Nicholas is remembered… in every Bioethics class

Dear Reg Green,

I was grading some Bioethics papers today and realized not for the first time how Nicholas’ name always features in my students’ discussion of organ transplantation, and ways to help increase donor registration.

The Nicholas effect has truly entered into the hearts of my Ohio based class each year around this time. For them, your video really shows the human face of medical dilemmas… that medicine is not just a science but a human relationship, and the hope that something good can emerge even in the darkest of days.

Andrew Trew, John Carroll University

Prof. Andrew Trew and some of his students

Your family’s message has inspired every one of my pre health students… So, many are now practicing in the healthcare field…

I like to think they have not forgotten Nicholas.

Andrew Trew

Department of Philosophy

John Carroll University

Ohio

Prof. Andrew Trew and some of his students

Prof. Andrew Trew and some of his students

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In the news: “Transplants, that gift from Nicholas’ and Rolly’s parents that saved lives” (from ‘Il Corriere della Sera’)

Author: Maria Giovanna Faiella.

Date: September 30, 2022

The stories of children, struck by a tragic fate, will be told where organ donation is almost non-existent. In Italy, 28% still oppose donations.

The story shook the conscience of Italians. Nicholas Green, the 7-year-old American boy on vacation in Italy with his family, was shot to death from a bullet on the Salerno Reggio Calabria highway, 28 years ago: thanks to his parents decision to donate his organs and corneas, five people were saved and sight was restored to two others. The gesture prompted many compatriots to follow the example of the Greens: donations, therefore transplants, increased and lives were saved.

Last April, Rolly Prajapati, a six-year-old Indian girl, was killed in a shooting: her parents also decided to donate organs. Nicholas’ and Rolly’s families have turned their personal tragedy into a generous act of solidarity with people, unknown to them, waiting for a new organ. Now, with a new campaign to increase organ donation which starts in Messina on October 1st, the hope is that the Nicholas effect will be repeated in the poorest countries in the world — but also in developed ones, including Italy, where every day someone on the waiting list dies.

Rome press conference

The speakers of the press conference

Love for Italy reciprocated

Reginald Green, Nicholas’ father, returned to Italy to support the new campaign: it will start on the same date (October 1) and in the same hospital where Nicholas died; this time the story of a little Indian girl will help tell the world that what distinguishes the life of an organ donor is not the sudden calamity that caused his death, but the new life that it has generated, and the hope of a better world that follows. Nicholas – remembers moved Reginald Green, now 93 – loved Italy and although he was only seven, we had already brought him here three times. “Since his death, Italy has repaid that love of him many times, including over a hundred places named after him. Even more, the love of Italy was revealed in a practical way: in the ten years following his death, organ donation rates tripled. Understanding the strength of that reaction is crucial to our new campaign which will be similar to the one that focused on Nicholas and which was so successful in Italy, but this time it will include Rolly. We will tell their stories in places in the world where organ donation is almost non-existent and where, every year, hundreds of thousands of people die while they could be saved by transplanting new organs if they were donated.”

Replicate the Nicholas effect

With the pandemic, donation rates have dropped around the world – explains Professor Deepak Gupta, a neurosurgeon at the All India Institute of Medical Sciences in New Delhi, who coordinated Rolly Prajapati’s organ donation. In India, where organ donations are very few and pediatric ones are almost unknown, thanks to the media attention for the story of Rolly, whose organs have saved other children, donations increased from April to August by over 60%. The hope is that the Nicholas Effect – which has driven the increase in donations in Italy – will be repeated in the poorest countries in the world but also in the areas lagging behind with donations, including some Italian regions.

There are those who still oppose it

“In Italy, at the beginning of the pandemic there was a decline in donations and transplants. Last year there was a recovery, with an increase of more than 10 percent compared to 2020, and donations also increased by 6%”, says Letizia Lombardini, medical director of the National Transplant Center. In our country too, the availability of donated organs is still lower than needed. “Last year there were over 8,000 people on the waiting list for a transplant”, Lombardini reports. In our country, the opposition rate to donations averaged 28 percent. In addition to the refusal to remove the organs made by the relatives of the deceased person, they also registered too many “no” responses to donation at the time of issue or renewal of the identity card. Dr. Lombardini reports: “In 2021, out of 5 million Italians who renewed their identity cards, 3 million expressed their willingness to donate organs, several said “no”, others still did not express themselves.”

International conference

The organ donation awareness campaign starts in Messina where the first edition of the International Conference will be held on 1 and 2 October (DONARTE 2022 – DOnation and Art: Nicholas And Rolly Testimonials.)
“Sicily is at the bottom of the national donor ranking. There are just 11 donors per million inhabitants (compared to a national average of 24), while the opposition rate (people opposing donation) is over 40 percent” – the director of the anesthesia complex operating unit of the “Martino” Polyclinic of Messina, Anna Teresa Mazzeo said. “The awareness of citizens is fundamental, which must go hand in hand with the training of health personnel”.

