boy’s Gift to the World, 15th Anniversary Edition, AuthorHouse, 2009, with permission of Reg Green.1Section was adapted from The Nicholas Effect: A Boy’s Gift to the World, 15th Anniversary Edition, AuthorHouse, 2009, with permission of Reg Green.Everything seemed normal on that warm September night on the freeway in the toe of Italy: an American family on vacation driving to Sicily. The two children, Nicholas, aged 7, and Eleanor, 4, were asleep in the backseat. Maggie, my wife, was dozing next to me, when a car that had been behind us pulled out as if to overtake but instead came alongside us and stayed there.“Something’s wrong here,” I said, half to myself. Maggie woke instantly, looked across and saw two men in masks, one with a pistol. A moment later, through the night, came the sounds of loud, angry, savage cries, the words indistinguishable but clearly telling us to pull over.The danger in that was too obvious. Instead, I accelerated, they accelerated too. I floored the car, they floored theirs, and the two cars raced along the road side by side. Then there was a deafening explosion and the side window where the children were sleeping disintegrated. Maggie turned around to make sure they were safe; both appeared to be sleeping peacefully. A second or two later another bullet blew in the driver’s side window.But by now we were pulling away and, from seeing them alongside, I saw them next in the wing mirror, then the driver’s mirror, then they disappeared back into the night. I raced on at top speed, looking for somewhere with lights, people. As it happened, there had been an accident on the road. The police and an ambulance were there. I stopped and opened the car door. As the interior light came on, Nicholas didn’t move. I looked closer and saw his tongue was sticking out and there was a trace of vomit on his chin. One of those bullets had lodged at the base of his brain.After the first stunned confusion, he was bundled into the ambulance and, while we answered questions from police, it took off into the unknown. I had never known such bleakness.Two days later the doctors at the Policlinico in Messina, Sicily, told us he was brain dead, and all the brightly colored dreams of a young idealist died too. That was 20 years ago but I still clearly remember thinking: “After this, how am I going to get through the rest of my life without him.” Never to hold his hand again to go out for a walk, never to hear him say, “Goodnight, daddy.”It was then that Maggie said quietly, “Now that he has gone, shouldn’t we donate the organs?”“Yes,” I said.It was that simple. It was clear that he didn’t need that body anymore but we knew somewhere out there were people who did desperately need what that little body could give. We told the doctors of our decision and, for the first time since I had opened the car door, there was something to relieve what until then had not had a shred of good in it.There were 7 recipients, 4 of them teenagers: Nicholas’ pure heart, two kidneys, liver, pancreas cells, and both corneas. All—and their families—had suffered pain, fear and, for the 5 organ recipients, the prospect of dying at any time with the utterly helpless feeling that they could do nothing to influence the donation that could save them. When Nicholas died they were just statistics to us on a very long waiting list. But we soon met them all and, realizing what they had gone through and what would have happened to them, I know that if we had simply packed our bags and shrugged off their problems as none of our concern, we could never have looked back without a deep sense of shame.We have lost touch with two of them but we know the other 5 are living full and productive lives. One, who was in her final coma on the day Nicholas died, had a baby, whom they called Nicholas. Another, who had had 5 operations on his heart, all of which had failed, plays soccer. All the teenagers are now approaching middle age. One of the adults is divorced, which didn’t sadden me as it might have done: life goes on.In overwhelming numbers, people in developed countries say they favor organ donation. Yet, supply falls short everywhere. Everyone emphasizes different causes but I see it most clearly from the point of view of the families who arrive at the hospital to find someone they love, who was in perfect health only a few hours before, is now dying—a road accident, violence, a stroke, none of which they could prepare for. Suddenly they are faced with making a decision there and then about something they have never seriously thought about. They are tired and frightened and there is a gnawing emptiness inside them that will last for weeks. Many say “no” and regret it for the rest of their lives.By contrast, I can hardly remember any who regretted the decision of the hundreds of donor families I have met. Almost all of them say: “Don’t be afraid to ask bereaved families to donate.” Let’s be clear: it doesn’t take the pain away. But it does put something on the other side of the balance.In the last 20 years and a million air miles, I have tried to put the idea of organ donation in people’s minds—in two books; a made-for-television movie, Nicholas’ Gift, starring Jamie Lee Curtis, which has been seen by 100 million people around the world; a flow of articles to some of the world’s largest, and smallest, publications; interviews on the largest television shows in the US and abroad; talks in kindergartens and hospices; a half dozen