Category Archives: Italy

The final beat of Nicholas Green’s heart of gold

The boy who received my son’s heart died Tuesday, although he wasn’t really a boy any longer. He was 37 years old. But when my 7-year old son, Nicholas, was shot in an attempted carjacking on a family vacation in Italy, Andrea Mongiardo was just 15.

At the hospital in Sicily, my wife, Maggie, and I decided to donate Nicholas’ organs and corneas for transplant. They went to seven very sick Italians, four of them teenagers.

Perhaps the most agonizing feature of being on a transplant waiting list is that patients can do nothing at all to influence if and when a new organ becomes available. Their future depends entirely on whether a family they have never met is willing to put its own mourning aside to help total strangers.

When Maggie and I were told that Nicholas had no brain activity, it was she who said, in her usual thoughtful way, “Shouldn’t we donate his organs?” We had no sense of what the outcome would be, who could be saved, what they would be like. But we realized we could squeeze some good from what was otherwise just a meaningless act of violence.

What we couldn’t have guessed was how much good: News of our decision spread like wildfire and so galvanized Italy that in the next 10 years organ donation rates there tripled, an increase no other country came close to. As a result, thousands of people are alive who would have died.

Some of Nicholas’ recipients were very close to death. One was a diabetic who was almost blind, couldn’t walk without help and was dependent on others. After receiving Nicholas’ pancreas cells, she moved into an apartment of her own for the first time in her life.

A 19-year-old got Nicholas’ liver. The day he died, she was in a coma. She bounced back to health, married her childhood sweetheart a year later, and a year after that they had a baby boy, whom they named Nicholas. He is now a tall, handsome young man with no trace of the liver weakness that has dogged his family.

Andrea took longer to heal. He had been sick for so long that his strength was undermined and, whereas the other six were soon back in circulation, he only slowly came back to full health. But when he did, it was for real. He got a job, played soccer, lived more normally than he had ever been able to growing up.

And that is how things stood until we got an email on Tuesday. “His heart was still functioning,” Andrea’s longtime doctor told us, “but the lungs were fibrotic because of drug toxicity related to chemotherapy treatment received three years ago after diagnosis of lymphoma. The final cause of death was respiratory failure.”

It was deflating, like the loss of a young nephew you never dreamed would go before you did. But we don’t feel as if Nicholas died all over again, as some doctors fear will happen to donor families. And, of course, we still have no regrets about the decision we took in 1994.

When the Italian media first asked Maggie how she felt about our son’s heart being transplanted into another boy’s chest, she said: “I always hoped Nicholas would have a long life. Now I hope his heart has a long life.”

Sadly, Nicholas’ heart didn’t reach old age. It did, however, perform nobly for three decades. I’m not surprised: I always knew it was pure gold.

What we couldn’t have guessed was how much good: News of our decision spread like wildfire and so galvanized Italy that in the next 10 years organ donation rates there tripled, an increase no other country came close to. As a result, thousands of people are alive who would have died.

Some of Nicholas’ recipients were very close to death. One was a diabetic who was almost blind, couldn’t walk without help and was dependent on others. After receiving Nicholas’ pancreas cells, she moved into an apartment of her own for the first time in her life.

A 19-year-old got Nicholas’ liver. The day he died, she was in a coma. She bounced back to health, married her childhood sweetheart a year later, and a year after that they had a baby boy, whom they named Nicholas. He is now a tall, handsome young man with no trace of the liver weakness that has dogged his family.

Andrea took longer to heal. He had been sick for so long that his strength was undermined and, whereas the other six were soon back in circulation, he only slowly came back to full health. But when he did, it was for real. He got a job, played soccer, lived more normally than he had ever been able to growing up.

And that is how things stood until we got an email on Tuesday. “His heart was still functioning,” Andrea’s longtime doctor told us, “but the lungs were fibrotic because of drug toxicity related to chemotherapy treatment received three years ago after diagnosis of lymphoma. The final cause of death was respiratory failure.”

It was deflating, like the loss of a young nephew you never dreamed would go before you did. But we don’t feel as if Nicholas died all over again, as some doctors fear will happen to donor families. And, of course, we still have no regrets about the decision we took in 1994.

When the Italian media first asked Maggie how she felt about our son’s heart being transplanted into another boy’s chest, she said: “I always hoped Nicholas would have a long life. Now I hope his heart has a long life.”

