If you had passed Imogen Taylor and Nicholas Battle at the Royal Academy last summer, laughing at some of the more outlandish Dali paintings, Imogen pleased to see up close the work of her favourite artist Modigliani, you probably wouldn't have given them a second glance. But the poignancy of this, only their second meeting, defies belief. Three years earlier, the death of Nicholas's 25-year-old daughter Lucy transformed Imogen's life.
Lucy was crossing London's Clapham Road when she was hit by a motorbike. Nicholas thinks she was buying sweets and crisps before travelling home to visit her family in Newbury, Berkshire. Nicholas's extraordinary generosity of spirit leads him to add: "The chap on the bike wasn't doing more than 30, but you know how they are, weaving in and out. It's easy not to see them."
Lucy was taken to King's College hospital, where neurosurgical and intensive-care teams swung into action. Nicholas says they were "outstanding, wonderful", but that even on the day of the accident her family was told she was unlikely to survive. If she did, she would be very different.
For five days, Nicholas, his wife and Lucy's two sisters maintained a bedside vigil - until, Nicholas says, "the pressure inside her head from the knock she'd had started going up instead of down. She had clearly died, although on life-support they can keep you going artificially for ever."
Lucy's family knew then that it was a question of when to turn off the machines that were keeping her breath flowing, her skin pink. What they didn't know was that her doctors had another question to ask.
As Nicholas says: "They wanted to know whether they could use Lucy's organs for transplant. I really felt for the surgeon who had to broach the question while we tried to come to terms with such a loss." But he adds that when it came, it was as if from a friend, from someone who had shared their tragedy over the previous five days. "Their bedside manner towards us was so good, and we trusted their judgment."
The son of a surgeon, Nicholas says he had a head start. "I knew and understood doctors, the challenges of their work. So often people are suspicious of them, of what they're up to, but I regarded them as essentially friendly."
He also knew that time was of the essence. A week of deliberation was not an option. If Lucy's organs were to help others to live, or to live better lives, they had to be removed and used fast. The family said yes almost immediately.
Soon after this decision, in the early hours of Sunday morning, the phone rang in Imogen's house in Dulwich, south London. She was 33, a diabetes sufferer since infancy, destined to spend hours every other day hooked up to a dialysis machine doing the work of her failing kidneys. Other complications might well have led to further severe illness and disability, and shortened her life.
A kidney and pancreas transplant, however, could reverse all this. She recalls: "I'd been desperate for this moment, to be told they had found a matching donor, but when I got the call, I had just one overwhelming thought: somewhere there was a family going through the most unbelievable, the worst possible pain."
Imogen reached the hospital within the four hours they said she had to spare, and the transplant went ahead. She feels better now than ever, says that being cured of diabetes has prevented the sight loss that she suffered as a teenager from worsening and opened up previously undreamt-of possibilities, such as having a child.
Nicholas has been invited back to King's to talk to staff about what made him and his family say yes. "They need to ensure that people trust them, somehow, amid all the distress, explain that the decision has to be quick, and convey the real value of agreeing, that it changes lives."
Nicholas understands people's reservations about the possibility that their loved ones will be disfigured in the process of removing organs, but says, "This operation is done as carefully as any other, and all the wounds closed afterwards." He finds it less easy to see why donors occasionally want to specify the race of the recipient, a stipulation that sometimes makes donation impossible. Donors or their families cannot state who will receive organs or tissues, but are free to request that parts of the body are not used. Reproductive organs or tissue are never transplanted.
The NHS organ donor register currently has more than 10m names. Organ-sharing between countries helps ensure that organs reach matched recipients, but despite this, hundreds die every year while on the waiting list, and others never get that far. The gap between the number of donors and potential recipients is growing, and is expected to widen as kidney failure becomes more common, scientific advances increase the potential for transplant and the population grows older.
For children, the situation is no better. Dr Paul Aurora, a transplant consultant at Great Ormond Street hospital in London, regularly sees the tragedy of a lack of donors. As he says, "The worst thing for children and families is agonising about joining the waiting list, but not getting an organ before it's too late. This happens to 50% of children waiting for lungs and 10% of those who need hearts. More donors are desperately needed."