Originally published in “Il Corriere della Sera” newspaper. Link: https://www.corriere.it/salute/22_settembre_30/trapianti-dono-genitori-piccoli-nicholas-green-rolly-prajapati-04b36fa4-4096-11ed-8b65-55aa2f703574.shtml

This English version is adapted from: https://time.news/transplants-that-gift-from-nicholas-and-rollys-parents-that-saved-lives-time-news/

 

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Organ Donations Set a Record at India’s Biggest Hospital

    In April of this year Dr. Deepak Gupta, professor of neurosurgery at the All-India Institute of Medical Sciences (AIIMS) Delhi, coordinated the organ donation of a six-year old girl, Rolly Prajapati, who was shot while sleeping next to her parents at her home in Noida. The circumstances were close to the shooting of my own seven-year old son, Nicholas Green, while we were on a family holiday in Italy from our home in California. In the following 10 years organ donation rates in Italy tripled, a phenomenon that is known there as “the Nicholas Effect.” (nicholasgreen.org)

Donarte 2022

From left to right: Dr. Antonio David (Dean of Messina University), Dr. Deepak Gupta, Reg Green and Dr. Anna Teresa Mazzeo at Donarte Conference, Messina, October 2022

    A striking change has shown itself in India too. Since Rolly’s death, the number of organ donations at AIIMS Delhi has risen to 13, higher in those five months than for any full year since the transplant program there began in 1994. The 3,200 bed hospital usually has five to eight donations in a full year.

    The donations since Rolly’s death have yielded 43 life-saving organs and 26 tissues, such as corneas to restore sight and heart valves to cure children born with congenital heart diseases. One of the donations was from the youngest child ever transplanted in India. This rapid rise is already being talked about as “the Rolly Effect.”

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Maria Pia, Dying at 19, Is Now a Radiant 47-Year Old

She is 47, lives in Sicily and likes true stories with happy endings. That’s understandable. She was on her deathbed when she was 19.

Her name is Maria Pia Pedala and she was saved from a seemingly inevitable death by a liver transplant. When I met her a few months later she already looked full of good health. Her way back continued so well that in two years she married her loyal sweetheart, Salvatore, and four years after the transplant had a baby boy and two years after that a girl, two whole lives that would never have been.

Maria Pia Pedalà and Reg Green

Maria Pia Pedalà and Reg Green at Donarte Conference, October 2022. Photo by Andrea Scarabelli

     All this was a long time ago — she received her new liver in 1994 — but recently, back in Sicily for a few days, I chatted with her just before she gave a speech promoting organ donation at Donarte 2022, an international conference on transplantation at the University of Messina, and I could see in her the prototype of a busy matronly housewife, who gets up by 5.30 am daily, keeps the house clean and tidy, gardens, cooks and deals with all the other needs of a loving family.

She watches her health carefully, goes to bed early, eats sensibly and takes her medications meticulously, feeling she has an obligation to both the healthcare staff who have kept watch over her from her teenage to middle years and to the family who saved her life.

The result is she can do everything normal people of her age can do and in a line-up no one would pick her out as the one who had been the sickest. She also finds a preciousness in the small things in life that eludes most people.

Transplantation is a medical miracle and, even though it is an everyday procedure in hospitals all over the world, it doesn’t stop being a miracle that physicians can take a body part of someone who has died, put it into the body of someone who is dying and bring out of it a healthy person.

In this case, for my family, the story has an element in it that takes it to a higher level still: our son was her donor.

Author:  Reg Green

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Twenty-eight Years Later: Where Are Nicholas’ Killers?

A newspaper in Italy recently asked how we felt about how Nicholas’ killers were treated.

This is what we said:

We never wanted revenge, only what the law prescribed. The one who drove the car was given 20 years in prison so he served the prescribed sentence and was then released. The one who fired the shot was sentenced to life imprisonment but became a ‘pentito’ (that is, he cooperated with the police and supplied information to clear up other crimes) and has had a good enough life under house arrest to have fathered two children. I have to leave it to Italians to decide if that is sufficient punishment for taking the life of an innocent child.

Reg Green

Corte di Cassazione - Roma

The “Corte di Cassazione”, ‘Supreme Court of Cassation’, in Rome (Source: Wikimedia)

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From “La Stampa” Italian newspaper

“La Stampa”, a national Italian newspaper edited in Turin, just published the article “Organ Donation Group Comforts Families Who Didn’t Donate” by Reg Green, on Friday 15th.