documentaries that have been shown in hospitals in every corner of the US; and a slew of pioneering events—so that if a day comes when that decision has to be made, a small voice at the back of their minds might remind them that in their calmer moments they saw clearly that by a nod of the head they can save multiple lives for whom there is no other cure.Organ Donation in ItalyThe narrative of Nicholas’ father is not just a tragedy or even just an inspiration. It also reminds us that death can still generate life by donating organs for the benefit of others when they are no longer of use to their original owners. This event had a powerful impact on Italians. They initially felt collective guilt over the murder, took it on their shoulders, and answered appropriately with both heart and mind. Justice was served efficiently with the imprisonment of the criminals who, it seems, had mistaken the Greens’ rented car for one delivering jewelry to stores in the region.Immediately after Nicholas was killed, organ donation rates in Italy soared; not card signings only, but actual donations. A beautiful flash in the pan, it seemed. But then the rate went up in the following year and the year after that and year after too for 10 years, at the end of which it had tripled. From having the second lowest donor rate in Western Europe, Italy now has one of the highest, indeed one of the highest in the world, and literally thousands of people are alive who would otherwise have died.Advances in medicine and the increasing skills of transplant surgeons and the strengthening of the transplant system have all made a solid contribution and are, of course, part of the story. But as the increase was greater than in any other developed country, it is clear that the story of one small boy was the catalyst that changed the thinking of millions.Places all over Italy are named for Nicholas, especially in the south where organ donation was almost unknown 20 years ago. A total of 104 have been traced in little towns and great cities, among them 25 schools, 23 parks, 48 streets and squares, an amphitheatre, a bridge, and a soccer cup. In Calabria, where Nicholas was shot, the hall of the main regional government building houses a sculpture, donated by his parents, by a San Francisco artist featuring 7 bells made from melted-down firearms confiscated by the police. The symbolism is clear to even the youngest visitor.The ripples continue to spread: the mayor of Rome, himself a transplant surgeon, recently began an initiative called Rome Gives, which focuses on schools. Survival is Not Enough, a campaign by the Italian Institute for Philosophical Studies which organizes events surrounding World Kidney Day in countries across Europe and in North Africa, builds on the same themes, with this year, for example, the president of the Italian National Committee for Bioethics stressing the importance of involving all members of the family in the decision to donate.Programs for organ donation have been started for children of all ages, even those in primary schools, where they learn solidarity as young citizens who can inspire their parents to register for donation. We believe nursing schools and universities should include organ donation in the classroom as tools to teach the unprecedented possibility people have to give life when their life is over.Finally, and this could be the goal of influential specialized journals like this one, we believe the great professionals who lead transplantation teams should start campaigning and writing individual case histories in clinical journals and outside them, since without donations, no life can be saved, no science can develop, and no paper can be written. A Father’s Story 1Section was adapted from The Nicholas Effect: A Boy’s Gift to the World, 15th Anniversary Edition, AuthorHouse, 2009, with permission of Reg Green.1Section was adapted from The Nicholas Effect: A Boy’s Gift to the World, 15th Anniversary Edition, AuthorHouse, 2009, with permission of Reg Green.Everything seemed normal on that warm September night on the freeway in the toe of Italy: an American family on vacation driving to Sicily. The two children, Nicholas, aged 7, and Eleanor, 4, were asleep in the backseat. Maggie, my wife, was dozing next to me, when a car that had been behind us pulled out as if to overtake but instead came alongside us and stayed there.“Something’s wrong here,” I said, half to myself. Maggie woke instantly, looked across and saw two men in masks, one with a pistol. A moment later, through the night, came the sounds of loud, angry, savage cries, the words indistinguishable but clearly telling us to pull over.The danger in that was too obvious. Instead, I accelerated, they accelerated too. I floored the car, they floored theirs, and the two cars raced along the road side by side. Then there was a deafening explosion and the side window where the children were sleeping disintegrated. Maggie turned around to make sure they were safe; both appeared to be sleeping peacefully. A second or two later another bullet blew in the driver’s side window.But by now we were pulling away and, from seeing them alongside, I saw them next in the wing mirror, then the driver’s mirror, then they disappeared back into the night. I raced on at top speed, looking for somewhere with lights, people. As it happened, there had been an accident on the road. The police and an ambulance were there. I stopped and opened the car