**1. Introduction**

Imagine the thrill of opening an unsigned letter that says, "You don't know me but you saved my life." For a moment your mind goes blank. Is this someone's idea of a joke? Did it come to you by mistake? Then you make the connection and your mind is flooded with half-buried memories. The letter is from Andrea, the 15-year old boy who received your son's heart when you donated his organs. You remember Andrea was "struggling to stay alive" before the transplant, his doctor told you. At the time you could not get the phrase out of your mind. He was "grossly undernourished," weighing only 27 kilos, the doctor added, had to go to the hospital twice a week for blood transfusions and shuffled around like an old man. In short, for all practical purposes his life was over.

You read on: "I have a job, I can even play soccer." It sounds like a miracle. It is a miracle: the transplantation of organs, a medical miracle that was first successfully done in my own lifetime and has become not simply the preferred cure, but the only cure, for many terminally-ill patients all over the world. Andrea's story is not imaginary: it is all too real and with a far better outcome than for many patients on the transplant waiting list.

HIs story became part of our family's life when my wife, Maggie, and I and our two children, Nicholas, aged seven, and four-year old Eleanor were on vacation in Italy. We had traveled from our home in Bodega Bay, California to Rome and were driving on the main highway from Naples to Sicily. It was at about 10 o'clock at night in Calabria, the toe of Italy, when a car that had been behind us drove alongside and instead of overtaking stayed there. "There's something wrong here," I said half to myself.

Maggie, who had been dozing, woke up immediately, in time to hear savage, angry yells from the other car, not a word intelligible, but obviously telling us to stop. From the corner of my eye, I saw some rust or dirt marks on the hood of their car. It looked older than our rented car and it flashed into my mind that we could probably outdistance them if we needed to.

Maggie looked over and saw a few feet away two masked men, one of them waving a pistol. Obviously, if we did stop we'd be completely at their mercy so instead I accelerated. They accelerated too, I floored the car, they floored theirs, and the two cars raced down the road side by side until there was a deafening explosion and a bullet shattered the rear passenger window, where the children were sleeping.

Maggie immediately turned around to make sure they were safe. Both appeared to be sleeping peacefully—it seemed a blessing at the time—but now it was beyond doubt that these were not young thugs out for a thrill but dangerous criminals. A moment later the driver's side window was shattered by another bullet, glass flying everywhere, and how it missed the two of us on the front seat we will never know. But by now we were doing what I'd hoped, pulling away and from seeing them alongside I saw their headlights in the wing mirror, then in the rear-view mirror, and then they disappeared back into the night.

What a relief. We'd escaped. I kept driving at top speed, however—who knew if they might come back?—and, as it happens, a few miles further there had been an accident. The police were there, an ambulance was getting ready to take an injured man away. I pulled over and stopped, the police shouting at us to move on. I got out of the car to explain but when the interior light came on Nicholas did not move. I looked closer and saw his tongue was sticking out and there was a trace of vomit on his chin. One of those bullets had hit him in the head.

Shocked beyond belief, I said something to Maggie. She looked too and cried out in horror: it was the only time through everything that followed that she raised her voice. Nicholas was in a coma and was rushed to hospital in Messina, Sicily. An interminable two days later, without ever regaining consciousness, he was declared brain dead. I have never known such bleakness.

#### **2. The shot was heard around the world**

That was 26 years ago but I remember in exact detail sitting in the sunny hospital room as the doctors told us there was no more hope, holding Maggie's hand, trying to come to grips with the idea that he and I would never again go out for one of our

**19**

around the world.

through the body.

*The Results Are Positive for Both Sides in the Great Majority of Cases When Organ Donor…*

walks where I could make him helpless with laughter at some tale that one of his inventive questions provoked, never again hear him say "Goodnight, Daddy." It was then that Maggie said quietly, "Shouldn't we donate his organs?" and I said "Yes." It was that simple. Until that moment, everything had been totally black. There wasn't a shred of good in it. Now, for the first time since the shooting, I could see that

Nicholas was a magical little creature, who brought sunshine into every day. I don't think he ever hurt anyone in his life. His teacher said she always knew he was her teacher. As one of his classmates said "he would always play with some other kid when no one else would" and since he died nothing has ever been quite the same. But neither Maggie nor I have ever had a moment's regret that we made the donation. In fact, having met the recipients and knowing what would have happened to them if we had made a different decision, I know that if we had packed our bags and shrugged off their problems as none of our concern, neither of us could

As it turned out, a lot more good came out of it than anyone could have imagined. There were seven recipients, five organs and two corneas—that surprised me, it seemed too many for such a small body. Four of them were teenagers and most of them were very close to death. In Italy at the time organ donation rates were almost the lowest in Western Europe but the story so electrified the whole country that in the next ten years donation rates tripled, a rate of increase no other country has ever come close to, and literally thousands of Italians were saved from an early death [1].