La stampa article - July 15 2022

Article title: “Another beautiful deed after 28 years”

Link to the article in English in this blog: https://nicholaseffect.org/2022/07/01/organ-donation-group-comforts-families-who-didnt-donate/

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Organ Donation Group Comforts Families Who Didn’t Donate 

The Aido division for the Province of Alessandria (a volunteer group in the Piedmont region of Northern Italy, alessandria.provincia@aido.it) and the Alessandria hospital will soon start a new service that they have called the “Nicholas’ room” (named for ‘our’ Nicholas) to denote an environment of serenity to give psychological support not just to the families of organ donors but also to those who decided not to donate. “These people do not deserve to be judged, but must be supported and helped,” the group’s president, Nadia Biancato, said.

“That ‘no’ said in a dramatic moment can lead to beautiful unselfish deeds in the future.” It can also stimulate them to talk of their experience so that others might make different decisions about organ donation, she added.

Aido Alessandria - Nicholas' room

The introduction of “Nicholas’ room” project

The plan is to extend the project to all other areas of Piedmont. The City of Health hospital in Turin, Piedmont’s capital, already runs a similar project for donor families and has been very pleased with the results but the Alessandria version is the first in Italy to include non-donors.
Here are two links to local news sources (in Italian):

https://radiogold.it/cronaca/315900-alessandria-sostegno-psicologico-famiglie-donazione-organi/

https://www.ilpiccolo.net/generic/2022/06/08/video/nicholas-green-e-la-casa-che-da-supporto-psicologico-140764/

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“For 27 years, organ donation has been boosted by ‘the Nicholas effect'”

By Diane Daniel, American Heart Association News

Link to the article, AHA website: https://www.heart.org/en/news/2022/04/19/for-27-years-organ-donation-has-been-boosted-by-the-nicholas-effect

 

     Nicholas Green should’ve turned 35 this year.

Instead, a random act of violence claimed his life while he was on vacation with his family in Italy more than 27 years ago. The story captivated a worldwide audience. So did what happened next.

Nicholas’ organs and corneas were donated to seven people. His heart went to a 15-year-old boy and one of his corneas to a mother who’d struggled to see her baby.

Recognizing the opportunity to turn his family’s tragedy into a blessing for others, Reg Green, Nicholas’ father, began a quest that has changed countless lives. It’s been the source of a TV movie, the inspiration for a bell tower in California and the impetus for a campaign in Italy that could help connect more recipients with the families of their donor.

Now 93, Reg lives in La Cañada Flintridge, California, outside of Los Angeles. Although injuries have recently kept him from what used to be a daily hike in the foothills near his home, he can be found every day answering emails, making calls or writing articles in hopes of saving and improving lives via what the Italian media dubbed “the Nicholas effect.”

“It’s amazed me that it’s touched so many different people and has lasted all these years,” Reg said. “It’s a bigger thing than I could have possibly imagined.”

AHA ARTICLE April 2022

Screenshot of AHA article

The story begins in September 1994, when Reg and Maggie Green were driving on a highway in Italy. Their children, 7-year-old Nicholas and 4-year-old Eleanor, were asleep in the back seat of the family’s rental car.

Thieves thought their car was carrying jewels. They shot through the back window. Only one bullet hit any of them. It lodged at the base of Nicholas’ brain.

Over the next two days, doctors at a hospital in Sicily tried saving the boy. Meanwhile, the sensational story – a young American shot by highway robbers in Italy because of a case of mistaken identity – rapidly generated headlines throughout the country and beyond.

When doctors declared Nicholas brain-dead, Italians poured out their grief, from people on the street to the prime minister.

Maggie and Reg decided to donate Nicholas’ organs and corneas. They went to four teenagers and three adults.

If one little body could do all that, Reg thought, imagine how many could be helped if more people became organ donors?

“I knew we’d been handed an opportunity,” said Reg, who had earlier worked as a journalist in London and was then writing a financial newsletter. “I saw this as the biggest news story of my life. We had the chance to change the direction of organ donation.”

Back home in California’s Bay Area, Reg and Maggie established The Nicholas Green Foundation to support organ and tissue donation worldwide.

In Italy, the impact “was almost instantaneous,” Reg said. “Donation rates went up 30% in the fourth quarter of 1994 and rose every year for the next 10 years until they were triple what they had been before he was killed.”

Reg was soon giving interviews and publishing opinion articles in countries as diverse as India, Australia and Venezuela. He and Maggie started traveling anywhere they were invited to promote their cause. (Maggie stopped traveling as much in 1996, when she and Reg had twins, Laura and Martin.)

“People around the world were realizing, some for the first time, the power of organ donation,” Reg said.

The momentum took many forms.

In 1995, sculptor Bruce Hasson volunteered to build a bell tower dedicated to children who have died. Italians donated more than 140 bells, with the centerpiece blessed by Pope John Paul II. (In 2018, Nicolas’ sister Eleanor was married at the site of the sculpture.)