Because it is vital to remove and transplant organs quickly after death (tissue can be taken later and stored for longer), they almost always come from people who die in hospital while in intensive care following an accident or trauma such as a car crash or stroke. Improved medical technology and road safety have reduced the number of people who die in these circumstances, but it is also often the case that organs that could be used are not, because families are unaware of their loved one's wishes. For those who are clear about being donors but die in circumstances that leave their organs unsuitable for transplant, tissues or corneas (used to restore sight) may still be used.
Sue Sutherland, chief executive of Transplant UK, is sometimes asked why we do not follow the Spanish model to boost donation rates. There, an "opt-out" system means that individuals must make it known if they do not wish to be donors. In 2001, their donor rates were 32.5 per million of the population compared with 13.1 in the UK. But Spain also has twice as many fatal road accidents as here and double the number of intensive-care beds.
While aware of the pressing need to increase UK donor rates, Sutherland insists that our system works. "There are some less well-known facts about Spain, for example that they discard 29% of the kidneys that could be used for transplantation, compared with 4% in the UK. They also have transplant coordinators in every hospital and encourage families hard to agree to donation. We must get people on side so that donation is a free choice."
Nicholas, who sees Imogen as living proof of the importance of donation, agrees: "Most people are decent and caring, with a firm belief in humanity. I find it difficult to picture families saying no if they understand the procedures and need." A recent survey revealed that 90% of the public agree in principle with organ donation, and Sutherland is committed to turning this figure into numbers on the register.
Nicholas understands why some people do not want to sign up, as if it is somehow tempting fate, and he agrees with Sutherland's view about encouraging potential donors through increased awareness rather than coercion. "You can't encourage something so personal at a government level. The system will succeed if people know its importance."
Lucy died four years ago this July. Her mother and sisters find it hard to talk about her, while Nicholas does so if it can help people understand why organ donation matters. While the recipients of Lucy's kidneys, pancreas and heart valves can be in no doubt about her gift to them, Nicholas is also clear that knowing that she has helped others has been enormous comfort to his family - and knowing Imogen strengthens this.
The actor, who as Imogen Millais-Scott played the lead role in Ken Russell's 1987 film Salome's Last Dance, hopes that her "magnificent health" will enable her to act again. Her friendship with Nicholas developed slowly, through correspondence, after she wrote to the family expressing her gratitude, and if possible to offer them some comfort. While this is common, it is done anonymously through transplant coordinators, and it is unusual for donor families and recipients to meet. Of her first letter, Imogen says: "I'm not sure I would be able to write anything so passionate now, but I was desperate for them to know what Lucy had done for me. She is, without question, my hero."
She first met Nicholas in her local Cafe Rouge. She would not have chosen somewhere so bright and brash, so full of young people - the kind of place she imagined Lucy spending time - but Nicholas didn't want anything too sombre.
Imogen describes it as "The most terrifying day of my life. I was certain I couldn't live up to Nicholas's expectations of me, the person to whom Lucy had literally given back life. I tried so hard to get it right, my appearance, what I said. Counsellors at the hospital told me to be myself, reminded me that he already knew me from my letters." At that meeting Imogen asked Nicholas if he could tell her a little about Lucy, and she treasures the photograph of Lucy with her sisters that he gave her.
It is easy to say that Nicholas's friendly, charming demeanour belies deep sadness, and that Imogen looks well, but both are true, and both are Lucy's legacy. Her family's only request when agreeing that her organs could be used for transplant was that her eyes be left intact. Their beloved Lucy's beautiful face, which Nicholas says was marked with only a few scratches, was left as they will always remember her.
Transplant facts
* Kidneys, heart, lungs, pancreas, liver, small bowel, corneas, heart valves, bone and tendons are all transplanted, and skin grafts used for severe burns.
* Potential donors should carry a donor card, put their names on the NHS organ donor register and tell their relatives. Organs and tissue from non-registered donors can be used with their family's agreement.
* The NHS's Transplant UK is responsible for allocating organs. The National Blood Service carries out the role for tissue donation, but transplant coordinators play a central streamlining role for both.
* In the latest year for which figures are available, organs from 1,164 donors led to 2,777 transplants. Some donors (of kidneys) were alive, but most donations were from people who had died.
* 2,297 people had their sight restored with corneal transplants.
· Transplant UK website: www.uktransplant.org.uk. Organ donor line: 0845 606 0400. National Blood Service: www.blood.co.uk. Giving blood or tissue: 0845 7 711 711.