Better still, the story captured the world's imagination. I do not suppose any serious newspaper or television station anywhere did not run the story prominently then and later as key developments occurred, including our highly-publicized meeting four months after the shooting with six of the seven recipients (Andrea was still recovering in hospital); the birth two years later of twins to Maggie and me, filling up what had been an empty house and putting the sparkle back in life for Eleanor, by then seven years old; the arrest of the two men, minor Mafia figures, who attacked us on one of the main roads in Italy because they had received a tip that a car delivering jewelry was coming through that night and seeing the Rome license plates on the rental car jumped to their fatal conclusion; and their trial, conviction and sentencing (twenty years in prison for one, life for the other—later commuted to house arrest for cooperating with the police for helping solve other crimes,

As a result of all this publicity tens of millions of people saw clearly for the first time that if someone they loved died of a brain injury they could save multiple families from devastation by a simple decision. Organ donation—then a mysterious, somewhat weird, not-to-be-talked-about process that, if it happened at all, happened to someone else—became a subject of conversation of serious-minded people

At that time, almost no one in the general population understood the crucial distinction between normal death and brain death: that in the first case the organs wither too quickly to be used so that only patients who are on a ventilator that can keep the organs viable for a few hours after the brain dies can be donors. Brain death is usually sudden death—a road accident, violence, a stroke—where the victim, though fatally injured, can be taken to a hospital with the blood still flowing

Since those deaths are only about 1 percent of the population it's no wonder that every donation is so precious and that so many patients die on the waiting list. It is also no wonder that many families who have said they are in favor of donating cannot go through with it when the time comes: they arrive at the

*DOI: http://dx.doi.org/10.5772/intechopen.93544*

something could be pulled from the rubble.

ever have looked back without a deep sense of shame.

Now its donation rates are among the highest in Europe.

though there is room for doubt about how much he actually helped).

#### *The Results Are Positive for Both Sides in the Great Majority of Cases When Organ Donor… DOI: http://dx.doi.org/10.5772/intechopen.93544*

walks where I could make him helpless with laughter at some tale that one of his inventive questions provoked, never again hear him say "Goodnight, Daddy." It was then that Maggie said quietly, "Shouldn't we donate his organs?" and I said "Yes." It was that simple. Until that moment, everything had been totally black. There wasn't a shred of good in it. Now, for the first time since the shooting, I could see that something could be pulled from the rubble.

Nicholas was a magical little creature, who brought sunshine into every day. I don't think he ever hurt anyone in his life. His teacher said she always knew he was her teacher. As one of his classmates said "he would always play with some other kid when no one else would" and since he died nothing has ever been quite the same.

But neither Maggie nor I have ever had a moment's regret that we made the donation. In fact, having met the recipients and knowing what would have happened to them if we had made a different decision, I know that if we had packed our bags and shrugged off their problems as none of our concern, neither of us could ever have looked back without a deep sense of shame.

As it turned out, a lot more good came out of it than anyone could have imagined. There were seven recipients, five organs and two corneas—that surprised me, it seemed too many for such a small body. Four of them were teenagers and most of them were very close to death. In Italy at the time organ donation rates were almost the lowest in Western Europe but the story so electrified the whole country that in the next ten years donation rates tripled, a rate of increase no other country has ever come close to, and literally thousands of Italians were saved from an early death [1]. Now its donation rates are among the highest in Europe.

Better still, the story captured the world's imagination. I do not suppose any serious newspaper or television station anywhere did not run the story prominently then and later as key developments occurred, including our highly-publicized meeting four months after the shooting with six of the seven recipients (Andrea was still recovering in hospital); the birth two years later of twins to Maggie and me, filling up what had been an empty house and putting the sparkle back in life for Eleanor, by then seven years old; the arrest of the two men, minor Mafia figures, who attacked us on one of the main roads in Italy because they had received a tip that a car delivering jewelry was coming through that night and seeing the Rome license plates on the rental car jumped to their fatal conclusion; and their trial, conviction and sentencing (twenty years in prison for one, life for the other—later commuted to house arrest for cooperating with the police for helping solve other crimes, though there is room for doubt about how much he actually helped).

