Survival is not enough: Organ Donation as seen by the family of Nicholas Green

Nicholas Green. Travel in Italy in 1994

Nicholas loved Italy. For a seven-year old boy he’d seen a lot of it, all the way from the Dolomites and the chessboard at Marostica to Paestum and Portofino. He had even crossed the Rubicon. To him the magic in life was quite real and Italy’s history fired his imagination – the monuments, the Roman roads going to the end of the known world, the stories of classical heroes. He too wanted to do noble deeds that would change the world.

But also, of course, he was just a small boy. One day in Verona we had seen all the sights – the Arena, the castle, and Juliet’s house – and on the way home I said to him “What was the best thing we did today?” He didn’t hesitate: “Lunch at McDonalds,” he said.

It was just about a year later – September 29, 1994 – that we were on the Salerno-Reggio di Calabria autostrada. It seemed like any other major road in Europe. Traffic was light and moving fast. Visibility was good. It was about 10 or 10.30 pm.

We were a family of four from California on vacation and were on our way to Sicily.

I was driving, my wife, Maggie, dozing next to me and the two children, Nicholas and Eleanor, 4 years old, asleep on the back seat. I may have been thinking, as I often did in those days, “How can anyone be so happy?”

It was then that I noticed something in the rearview mirror that looked quite ordinary at first glance, a car coming up fast behind us, then closer and closer. For the first time I felt a quiver of uneasiness. I remember saying to myself, “There’s something wrong here.”

At that moment, it pulled out into the overtaking lane and I breathed a sigh of relief. Nothing wrong after all.

But, instead of pulling away, it ran alongside us and stayed there.

Now I spoke aloud: “Something’s happening.” Maggie woke immediately, just as from the other car came the sound of loud, angry voices, a deep-throated menacing roar, the words indistinguishable, but clearly ordering us to stop.

“If we stop, they can do anything they like with us,” I thought.

Out of the corner of my eye, I saw the hood of their car, next to ours, and noticed what appeared to be spots of rust or dirt. That turned out to be important later because it helped identify the car. A thought ran through my mind, “It looks like an older car than ours. We can probably outdistance them.” I held the wheel tight, in case they tried to force us off the road, and fixed my eyes on the road ahead.

“We can’t stop,” I said to Maggie. “We have to get away.” As usual, she didn’t try to second-guess. I was at the wheel and she left the decision to me. I pressed the accelerator and the voices roared out again. By now we were picking up speed.

A moment later, all hopes of an easy way out disappeared. There was a deafening explosion and a bullet blew out the side window by the back seat. Maggie turned round quickly to make sure the children were safe. Both seemed to be sound asleep.

At that moment there was another explosion, and the driver’s window disintegrated, the bullet missing Maggie and me by inches. Now, however, we were definitely pulling away, and to an onset of relief I saw them falling farther and farther behind until, from being next to us, I saw their lights in my wing mirror, then in the driving mirror and then they disappeared into the night. “They’ve dropped back,” I said told Maggie. I felt safer, but who knew if they might not come back again? I kept my foot on the floor. We sped through the night, on our own again.


(A few weeks later two men, Michele Iannello and Francesco Mesiano were arrested and eventually convicted, one to life, the other to twenty years. They have denied it throughout so only they know the truth but the most plausible explanation I have heard is that they mistook our rented car with its Rome license plates for one scheduled to come along that road that night delivering jewelry).


We drove on, looking for a filling station, somewhere with bright lights and people, and a telephone to call the police. As it happened, before we reached one, we came across a serious accident, with police already there and an ambulance at the side of the road.

I stopped and as I opened the car door and the light came on Nicholas didn’t move. His tongue was sticking out and he had a trace of vomit on his chin. That was the first time we knew anything was wrong.

He was taken to a small hospital and we followed. The one hope I’d clung to was that he’d been hit by a glancing blow that had knocked him out. The head doctor explained gently that they were sending him to the nearest big hospital, the Policlinico in Messina, because he was too seriously wounded for them to deal with. I’d never known such bleakness.


We were driven in a police car and as we docked in Sicily a flutter of hope started up. Perhaps the decision of the small hospital was just precautionary. Perhaps the much bigger hospital had facilities that would reveal a less serious situation.

The waiting room hushed as we entered. We were taken immediately into a bare room with perhaps a dozen doctors and nurses, all waiting for us, all absolutely still and silent. The chief surgeon introduced himself. Without preamble he said simply, “The situation is very dramatic.” The small shoots of hope withered away.

The bullet had lodged at the stem of the brain. It was too deep to operate on. The only hope was that his condition would stabilize and that in time they might be able to do something. The only thing for us to do, they said, was to go to bed, keep as strong as possible, and check back the next day.


In all our dealings with them we felt the hospital did everything it could to help us, giving Nicholas the best treatment it could, of course, but also telling us about his condition in the plain straightforward way we asked for. I never felt they were either painting too bright a picture or being unduly negative and they answered patiently every question we had. But obviously they were facing a formidable task.


