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Cora’s last smile

Cora Hill of Orlando, Florida, 22 years old, dying from cystic fibrosis and, having received a new pair lungs that in time failed, in chronic pain and too weak for another transplant, came to a decision: calmly, but definitively, she told her family she wanted to be taken off life support and donate her kidneys.

Cora Hill - hospital

In this photo, courtesy of the Hill family, she is holding the baby of a friend. Two days later, her ventilator was switched off and the lives of two very sick people were transformed. Her mother, Dee (who is in the photo) says it was Cora’s last smile.

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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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Donated organs go to people in the greatest need so they are usually very sick, sometimes within hours of death. What happens to them?

When all goes well with a transplant operation patients who couldn’t walk across the room without having to stop for breath are out of the hospital in a few days after their transplant, back at work soon after, playing sports again. Athletes return to compete, including the Olympics, NBA championships and marathons.
Generally, their whole life changes. They become rejuvenated, take up pursuits they have never had the energy for, have babies that were previously not even a possibility, climb mountains, get degrees and travel to faraway places. They relish even the most mundane routines – shopping, driving the car to work, being alone without worrying about a catastrophe.
They come from all walks of life, all temperaments and all philosophies. Some are deeply religious, seeing the hand of God in their own experience; some are intermittent worshippers, some firm non-believers – in fact, a cross-section of society.
A common thread, however, brings them all together: gratitude: they have their donor’s photo in their wallet, send flowers to the family on birthdays, light candles and determine to be worthy of the gift they received. The other people in this inspiring equation are the ones who saved them. The great majority of donors never met the recipient and never will. They died and, in dying, their families, often acting on what their loved one had told them, agreed to make their gift without any knowledge of where it would go.

What kind of people are donors?

Donor families are as diverse as recipients. Some had scarcely heard of transplantation until suddenly faced with the death of one of their members. Others had talked about it freely. Some came to the decision agonizingly. For others it was so obvious they didn’t even debate it. But all, at the moment when they were most vulnerable, instead of turning inward in bitterness and despair, set aside their grief long enough to help people they could only dimly imagine.
Some donors didn’t die. Nowadays, one in five are living donors, who undergo a major and otherwise completely unnecessary operation, to give a kidney or part of their liver or lungs, to help someone in need. Mostly that someone is a close relative and they regard the donation as a privilege. But at times it is a casual acquaintance or even a total stranger. When asked why they would put themselves at risk they typically shrug and say simply: “They needed it more than I did.”
Despite all these differences, the power of transplantation has produced a strikingly uniform response among donor families. Among all the hundreds of donor families I have met, I can scarcely remember one who regretted the decision. Almost all say it was the one good thing to come out of a terrible time.
It is those who didn’t donate who often have regrets. At meetings about organ donation people will come up, with tears in their eyes, to say, “I wish I’d done that.” Five, ten, sometimes twenty years earlier a family member had suffered brain death. No one approached them about donating or they were too upset to think about it or at the time the idea frightened them. Now they feel that somehow they let that loved one down.
Not that donation takes away the loneliness. More often than I like to remember, I will meet a young couple who say quietly something like this: “A few months ago our daughter’s school had a presentation on transplantation. She told us that if anything happened to her she’d want to be a donor.”
They pause to pluck up courage and my heart sinks, knowing what is coming. “A few weeks later,” they add, “she was killed coming home from school on her bicycle. We didn’t hesitate.”
People like that speak of the peace of mind the decision has brought them and the way it has helped them heal. “It’s given a meaning to her death,” they say. “It produced something good instead of everything being a waste.”

If you want to be an organ and tissue donor, you must tell your family. Here’s why:

In the absence of any previous discussion, a family in the waiting room of a trauma hospital is often bewildered. The circumstances of sudden death are always searing but, in addition, family opinion may be divided, some members who need to be consulted may be away, emotions can be running out of control. Misconceptions are commonplace. Some people are convinced that if they sign a donor card the doctors will not try as hard to save them. Some think their church is against transplantation. Others say of someone who has just died, “I don’t want her to be hurt anymore.”
Everything is working against calm thought. A mother may have to call her husband at work to tell him their child was hit by a car. A father may have to tell his children their mother is not coming home.
Making a major, irrevocable decision there and then about something they have never seriously thought about is too much for many people. They say ‘no’ and often regret it for the rest of their lives.

Do you know why the need for donated organs is so urgent?

