I wrote about the use of Facebook in the UK to find a kidney donor in the first part of this article. The source material for this came from a BBC News post. In the same week I read about a very different experience of a family whose decision to donate their son’s organs, led to a three-fold increase in organ donations over a decade. Probably those more in touch with films and the news know about the story of Nicholas Green already but for me this was all new.

Nicholas was travelling in a car on holiday with his American parents and sister in Sicily. For some reason, which remains a mystery, the family was shot at by another car and Nicholas was hit in the head. He went into a coma and died a few days later in hospital. What I find remarkable is that despite the situation of the family holiday turning into a nightmare, and being thousands of miles away from home, the parents decided that they would donate Nicholas’ organs for transplantation. Seven people, four adults and three children, benefited from this altruistic gesture and there is a wonderful picture of the Green family with all the recipients.

According to the article, the killing of a child combined with the generosity of the parents’ gift had a major effect on a good proportion of the Italian population. People were appalled at the killing but inspired by the parents’ response which is shown in the figures. Prior to Nicholas’ killing, 6.2 people per million donated an organ, but by 2006, 20 people per million population donated; over a three-fold increase. This is known in Italy as the “Nicholas Effect”. During this period though, Italy adopted an opt-out presumed consent strategy so I wonder how much of the increase might be attributed to the change in system?

At the beginning of December 2015 Wales, a country within the UK, also changed to an opt-out presumed consent system. Over the next six months, thirty-one people donated sixty organs; ten of the donors were in the presumed consent category and these ten people donated 32 organs. To put this another way, the opt-out system increased the number of donors by half which allowed the number of donated organs to double. The figures were reported in the Guardian Newspaper and due to the relatively small population involved, may not be representative of an ongoing change but let’s assume they are indicative of the presumed consent change. These remarkable figures show a dramatic increase in organ availability but I want to put them in context of Italy’s donation rates.

If the same trend that happened in Wales worked for Italy then presumed consent would change a 6.2 people per million donation rate into a 9.3 people per million. The 9.3 people figure though is much lower than the 20 people per million quote for 2006. On these figures, it would be fair to say the Nicholas Effect doubled the donation rates. It isn’t that simple though. A Facts and Figures report produced by the European Commission on Organ Donation and Transplantation in November 2014 shows that the introduction of Donor Transplant Coordinators into hospitals in Spain, Greece, Romania and Tuscany in Italy, doubled the donation rate over periods of between one and ten years. So the doubling of the rate in Italy may have been caused by other systemic changes.

So what are all these figures saying? Well I suppose on the one hand I could be saying that there is reason to believe that the Nicholas Effect might not actually exist, but the reality is that I just don’t know. In the same way that an individual Facebook campaign can have a positive effect on general organ donation in the UK, the story behind Nicholas Green could quite easy have a positive effect on donation in Italy. Statistics are all well and good but in the real world people are reliant on a chance to continue their lives through getting a new organ. Any increase in rates is good news for somebody waiting for a transplant whether it is from tragic but inspiring news stories, or investment into better donation networks.

One heartening thing I learnt from the European Commission report was that there are networks of countries that share organs for transplantation. Eurotransplant consists of Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, The Netherlands and Slovenia. Scandiatransplant is made up of Denmark, Finland, Sweden, Norway and Iceland. Whilst the South Alliance for Transplants consists of France, Spain, Portugal, Italy and Switzerland.

You may ask where the UK sits in this? I am not sure why, but it doesn’t. Looking at the Commission report, the UK has okay figures in the grand scheme of things but doesn’t hit the highs of Spain’s so there is room for improvement. One thing the report can’t show are the organs that could not be used by one country (or group) that could be used outside that country or zone. In the table it does show that 2% of organs from the Eurotransplant area go outside that region but no figures are given  for any of the other networks. I can only hope all the regions co-operate in a similar manner, for co-operation is key for such complex and rare treatments like liver transplants. And once again, I am reminded of Brexit and the attitude behind this nationalist fervour. It saddens me because this Scottish recipient received a liver from Ireland.