On the evening of September 29, 1994 Reginald Green and his wife Margaret were driving on the A3 motorway while vacationing in Southern Italy. Their two young children, 7-year old Nicholas and 4-year old Eleanor, were asleep in the backseat when tragedy struct. Two men thought to be members of the Italian mafia mistook their rental car for one belonging to a jeweler. They followed closely behind Green’s rental car and then pulled alongside. Their faces masked, they shouted at Green in Italian. Green accelerated to get away. When Green didn’t pull over the men fired shots into the back of his rental car striking his son Nicholas in the head. Although mafia violence was not uncommon in Southern Italy the fact that a young boy was killed while vacationing with his family shocked the nation. The police spared no expense hunting down Nicholas’ killers. Francesco Mesiano and Michele Iannello were arrested three days later and ultimately convicted of his murder.
Nicholas was the subject of a 1998 movie, “Nicholas’ Gift” starring Jamie Lee Curtis. Nicholas’ moving story is about turning a senseless, tragic death of a young boy into a chance for numerous other people to have a better life. Reginal Green made the decision to give his son Nicholas a legacy. He donated Nicholas’ organs. Ultimately seven people received donated organs from Nicholas. They can be seen with Reginal and Margaret Green here in a group photo. Reginal Green remarked in a press interview that Andrea Mongiardo, who received Nicholas’ heart, had it three times longer than Nicholas did. Mongiardo died in 2017. Back home Reginal Green started the Nicholas Green Foundation to promote organ donation worldwide.
The fact that Nicholas was able to help seven Italians through organ donation was big news in Italy. The year before Nicholas was killed 6.2 million Italians donated organs. Organ donations in Italy rose 30% the year after Nicholas was shot and has risen every following year. In 1999 Italy moved to an opt-out organ donation program from an opt-in program. With opt-in individuals have to specifically agree to donate organs as opposed to an opt-out when individuals are assumed to donate their organs unless they specifically decline. By 2006, a dozen years after Nicholas’ death, organ donations in Italy had skyrocketed to 20 million. This is often referred to as the “Nicholas Effect.”
One thing that is lost in this discussion is something that is obvious to an economist but unheard of by most other people. Today organs must be donated, they cannot be sold. For example, under federal law organs from a deceased family member cannot be sold to, say, offset funeral costs. A poor family who’s loved one dies may go thousands into debt to pay for burial. Or perhaps they take a cheaper route and choose cremation. Either way they’re destroying organs worth thousands of dollars probably because they are the only members of this lucrative association not allowed to profit. The transplant surgeon is not donating his or her time. Neither is the anesthesiologist. The hospital will seek reimbursement from any payer it can. The organ bank earns a profit off donated organs, even if it is a nonprofit organ bank. If families were allowed to earn, say, $10,000, from the post-death sale of a loved one’s organs far fewer organs would be buried rather than used to help others live.