As a result of all this publicity tens of millions of people saw clearly for the first time that if someone they loved died of a brain injury they could save multiple families from devastation by a simple decision. Organ donation—then a mysterious, somewhat weird, not-to-be-talked-about process that, if it happened at all, happened to someone else—became a subject of conversation of serious-minded people around the world.

At that time, almost no one in the general population understood the crucial distinction between normal death and brain death: that in the first case the organs wither too quickly to be used so that only patients who are on a ventilator that can keep the organs viable for a few hours after the brain dies can be donors. Brain death is usually sudden death—a road accident, violence, a stroke—where the victim, though fatally injured, can be taken to a hospital with the blood still flowing through the body.

Since those deaths are only about 1 percent of the population it's no wonder that every donation is so precious and that so many patients die on the waiting list. It is also no wonder that many families who have said they are in favor of donating cannot go through with it when the time comes: they arrive at the

*Bioethics in Medicine and Society*

the transplant waiting list.

to myself.

for all practical purposes his life was over.

probably outdistance them if we needed to.

and then they disappeared back into the night.

his chin. One of those bullets had hit him in the head.

brain dead. I have never known such bleakness.

**2. The shot was heard around the world**

undernourished," weighing only 27 kilos, the doctor added, had to go to the hospital twice a week for blood transfusions and shuffled around like an old man. In short,

You read on: "I have a job, I can even play soccer." It sounds like a miracle. It is a miracle: the transplantation of organs, a medical miracle that was first successfully done in my own lifetime and has become not simply the preferred cure, but the only cure, for many terminally-ill patients all over the world. Andrea's story is not imaginary: it is all too real and with a far better outcome than for many patients on

HIs story became part of our family's life when my wife, Maggie, and I and our two children, Nicholas, aged seven, and four-year old Eleanor were on vacation in Italy. We had traveled from our home in Bodega Bay, California to Rome and were driving on the main highway from Naples to Sicily. It was at about 10 o'clock at night in Calabria, the toe of Italy, when a car that had been behind us drove alongside and instead of overtaking stayed there. "There's something wrong here," I said half

Maggie, who had been dozing, woke up immediately, in time to hear savage, angry yells from the other car, not a word intelligible, but obviously telling us to stop. From the corner of my eye, I saw some rust or dirt marks on the hood of their car. It looked older than our rented car and it flashed into my mind that we could

Maggie looked over and saw a few feet away two masked men, one of them waving a pistol. Obviously, if we did stop we'd be completely at their mercy so instead I accelerated. They accelerated too, I floored the car, they floored theirs, and the two cars raced down the road side by side until there was a deafening explosion and a bullet shattered the rear passenger window, where the children were sleeping.

Maggie immediately turned around to make sure they were safe. Both appeared to be sleeping peacefully—it seemed a blessing at the time—but now it was beyond doubt that these were not young thugs out for a thrill but dangerous criminals. A moment later the driver's side window was shattered by another bullet, glass flying everywhere, and how it missed the two of us on the front seat we will never know. But by now we were doing what I'd hoped, pulling away and from seeing them alongside I saw their headlights in the wing mirror, then in the rear-view mirror,

What a relief. We'd escaped. I kept driving at top speed, however—who knew if they might come back?—and, as it happens, a few miles further there had been an accident. The police were there, an ambulance was getting ready to take an injured man away. I pulled over and stopped, the police shouting at us to move on. I got out of the car to explain but when the interior light came on Nicholas did not move. I looked closer and saw his tongue was sticking out and there was a trace of vomit on

Shocked beyond belief, I said something to Maggie. She looked too and cried out in horror: it was the only time through everything that followed that she raised her voice. Nicholas was in a coma and was rushed to hospital in Messina, Sicily. An interminable two days later, without ever regaining consciousness, he was declared

That was 26 years ago but I remember in exact detail sitting in the sunny hospital room as the doctors told us there was no more hope, holding Maggie's hand, trying to come to grips with the idea that he and I would never again go out for one of our

**18**

hospital to find someone they love, often painfully young and until then perfectly healthy, is dead or dying; their minds are in turmoil; they cling to the thought that there may still be hope. In those circumstances to be asked there and then if they will donate the organs is too much for many people: they say "no" and often realize only the next day that they have turned down what will probably be the best opportunity they will ever have to make the world a better place. But by then it is too late.