door. As the interior light came on, Nicholas didn’t move. I looked closer and saw his tongue was sticking out and there was a trace of vomit on his chin. One of those bullets had lodged at the base of his brain.After the first stunned confusion, he was bundled into the ambulance and, while we answered questions from police, it took off into the unknown. I had never known such bleakness.Two days later the doctors at the Policlinico in Messina, Sicily, told us he was brain dead, and all the brightly colored dreams of a young idealist died too. That was 20 years ago but I still clearly remember thinking: “After this, how am I going to get through the rest of my life without him.” Never to hold his hand again to go out for a walk, never to hear him say, “Goodnight, daddy.”It was then that Maggie said quietly, “Now that he has gone, shouldn’t we donate the organs?”“Yes,” I said.It was that simple. It was clear that he didn’t need that body anymore but we knew somewhere out there were people who did desperately need what that little body could give. We told the doctors of our decision and, for the first time since I had opened the car door, there was something to relieve what until then had not had a shred of good in it.There were 7 recipients, 4 of them teenagers: Nicholas’ pure heart, two kidneys, liver, pancreas cells, and both corneas. All—and their families—had suffered pain, fear and, for the 5 organ recipients, the prospect of dying at any time with the utterly helpless feeling that they could do nothing to influence the donation that could save them. When Nicholas died they were just statistics to us on a very long waiting list. But we soon met them all and, realizing what they had gone through and what would have happened to them, I know that if we had simply packed our bags and shrugged off their problems as none of our concern, we could never have looked back without a deep sense of shame.We have lost touch with two of them but we know the other 5 are living full and productive lives. One, who was in her final coma on the day Nicholas died, had a baby, whom they called Nicholas. Another, who had had 5 operations on his heart, all of which had failed, plays soccer. All the teenagers are now approaching middle age. One of the adults is divorced, which didn’t sadden me as it might have done: life goes on.In overwhelming numbers, people in developed countries say they favor organ donation. Yet, supply falls short everywhere. Everyone emphasizes different causes but I see it most clearly from the point of view of the families who arrive at the hospital to find someone they love, who was in perfect health only a few hours before, is now dying—a road accident, violence, a stroke, none of which they could prepare for. Suddenly they are faced with making a decision there and then about something they have never seriously thought about. They are tired and frightened and there is a gnawing emptiness inside them that will last for weeks. Many say “no” and regret it for the rest of their lives.By contrast, I can hardly remember any who regretted the decision of the hundreds of donor families I have met. Almost all of them say: “Don’t be afraid to ask bereaved families to donate.” Let’s be clear: it doesn’t take the pain away. But it does put something on the other side of the balance.In the last 20 years and a million air miles, I have tried to put the idea of organ donation in people’s minds—in two books; a made-for-television movie, Nicholas’ Gift, starring Jamie Lee Curtis, which has been seen by 100 million people around the world; a flow of articles to some of the world’s largest, and smallest, publications; interviews on the largest television shows in the US and abroad; talks in kindergartens and hospices; a half dozen documentaries that have been shown in hospitals in every corner of the US; and a slew of pioneering events—so that if a day comes when that decision has to be made, a small voice at the back of their minds might remind them that in their calmer moments they saw clearly that by a nod of the head they can save multiple lives for whom there is no other cure. Everything seemed normal on that warm September night on the freeway in the toe of Italy: an American family on vacation driving to Sicily. The two children, Nicholas, aged 7, and Eleanor, 4, were asleep in the backseat. Maggie, my wife, was dozing next to me, when a car that had been behind us pulled out as if to overtake but instead came alongside us and stayed there. “Something’s wrong here,” I said, half to myself. Maggie woke instantly, looked across and saw two men in masks, one with a pistol. A moment later, through the night, came the sounds of loud, angry, savage cries, the words indistinguishable but clearly telling us to pull over. The danger in that was too obvious. Instead, I accelerated, they accelerated too. I floored the car, they floored theirs, and the two cars raced along the road side by side. Then there was a deafening explosion and the side window where the children were sleeping disintegrated. Maggie turned around to make sure they were safe; both appeared to be sleeping peacefully. A second or two later another bullet blew in the driver’s side window. But by now we were pulling away and, from seeing them alongside, I saw them next in the wing mirror, then the driver’s mirror, then they disappeared back into the night. I raced on at top speed, looking for somewhere with lights, people. As it happened, there