Nineteen-year-old Maria Pia Pedala was in a coma from liver failure in Sicily, Italy, on Sept. 29, 1994, when a 7-year-old American boy was shot dead while on vacation with his family in the country. Though Italy had one of the lowest rates of organ donation in western Europe at the time, Nicholas Green's parents opted to donate his organs. It was a life-saving decision for Pedala and six others, including 15-year-old Andrea Mongiardo, who received Nicholas' heart. But it had an effect on many more. Nicholas' parents campaigned hard for organ donation in the years that followed, showing good could come out of tragedy, reports the BBC. Their efforts, says Reg Green, had a "quite astonishing effect which we couldn't possibly have foreseen."
In a little over a decade, Italy's organ donation rate more than tripled. Though the country adopted an opt-out rather than an opt-in system for organ donation in 1999, officials also credit the "Nicholas Effect." As Green notes, other countries use opt-in systems but "no other country has tripled organ donation." Green, 88, continues to raise awareness about organ donation to this day, traveling to Italy twice a year. During his most recent visit, he met with Pedala, who has since given birth to a son named Nicholas. He was unable to meet Mongiardo, who died earlier this year of respiratory failure related to chemotherapy treatment for lymphoma, Green writes at the Los Angeles Times. But Green knows that at 37, he had a heart of "pure gold."