The need is urgent because the potential supply is so limited. In the great majority of deaths, where the heart stops beating, the organs deteriorate too quickly to be transplanted. Most donated organs come
from the small number of people, whose brain has stopped working and are truly dead, but who are on a ventilator that can keep their organs viable for a short time. By contrast, almost anyone can donate tissue – corneas to restore sight, skin to cure burns, bone to straighten spines, ligaments so that invalids can walk again. A donation produces on average three or four organs, saving three or four families from devastation, in addition to tissue that can help up to 50 people. Most people in their whole lives will never again have as great an opportunity to change the world for the better as they have at that moment. With that much on the line, I often wonder what possible debate there can be about what is the right thing to do.
Material on this blog often comes from Reg Green’s published articles and books.
This preface is from “The Gift that Heals” (www.authorhouse.com)

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Transplants, once medical miracles, are now routine

Close to half a million people in the United States have had an organ transplant. Millions have had a tissue transplant: skin, bone, corneas, heart valves, tendons. Yet, although transplantation is an everyday procedure in hundreds of hospitals around the world, public opinion
still treats it as though it were on the fringe of medicine. Few people think about it at all until they become personally involved. It then takes over their lives.
The sobering fact is that any one of us could need a new organ or tissue to save our lives — and virtually every one of us could be a donor.
Many people who become involved are ordinary men, women and children who one day were told that unless someone donated a new heart or liver, kidney, lungs or pancreas they could not expect to live much longer. At that moment, they realized, perhaps for the first time, that probably someone else would have to die to give them the organ they needed. Some of them have been sick all their lives, never knowing a normal day, going in and out of hospitals and aware that the end could come at any time. Others, including some world-class athletes, are seemingly in perfect health but are struck down without warning by a virus. Some are people whose lives, though not threatened, are miserably constricted or in chronic pain: blind, suffering from severe burns and
bent spines, unable to walk or pick up their children.
Into their world comes transplantation like a lifeline, some would say a miracle. It is not simply the best cure. For most of them it is the only cure. And because of the rapid advances in medical science, more and more people can benefit from it – sicker people, older people and people with more complex problems.
It is the most egalitarian of cures, leaping over all the normal social barriers. White men are walking around with black men’s hearts inside them and vice versa. Asians are breathing through Hispanic lungs and vice versa. And — dare I say it? — Democrats see the world through Republican corneas and vice versa.
Transplantation is not a cure-all. As with any surgical procedure, complications of all sorts are possible, the powerful medications that recipients have to take so the body will not reject the new organ can have serious side effects and patients, who were sick enough to get to
the top of the long waiting lists, have often developed other diseases that undermine their health, regardless of the revivifying effect of the new organ.
Even so, the results are astounding. However many times it happens, an inert organ, that has been taken from someone already dead, and springs suddenly into life in another dying body, still seems
to most of us to have more in common with science fiction than regular medicine.
Success rates have generally advanced steadily year by year and dramatically over the decades. Results vary widely depending on the organ but about 95 percent of patients who have had a
kidney transplant are alive after one year, 80 percent after five years and 60 percent after ten years. About 90 percent of heart patients are alive after one year, 75 percent after five years and 55 percent after ten. For lung patients the figures are 85 percent, 50 percent and 25 percent.
Given that all these people were terminally ill, that many were close to death at the time of their operation and that, over the years, some proportion of them will die from unrelated causes, the distance transplantation has come speaks for itself.
The waiting lists are the most obvious indicator of the distance it has still to go. The people on those lists live perpetually on the edge, always aware of a winner-takes-all race between a wasting disease and a cure over which they have no control. Every day 22 of them die. In mid-2015
around 120,000 are waiting for an organ, compared with fewer than 20,000 twenty years earlier.
But seen from another angle, those ever-lengthening lists are a measure of the progress of transplantation.
As techniques have improved across the board, demand for the procedure has skyrocketed, moving it in a few decades from experimental to common therapy.
The limiting factor, always, holding up everything, is the shortage of donated organs – and that limitation is a recurring theme of this blog.

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July 2, 2015 · 12:29 am

The boy who saved thousands of lives

I am the father of seven-year old Nicholas Green, of Bodega Bay, California, who was shot in an attempted carjacking in Italy while we were driving on the main road south from Naples on a family vacation. My wife, Maggie, and I donated his organs and corneas, which went to seven Italians, four them teenagers, most of them close to death. In the next ten years, organ donation rates in Italy, which were then just about the lowest in Europe, tripled – a rate of increase no other country came close to – so that thousands of people are alive who would have died. All around the world his story brought people’s attention to the acute shortage of donated organs and became known as ‘the Nicholas Effect.’

In this blog I want to publicize the continuing ripples of this decision and to show that every year thousands of other people – just like us — make the same decision to donate organs rather than bury them. But I also I want to show that even at the worst of times, when the temptation to turn inward in grief and bitterness is almost irresistible, the human spirit burns brightly enough in people of every kind that instead of being consumed they reach out to complete strangers and — quite simply – snatch them from death.

I hope you will find it interesting, Reg Green

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