had been an accident on the road. The police and an ambulance were there. I stopped and opened the car door. As the interior light came on, Nicholas didn’t move. I looked closer and saw his tongue was sticking out and there was a trace of vomit on his chin. One of those bullets had lodged at the base of his brain. After the first stunned confusion, he was bundled into the ambulance and, while we answered questions from police, it took off into the unknown. I had never known such bleakness. Two days later the doctors at the Policlinico in Messina, Sicily, told us he was brain dead, and all the brightly colored dreams of a young idealist died too. That was 20 years ago but I still clearly remember thinking: “After this, how am I going to get through the rest of my life without him.” Never to hold his hand again to go out for a walk, never to hear him say, “Goodnight, daddy.” It was then that Maggie said quietly, “Now that he has gone, shouldn’t we donate the organs?” “Yes,” I said. It was that simple. It was clear that he didn’t need that body anymore but we knew somewhere out there were people who did desperately need what that little body could give. We told the doctors of our decision and, for the first time since I had opened the car door, there was something to relieve what until then had not had a shred of good in it. There were 7 recipients, 4 of them teenagers: Nicholas’ pure heart, two kidneys, liver, pancreas cells, and both corneas. All—and their families—had suffered pain, fear and, for the 5 organ recipients, the prospect of dying at any time with the utterly helpless feeling that they could do nothing to influence the donation that could save them. When Nicholas died they were just statistics to us on a very long waiting list. But we soon met them all and, realizing what they had gone through and what would have happened to them, I know that if we had simply packed our bags and shrugged off their problems as none of our concern, we could never have looked back without a deep sense of shame. We have lost touch with two of them but we know the other 5 are living full and productive lives. One, who was in her final coma on the day Nicholas died, had a baby, whom they called Nicholas. Another, who had had 5 operations on his heart, all of which had failed, plays soccer. All the teenagers are now approaching middle age. One of the adults is divorced, which didn’t sadden me as it might have done: life goes on. In overwhelming numbers, people in developed countries say they favor organ donation. Yet, supply falls short everywhere. Everyone emphasizes different causes but I see it most clearly from the point of view of the families who arrive at the hospital to find someone they love, who was in perfect health only a few hours before, is now dying—a road accident, violence, a stroke, none of which they could prepare for. Suddenly they are faced with making a decision there and then about something they have never seriously thought about. They are tired and frightened and there is a gnawing emptiness inside them that will last for weeks. Many say “no” and regret it for the rest of their lives. By contrast, I can hardly remember any who regretted the decision of the hundreds of donor families I have met. Almost all of them say: “Don’t be afraid to ask bereaved families to donate.” Let’s be clear: it doesn’t take the pain away. But it does put something on the other side of the balance. In the last 20 years and a million air miles, I have tried to put the idea of organ donation in people’s minds—in two books; a made-for-television movie, Nicholas’ Gift, starring Jamie Lee Curtis, which has been seen by 100 million people around the world; a flow of articles to some of the world’s largest, and smallest, publications; interviews on the largest television shows in the US and abroad; talks in kindergartens and hospices; a half dozen documentaries that have been shown in hospitals in every corner of the US; and a slew of pioneering events—so that if a day comes when that decision has to be made, a small voice at the back of their minds might remind them that in their calmer moments they saw clearly that by a nod of the head they can save multiple lives for whom there is no other cure. Organ Donation in ItalyThe narrative of Nicholas’ father is not just a tragedy or even just an inspiration. It also reminds us that death can still generate life by donating organs for the benefit of others when they are no longer of use to their original owners. This event had a powerful impact on Italians. They initially felt collective guilt over the murder, took it on their shoulders, and answered appropriately with both heart and mind. Justice was served efficiently with the imprisonment of the criminals who, it seems, had mistaken the Greens’ rented car for one delivering jewelry to stores in the region.Immediately after Nicholas was killed, organ donation rates in Italy soared; not card signings only, but actual donations. A beautiful flash in the pan, it seemed. But then the rate went up in the following year and the year after that and year after too for 10 years, at the end of which it had tripled. From having the second lowest donor rate in Western Europe, Italy now has one of the highest, indeed one of the highest in the world, and literally thousands of people are alive who would otherwise have died.Advances in medicine and the increasing skills of transplant surgeons and the strengthening