Sadly, Nicholas’ heart didn’t reach old age. It did, however, perform nobly for three decades. I’m not surprised: I always knew it was pure gold.

Published on The Los Angeles Times.  
February 13, 2017

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Twenty-two years after he was shot, Italians still keep a little American boy in their hearts.

A few weeks ago an emotional email arrived from southern Italy from people we had never met. They are the Santangelo family, who — after our seven-year old son Nicholas was shot in an attempted carjacking in southern Italy and his organs and corneas donated to seven Italians — had opened a coffee bar named for him.

Now they were telling us they had three bars, all of them named Nicholas, and were inviting us to visit them. They seemed to think of him as part of their family. One of the young men in the family has the word Nicholas tattooed on his arm. Their business cards have his face on them.

As it happened, I was giving a talk to the Italian Transplantation Society soon after and my friend and tireless worker for the cause of organ donation, Andrea Scarabelli, who lives in Rome, offered to drive me to Naples.

        On the way down, we called ahead. When we arrived at the first location the whole family was waiting on the sidewalk, the men looking serious, some of the women in tears, the children fidgeting with excitement. Immediately we walked into the group, we were engulfed in hugs and smiles and more tears, some of them mine.

They proudly showed us the huge picture of Nicholas outside the café and I caught my breath, standing next to that beloved face with the honest open look I knew so well and the gentle whimsical smile. I remembered the time I gave a reporter a list of his organs that were transplanted and adding “I wish they could have used his freckles too.”

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Inside we were given steaming cups of coffee, so concentrated in the Italian style that they barely covered the bottom of the tiny cups. I asked for a Café Americano, much bigger, though still only a juvenile version of the mug I use at home. I felt like a sissy, as if I’d asked for Miller Lite in an Irish pub.

With the exquisite tact that Italians of all walks of life show to strangers, they did not press me with questions about Nicholas but nevertheless, seeing that they seemed likely to burst with curiosity, I told them stories about him, and that Eleanor, his sister, the four-year old who was sleeping next to him on the back seat of the car when he was shot, is now a 26-year old teacher; that Maggie, my wife, is the costumer for an opera company; that our twins, born two years after the shooting, are at college; and that the drought in California has shriveled up our lawn. In short, it was like visiting friends I’d known for years.

The mayor of the little town, a suburb of Naples, came too and Dr. Giusy de Rosa, whom I met when she was a teacher at the Nicholas Green Primary School in a nearby town. A renowned nephrologist was also there, Professor Emeritus Natale de Santo of the Second University of Naples, who has done everything he can to help make transplantation an essential part of medical study. This was an opportunity, they all felt, to draw attention to the urgent need for organ donation in an unusually persuasive setting.

None of the three locations is grand, just the traditional meeting places of locals where, along with the weather and the upcoming soccer match, the story of a small American boy whose donation changed the thinking of a nation would be told over and over.

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 “Why did you call it Nicholas?” young people often ask, one of the family told me. “When I tell them the story, they look him up on the Internet,” he added “and, when they come back the next time, they know more about him than I do.” Including, no doubt, that in the 10 years after he was killed organ donation rates in Italy, until then the lowest among comparable European countries, tripled (!) so that thousands of people are alive who would have died.

There are many ways to spread the message of organ donation. To me this kind of spontaneous grassroots growth is the most satisfying of all.

(Written on November 2016)

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Emotional Upsurge for Italian Earthquake Victims has one Precedent: Death of a Small American Boy

The recent devastating earthquake in Italy caused an enormous increase in blood donations. Searching for a parallel, the highly-respected health writer, Margherita De Bac, could only find one: an organ donation story. Here is an excerpt from her article in Italy’s largest newspaper, Corriere della Sera.

Earthquake, the Amatrice Effect, thousands of blood donors.

“The emotion after the earthquake brought a huge number of volunteers to the blood transfusion centers. Now the people in charge of such donations hope that the solidarity does not end. It has been called ‘The Amatrice Effect’. Thousands of blood units were donated by citizens to help the victims of the shock that crumbled towns between Lazio, Abruzzo, Umbria and Marche regions. There has never been such an immediate and spontaneous response [from blood donors.] The same thing happened in 1994, when the death of Nicholas Green, the American child killed along the Salerno-Reggio Calabria highway when he was traveling with his parents, moved the consciences of the Italian people about the problem of transplants…….. Sometimes emotion is worth one thousand campaigns of awareness.”

[After Nicholas’ organs were donated, donations in Italy increased every year for the next 10 years, until they were three times as high as before he was killed.]