In 1998, the TV movie “Nicholas’ Gift” aired, starring Jamie Lee Curtis. Earlier this year, Curtis posted on social media a remembrance of “the privilege of portraying Maggie Green” and cited the Nicholas effect. She called organ donation “honoring, humbling and haunting.”

In the early days of the nonprofit, Reg received a letter from a 21-year-old university student in Rome named Andrea Scarabelli. He wanted to help.

Scarabelli began translating articles published in Italy into English for the Greens. He later translated Reg’s books, articles and speeches into Italian and even arranged media tours all over Italy.

“Reg and Maggie really changed the attitude of a nation,” Scarabelli said. “Now organ donation is seen as a normal thing in Italy.”

When Nicholas’ organs were donated, the Greens were tremendously moved by getting to meet the recipients. One recipient was a 19-year-old woman who nearly died the same night as the boy; she’s now the mother of two, including a boy she named Nicholas.

However, laws in Italy changed, no longer facilitating contact between organ recipients and their donor’s family. Starting in 2016, Reg and Scarabelli began pushing to give donors and recipients opportunities to meet. A bill to that effect has been introduced by a group of legislators.

Maggie praised her husband’s tireless efforts.

“I’m a willing participant, but he’s always been the engine,” she said.

Maggie said that while her family has celebrated the life and grieved the death of Nicholas with the world, they have their private remembrances as well.

“People outside the family remember the day he died,” she said. “We remember his birthday.”

 

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Indian girl (6) shot, parents donate organs

Dr. Deepak Gupta, Professor of Neurosurgery at the All India Institute of Medical Sciences at Delhi, who headed the team that transplanted the organs of six-year old, Rolly Prajapati, has added a comment to ‘An Illiterate Family in India Gives the Educated World a Lesson’ (please see this article on the blog on May 3, 2022.)

He says, “I hope there will be some official recognition of the extremely rare decision by her parents: organ donation rates in India are among the lowest in the world. If only the Prime Minister would honor the family for their willingness to put their acute grief on one side until after they put in motion the process that saved the lives of people they knew absolutely nothing about, it would act as a beacon to encourage many other families to follow suit. Meanwhile, every year thousands of Indians, many of them young, some of them infants, die when one donated organ could have saved them.”

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An Illiterate Family in India Gives the Educated World a Lesson

A mother and father in India, neither of whom can read or write and work wearisome hours for poverty wages, have just given the world’s educated a lesson in simple humanity. When their six-year old daughter, Rolly, was shot as she slept alongside her father, at whom the bullet was probably aimed,  Harnarayan Prajapati (39) and Poonam Devi (37) donated her organs to save other children. They had never heard of organ donation until Dr. Deepak Gupta, professor of neurosurgery at the AIIMS medical center in Delhi, who was in charge of her case, told them about it when Rolly was declared brain dead on April 29. They agreed because they did not want other families to face the bleakness that had enveloped them. Organ donation is almost non-existent in India where the grinding poverty of the great majority of families leaves little energy at the end of a day to think about anything other than the basic routines of living.

Rolly and siblings

Rolly is in the center with two of her five siblings, Karamveer on the left, Khushi on the right.

Even among the growing middle class, defined as those earning more than $25,000 in purchasing power comparable to the United States, organ donation is widely viewed as something unnatural. Even more than in other countries Indians fear that if they indicate they are willing to be donors, the doctors will not try as hard to save them when they are seriously injured. To all of them, the Prajapatis’ decision comes as a lesson that people in the most tragic situation need not turn inward in grief and despair but can transform life for multiple strangers. In rural India where rigid divisions are so traditional, the willingness to accept that the recipients can be of any caste is even more difficult. This small girl’s story should be a lesson to those who say they are in favor of organ donation but, like so many, are unwilling to go through with it when the decision is about one of their own family.

WhatsApp Image 2022-05-03 at 2.58.03 PM

Rolly’s parents, Hamarayan Prajapati and Poonam Devi

P.S. When I heard from Dr. Deepak Gupta about Rolly, I asked him to give this message to her mother and father. I offer it to any other family who has had to face the loss of a loved one.

To the family of little Rolly:

     I am the father of a seven-year old American boy, Nicholas Green. who was shot while we were on a family vacation in Italy and whose organs and corneas my wife, Maggie, and I donated to seven Italians, four of them teenagers. I am writing to you in hopes that I can offer a little solace for your crushing loss. For now, I expect that you can think of little else but how bleak and meaningless everything seems and how even the most routine task causes a stab in the heart because she is not with you. But in time I hope you will come to see how you have not simply transformed the lives of the recipients but how you have given inspiration to a world crying out for hope. You have given your daughter’s life a higher significance than  you could ever have foreseen. I imagine her saying: “I’m very proud of you.”

With great affection, Reg (and Maggie) Green

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