of the transplant system have all made a solid contribution and are, of course, part of the story. But as the increase was greater than in any other developed country, it is clear that the story of one small boy was the catalyst that changed the thinking of millions.Places all over Italy are named for Nicholas, especially in the south where organ donation was almost unknown 20 years ago. A total of 104 have been traced in little towns and great cities, among them 25 schools, 23 parks, 48 streets and squares, an amphitheatre, a bridge, and a soccer cup. In Calabria, where Nicholas was shot, the hall of the main regional government building houses a sculpture, donated by his parents, by a San Francisco artist featuring 7 bells made from melted-down firearms confiscated by the police. The symbolism is clear to even the youngest visitor.The ripples continue to spread: the mayor of Rome, himself a transplant surgeon, recently began an initiative called Rome Gives, which focuses on schools. Survival is Not Enough, a campaign by the Italian Institute for Philosophical Studies which organizes events surrounding World Kidney Day in countries across Europe and in North Africa, builds on the same themes, with this year, for example, the president of the Italian National Committee for Bioethics stressing the importance of involving all members of the family in the decision to donate.Programs for organ donation have been started for children of all ages, even those in primary schools, where they learn solidarity as young citizens who can inspire their parents to register for donation. We believe nursing schools and universities should include organ donation in the classroom as tools to teach the unprecedented possibility people have to give life when their life is over.Finally, and this could be the goal of influential specialized journals like this one, we believe the great professionals who lead transplantation teams should start campaigning and writing individual case histories in clinical journals and outside them, since without donations, no life can be saved, no science can develop, and no paper can be written. The narrative of Nicholas’ father is not just a tragedy or even just an inspiration. It also reminds us that death can still generate life by donating organs for the benefit of others when they are no longer of use to their original owners. This event had a powerful impact on Italians. They initially felt collective guilt over the murder, took it on their shoulders, and answered appropriately with both heart and mind. Justice was served efficiently with the imprisonment of the criminals who, it seems, had mistaken the Greens’ rented car for one delivering jewelry to stores in the region. Immediately after Nicholas was killed, organ donation rates in Italy soared; not card signings only, but actual donations. A beautiful flash in the pan, it seemed. But then the rate went up in the following year and the year after that and year after too for 10 years, at the end of which it had tripled. From having the second lowest donor rate in Western Europe, Italy now has one of the highest, indeed one of the highest in the world, and literally thousands of people are alive who would otherwise have died. Advances in medicine and the increasing skills of transplant surgeons and the strengthening of the transplant system have all made a solid contribution and are, of course, part of the story. But as the increase was greater than in any other developed country, it is clear that the story of one small boy was the catalyst that changed the thinking of millions. Places all over Italy are named for Nicholas, especially in the south where organ donation was almost unknown 20 years ago. A total of 104 have been traced in little towns and great cities, among them 25 schools, 23 parks, 48 streets and squares, an amphitheatre, a bridge, and a soccer cup. In Calabria, where Nicholas was shot, the hall of the main regional government building houses a sculpture, donated by his parents, by a San Francisco artist featuring 7 bells made from melted-down firearms confiscated by the police. The symbolism is clear to even the youngest visitor. The ripples continue to spread: the mayor of Rome, himself a transplant surgeon, recently began an initiative called Rome Gives, which focuses on schools. Survival is Not Enough, a campaign by the Italian Institute for Philosophical Studies which organizes events surrounding World Kidney Day in countries across Europe and in North Africa, builds on the same themes, with this year, for example, the president of the Italian National Committee for Bioethics stressing the importance of involving all members of the family in the decision to donate. Programs for organ donation have been started for children of all ages, even those in primary schools, where they learn solidarity as young citizens who can inspire their parents to register for donation. We believe nursing schools and universities should include organ donation in the classroom as tools to teach the unprecedented possibility people have to give life when their life is over. Finally, and this could be the goal of influential specialized journals like this one, we believe the great professionals who lead transplantation teams should start campaigning and writing individual case histories in clinical journals and outside them, since without donations, no life can be saved, no science can develop, and no paper can be written.