Link to the article: http://www.corriere.it/salute/16_agosto_29/terremoto-effetto-amatrice-d5eae0fc-6e06-11e6-8bf4-ee6b05dcd2d0.shtml

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Bike Race

On organ donation day in Italy (May 29), a cycling team led by Francesco Avanzini, a 62 year-old man who had a kidney transplant 29 years ago, cycled the very tough 50 kilometers, along the glorious coast from Sestri Levante to Genoa. It was like many other activities for organ donation that day but for me it had not one, not two, but three special features. First, I have become friends with Francesco and have seen a degree of moral courage in him that matches the physical courage he needed to stay alive. Second, the race went close to the very first place I stayed in Italy 65 (!) years ago when I had saved enough money to go abroad for the first time. And third could I, as a young man, have ever imagined on that first visit that a race would one day pass this way that would end at a bridge named for my own son?

genoa bridge sign

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Strikebreakers

Driving to another meeting in Sicily, without much time to spare, we suddenly came across twenty or so burly men who had set up a road block, strikers protesting the closing of the local plant of an oil company and the subsequent loss of jobs. A long line of drivers were arguing that they should be let through: I imagined kids waiting to be picked up at school, aged parents hanging around hospital waiting rooms, concerts, meals and homework missed. But the strikers were adamant. “Wait here till we open the road. This is important to us.” Nevertheless, my driver inched forward until we were alongside the strikers’ leader. “Where are you going? Stay in line with everyone else,” he was told brusquely. “I’ve got the father of Nicholas Green with me, the American child who was shot on the freeway in Calabria. He’s going to give a talk on organ donation at a school,” my driver replied. A skeptical face ducked down by the window, looked at me quizzically, then smiled broadly. “Let this one through,” he said to his pals and waved us on majestically.

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Donor is Like a Member of the Family

On a recent visit to Sicily, where four of Nicholas’ recipients live, I was invited to speak to the kindergartners at the Rita Atria School in Palermo, who listened breathlessly to the tale of a boy, just a year or two older than themselves, who saved other children when no one else in the world could. Afterward I talked with the principal about the visit Maggie and I made to the same school 21 years ago and were received with the same rapt attention then too. It dawned on me that these were the little children of the little children we talked to on that first visit: a whole generation of families for whom Nicholas has been part of their lives.

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“Nicholas has grown and lives in me”

“Nicholas has grown and lives in me”

 The touching meeting between the father of Nicholas Green, the child killed along the Salerno-Reggio Calabria highway in 1994, and the woman who received the liver of the child. “At night, when I lift my eyes to the sky and see the brightest star, I know he is there. He is my guardian angel.”

Visto - Feb 19 2016 - part 1

(Visto magazine – February 19, 2016)

“The day Nicholas died, October 1st 1994, Maria Pia was only 19 years old and she was dying. Only a transplant could save her. Looking at her now, a vigorous mother of two lovely children and wife to a loving husband, tears come to my eyes thinking that, if my wife Maggie and I had made a different decision that day, nothing of this would be possible. If we hadn’t helped her and the others, I know we would never have forgiven ourselves”. Twentyone years have passed since Maria Pia Pedalà, in her final hepatic coma in a hospital bed, was saved at the very last moment by a liver transplant: the donor of the organ and of a new life was an American child, Nicholas Green, only seven years old, who was vacationing with his family in Italy and was declared brain dead after having been shot on September 29 1994 by two robbers along Salerno-Reggio Calabria Highway .

Since then, Maria Pia Pedalà has kept in touch from time to time with Nicholas’ parents whose deed of love gave a new life to her and to other three teenagers and an adult, and also sight to two more people thanks to the donation of the kidneys, liver, heart, corneas and pancreas cells. Since then, Nicholas’ father comes to Italy every year – where more than 100 places including streets, schools, parks, squares have been named for the little Green child. The most recent visit took place on February 3rd, on occasion of a conference on organ donation organized in Palermo at the Mediterranean Institute for Transplants and Special Treatments (ISMETT). And right here in Palermo, Green met Maria Pia Pedalà again. Over these years she married and had two children, Alessia, 15 years old, and Nicholas, 17, who got his name to honor her mother’s donor.

“Every meeting with the Greens is a unique emotion for me: I feel a shiver running down my back” Maria Pia explains. “His hug is something you cannot explain, like that of a father to a son: there is something indissoluble that ties me to him because Nicholas lives in me.