No sign of brain activity

The end came undramatically. We were called to the hospital, and the chief neurologist said in a flat voice, “I have bad news. We can find no sign of brain activity.” What does this mean? “He is brain dead.” Is there any hope? “I don’t believe there is any hope at all. However, we will do a series of tests to be sure.” A half hour or so passed while we sat and held hands in that sunny room, not speaking much and grappling with the realization that I would never go out with him for one of our walks again, never hear him say “Goodnight, daddy.”

The result of the scan was brought in: there was still no activity. He had died, like one of his classical heroes, on the shores of the straits of Messina.

A few more moments passed then Maggie said, “Now that he’s gone, shouldn’t we donate his organs?” “Yes,” I said, and that was all there was to it.

It was clear that he didn’t need that body anymore but we were dimly aware that somewhere out there were people – you couldn’t visualize what they looked like – who desperately did need what that little body could give. Until then there had been no good in it, just a meaningless loss. Now at least something could be salvaged, though at the time we had no idea how much.

We told the doctors and they explained the procedure, which seemed clear and simple. We signed the forms and left. It was the least difficult major decision either of us has ever had to make.

Since then we have never had a moment’ s regret and I can add that of all the hundreds, maybe thousands, of donor families we have met since then I can scarcely remember one who did have a regret. In fact, it is the ones who didn’t donate who often say to us “I wish I had done that.” They feel they have missed an opportunity to make the world a better place that will never recur (1-6).


The organs saved 7 persons

Within a few hours we received a message from the mayor of Rome, expressing his sympathy and gratitude. From this we learned Nicholas’ pure heart had gone to a Roman boy, who had had five operations on his heart, all of which had failed. Soon the names of all the others became public. There were seven of them in all, who besides the heart received the two kidneys, the liver, the pancreas cells and the two corneas. Four of them were teenagers with all their lives ahead of them.

We have lost touch with two of them but when we last heard of the other five they were living productive and fulfilling lives. After 18 years, it is a triumph for transplantation and Italian medicine.

I know now, though I did not know it at the time, that in Italy the two sides are not permitted to meet but the circumstances in our case were so extraordinary that not only were the recipients known around the world but we were asked to come back to meet them in events involving the Church, politicians and health authorities at the highest level.


Obviously, only these unusual circumstances make our case different from decisions that families in lonely hospital rooms all over Italy make in favor of organ and tissue donation. The pain is the same, as are the benefits to multiple terminally-ill recipients.

Most of these donor families, I suppose, feel much as we did. We would have done anything to have kept Nicholas alive. But he was dead and nothing we did to his body could hurt him in any way conceivable to us. But the gift of that body, far from disfiguring him, transformed his earthly self into a symbol of sharing life rather than hoarding it.


We were learning too – of the misery of patients on those agonizingly long waiting lists, and how many died on them –so that we determined to use the publicity surrounding our story to do everything we could to etch on people’s minds what a mighty power they have in their hands to give or withhold life. We made a series of educational films (one in Italian) that hospitals and schools in every corner of the United States – and some in Italy — have shown, written two books, both available in Italian, one of which was the basis for a television film starring Jamie Lee Curtis that has been seen by 100 million people and has converted many millions of them to organ donation. I can send copies of any of these materials to anyone who wants them.

We have given interviews to leading newspapers and television programs around the world, written innumerable articles and made speeches everywhere from Venezuela to Taiwan. In short we have tried to make our personal story into something anyone can imagine happening to themselves. Once that happens they are much more likely to say yes.


I doubt that any other country in the world would have shown the compassion that Italy did. People of every kind seemed to want to put their arms around us.

More than that, they channeled these noble emotions into acts of practical value. Immediately after Nicholas was killed organ donation rates shot up. By the following year they had almost doubled and went on rising year after year.

From being the bottom in Western Europe in organ donations (except for Greece) Italy is now near the top. Thousands of people are alive who would have died. An increase like that, of course, has multiple causes: among them the astonishing and ever-improving skills of medical professionals at every stage of the transplantation process; an army of dedicated volunteers; more favorable laws; a better informed public; the support of the media and so on.

I leave it to you to decide what contribution Nicholas’ story made to that extraordinary increase. But clearly it was a catalyst of major proportions – and one that continues to affect attitudes to organ donation around the world.


Common people can change the world

As one young Italian woman wrote, “Since when your son has died my heart is beating faster. I think that people, common persons, can change the world. When you go to the little graveyard place please say this to him, ‘They closed your eyes but you opened mine.’



  1. Green R. The Nicholas Effect. A Boy’s Gift to the World. 1999.
  2. Green R. The gift that heals. 2007.
  3. Green R, De Rosa G, Scarabelli A, Citterio F, De Santo LS, De Rosa G, De Santo NG, The murder of Nicholas Green 200 years after his assassination. GIN, 2014;31: 1/12
  4. De Santo NG, Scarabelli A, Citterio F, De Santo LS, De Rosa G. The Italian places of Nicholas Green. Organ donation 20 years later. Am J Kidney Dis 2014; 64: A17/19.
  5. Green R. Put My Name in the Registry to Donate All My Organs. In: DE Santo NG, Citterio F, Ayse Balat et al. Survival is Not Enough 10.Italian Institute for Philosophical Studies, Naples, 2016; 17-21
  6. Green R. Una vita, una storia, Vol. 2, Anno 30 Mar-Apr 2013