Organ donation after death: why do so many in Italy still say “no”? The Story of Nicholas Green

Does anyone remember that first October 1994? Italy woke up in disbelief to the front pages of the newspapers. They reported the news of a 7-year-old American boy, Nicholas Green, who was shot in the head the night before while he and his family were going on holiday in Calabria. He died two days later, the innocent victim of a robbery.

Reginald and Margaret Green, the parents, overcame their immense pain and decided to donate their son’s organs, saving seven people awaiting transplants. The “Nicholas effect”, as it was nicknamed, led to a considerable increase in donations in a country that until then had shown distrust and indifference.

Thirty years later, what remains in our country’s collective memory of that child and of the choice to donate his organs, made by dad Reg and mum Maggie? Reg, 93 years old, former journalist and writer, will return to Italy with his wife Maggie for a series of commemorative meetings in Rome, Messina and Milan. He agreed to help those who do not remember and those who do not know Nicholas’ story, retracing those tragic moments with us.

And, who knows, help make them think over five million Italians whoaccording to the latest data from the National Transplant Center, they oppose to a gesture, that of donation, capable of changing the fate of a person who could even die without a transplant. Given the record results recorded in 2023 for donations and transplants of organs, tissues and hematopoietic stem cells in our country, there are still around 8 thousand patients on the waiting list: around 6 thousand patients waiting for a new kidney.

The «Nicholas effect»

Since that September 29th 30 years ago, nothing has been the same in the world of transplants. In Italy, above all, but also abroad. The “Nicholas effect”, as it was nicknamed, shook consciences. To understand its scope for us, just take a look at the reports of the National Transplant Center and follow the trend of the vertical bars of the histograms: in 1994 there were 7.9 donors per million inhabitants, the following year it reached 10.1.

Reginald Green, who was Nicholas?
«For us she was a little magical creature: imaginative, funny and sincere. His teacher said he was the most generous child she had ever taught.”

What were his passions?
«He threw himself into everything he did, but putting himself in the shoes of historical figures was one of his favorites. In Rome, she Maggie picked some bay leaves from the ground and made a wreath of them: he liked her. We read to him the children’s versions of Roman and Greek myths: when it was Polyphemus’ turn to pass his hands over the sheep that Ulysses and his men had clung to to escape the cave, I thought he would explode with excitement.”

Did you have a favorite “hero”?
“Many, but Robin Hood was the most enduring.”

Your growing up dream?
«Once, when they asked him in class, he replied “all the jobs in the world”. One day in Venice we saw the rubbish collected by barges, instead of by trucks as happens here on the mainland. “This is what I would like to do,” Nicholas said. Now, when I think of Venice, I imagine him as the captain of a garbage barge.”

What happened that night of September 29, 1994?
«Around 10pm, I was driving on the Salerno-Reggio Calabria motorway. Maggie was next to me dozing. Nicholas and his 4-year-old sister Eleanor were sleeping in the back seat when a car behind us started to overtake but then remained side by side for a few minutes. “There’s something wrong,” I said to myself. Maggie woke up instantly: loud, angry, wild screams were coming from the car, the words indistinguishable but clearly telling us to pull over. Maggie saw two masked men, one of whom was holding a gun aimed at her.”

Why didn’t he stop?
«The danger was evident. I sped up, and so did they. The two cars ran side by side along the road. Then there was a deafening explosion and the rear side window was shattered by a bullet. Maggie turned to make sure the children were safe. They both seemed to be sleeping soundly. A few moments later my window was also smashed, glass flying everywhere. But, as I had hoped, we were moving away from the other car: I saw them in the rearview mirror and finally they disappeared into the night.

«We continued to run at full speed and as luck would have it, an accident occurred on the road, the police and an ambulance were there. I stopped and took a policeman to see the shattered windows, but when I opened the car door Nicholas didn’t move.”

How did you manage to reach the hospital in Messina?
«Our car was seized to collect evidence. We were taken to a small hospital where they told us that Nicholas was too seriously injured and that they would transport him to the nearest large hospital, the then Policlinico di Messina where we were taken in a police car. Once we arrived they told us that a bullet had lodged in the base of the brain, that Nicholas was too weak to be operated on, but they hoped that he would regain enough strength. Two days later he was declared brain dead. We were both pretty clear-headed, Maggie and I. We understood the diagnosis, but I had a greater feeling of emptiness than I had ever felt. In the hospital they were very professional but also warmly human, full of empathy, letting us know that our son was very serious but giving us hope.”

When did you decide to donate Nicholas’ organs?
“We sat there trying to absorb the fact that life had changed forever. I found myself thinking: I would never hear him say “Goodnight, Dad” again. Then one of us said to the other – we don’t remember which of us, but I’m pretty sure it was Maggie –: “now that he’s gone, shouldn’t we donate her organs?”. The other simply replied “yes”. It was so clear that Nicholas no longer needed that body. We knew, however, that other people were desperate for what that little body could give.”

Have you ever thought about organ donation before?
“Vaguely, I knew it was the right thing to do, but we had never talked about it and I hadn’t signed the donor card.”

In the news of the time, your calm and strength of spirit was often highlighted: how did you do it?
“It was clear that Nicholas was dead. I wondered if I would ever laugh again. I never felt like I was losing control, just that life would never be the same again. And it never was again. Even in the best of times, I still find myself thinking, ‘Wouldn’t Nicholas have liked that?'”

When did you last say goodbye to Nicholas: before he went into the operating room? With what words?
«It wasn’t then. I said goodbye to him when he was declared brain dead: I said goodbye. I stood next to his bed and asked his forgiveness for having put him in danger.”

Instead of hating this country, you immediately declared your love for Italy. How is it possible?
«As soon as the news spread that Nicholas had been shot, everywhere we went we found ourselves surrounded by people crying. I understood that these people would do everything in their power to prevent Nicholas’ death. Italy did not pull the trigger. Two men, so blinded that they didn’t care about the damage they were causing, did so. It could have happened anywhere.”

That “gift of a child to the world”, as we read on the Green Foundation website, sowed so much and so well: how can you explain it?
«I think the brutal end of a child who had never hurt anyone in his life was truly a shock. So when the transplants that occurred thanks to him became a symbol of life and not death, people rediscovered their hopes. The Calabrians we met, as well as people from all over Italy, remember Nicholas with so much affection that he reminds me of the good, not the bad, in people.”

Ever regret donating your child’s organs?
«We have never doubted that our decision, as well as the campaigns in favor of donation carried out over the years, were the right thing to do. And out of the hundreds of donor families around the world we have met, I can barely remember one who regretted donating. Often it is those who don’t do it who regret it.”

Thirty years after that tragic night, what remains in your memories?
“We still feel like there is a hole in our life.”

How would you like Nicholas and the Green family to be remembered in 30 years?
“They lit a fire and then worked tirelessly to keep it alive.”

The commemorations in Italy, between September and October

Between the end of September and the beginning of October, Reginald and Margaret Green will return to Italy for the 30th anniversary of Nicholas’ death. «We will participate in a conference at the Polyclinic of the University of Messina for doctors and researchers from all over the world – says Reginald -. We will also do what I have done in all 50 times I have been to Italy since Nicholas died: talk to the media and health groups about how one simple decision can save more families from a lifetime of pain.

«We will hold press conferences at the‘Bambino Gesù Hospital in Rome, the Niguarda Hospital in Milan and the Polyclinic of Messina. This will allow national newspapers and television to ask questions about Nicholas, other donors and recipients and also the latest developments in the transplant field. Maggie is very grateful that Italy still remembers Nicholas and that her memory contributes to a strong culture of giving.