Q: Maria Pia, many years passed from the transplant that saved your life. What do you remember of those days?

A: I was 19 and during those last two months I had been suffering stomach ache and nausea – I entered and exited emergency rooms at hospitals not knowing the cause, until one day the pains were so strong that I was urgently hospitalized, suffering high temperature and jaundice. The day after I fell into a coma: a silent and sudden hepatitis was making me die. I was moved to Rome in an Air Force plane and I was in very serious condition. A few days later the doctors told my relatives that an organ was available. My state was so terrible that my relatives were reluctant, fearing to worsen my ordeal. But the doctors insisted that I had to undergo surgery: not only the organ worked perfectly, but after 21 years I am still here.”

Visto - Feb 19 2016 - part 2

Q: when did you discover that your donor was a child only seven years old?

R: I remained in the intensive care unit for a couple of weeks and then I was moved to the ward where they gave me a newspaper: it talked of an angel who had come from a far place and saved seven people. I burst into tears, I felt guilty thinking that a child had died and I was alive instead. It is a feeling that I had very often, until the day that together with the other six recipients I had the opportunity to meet those wonderful parents: Maggie made me understand that their choice had been a choice of love, that the donation had helped them to contain their sorrow. All over these years we have always kept in touch, meeting each other when possible, otherwise through emails.”

Q: You are a mum now: how did you explain your story to your children?

A: “Since October 2nd 1994 Nicholas is part of me, therefore there was no need to explain anything.

They heard me talking of Nicholas since they were born, also because I have a photo of him in my house, the last one before he was killed, that Reginald and Maggie gave me. Besides the photo I placed a toy soldier with which Nicholas played: during the first meeting with all the recipients, Reginald gave one of them to each recipient, and since then I have been looking after it with love. To me Nicholas is my angel: when at night I lift my eyes to the sky and see the brightest star, I think ‘there he is’. Nicholas has grown with me, and it is as if I have two ages: 40 years, my birth age and then 28, the age he will be today.”

Q: Have you ever been in California, where Nicholas is buried?

A: “Yes, and it was an incredible emotion. I went there with my family on the 10th anniversary since Nicholas had died, in 2004, and I took there a bell made in my hometown, San Fratello. Nicholas was buried in a catholic church in Bodega Bay, a small village 60 miles north of San Francisco where the Greens lived before moving to Los Angeles. Nicholas loved the sound of bells and that’s why his parents built a monument, The Children’s Bell Tower, made with 140 bells sent by families from many parts of the world, mostly from Italy; the central bell was blessed by Pope John Paul II.

Q: How is your life after the transplant?

A: I live a very regular life, I don’t smoke, don’t drink, I am careful about what I eat, and I have never had problems. For many years I have taken immunosuppressant medicines, as the procedure requires, but I have been pregnant two times and everything went well. On the other hand my transplant took place on October 2nd, the day dedicated to the guardian angels and I think I have some very special guardian angels: I lost my mother when I was 12, and I lost a brother when I was a child. I suffered loneliness, but a year after the transplant I married my husband Salvatore and I welcome every day of my life as a gift”.

Q: Also thanks to Nicholas and the decision of the Greens, organ donations in Italy started to grow. Until then our Country was at the very bottom in Europe: how is the situation in your region now?

A: “In Sicily there is the ISMETT, a center of excellence as for transplants, and a culture of donation is more and more widespread. As for me, everytime I can, I go to schools to tell my story to the children to let them know what organ donation is. And everytime, they always ask me about Nicholas: his memory is alive now as it was twenty years ago and I am more than certain that people will keep talking of this angel for a long time.”

Article published on Visto magazine (Italy), February 19, 2016.

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Policlinico Gemelli Hospital – Italy

The Policlinico Gemelli hospital, connected to the Catholic University of Rome, says “The Nicholas Effect” video (available at www.nicholasgreen.org under DVDs)  is the most frequently-watched item on its website, even in competition with universal killers like cancer or headline grabbers like Zika.

Visit also https://nicholaseffect.org/links/

 

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Map of places named for Nicholas in Italy (Mappa dei luoghi intitolati a Nicholas in Italia)

Within days of Nicholas being killed, Italian communities of all sizes, from some of the largest cities to small villages began to talk about naming places for him. Twenty-one years later, 110 have been identified: streets, schools, parks, squares, and one bridge, all over Italy. Please click on any tab for more information.

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