Nicholas Green was just seven years old when ruthless killers shot him dead in a random act of horror during a family holiday in Italy in 1994.
His selfless parents Maggie and Reg decided to donate Nicholas’ heart to Andrea Mongiardo, an Italian teenage boy in desperate need of a transplant.
The act of kindness kept Mr Mongiardo alive for 22 more years until his death in February – meaning their beloved son’s heart only stopped beating this year.
But the American couple did not stop there – Nicholas’ organs went on to save the lives of five Italians and his corneas saved the sight of two others.
The gesture, as well as national horror at the random murder of a child, led to Italy’s organ donation rate tripling in a decade – a result hailed as the ‘Nicholas effect’.
Tragedy struck the Green family in October 1994 as they were driving through southern Italy towards their holiday apartment in Sicily.
Mrs Green was asleep in the front of the car while their two children Nicholas and Eleanor, then four, were asleep in the back.
Mr Green first felt anxious when a car began to tail them closely – but assumed it must be the police.
However instead of overtaking them, the motor pulled up alongside them and they heard angry shouts yelling at them to stop.
Mr Green sped up in fear, trying to race his family to safety.
Seconds later, a bullet shattered the window where the children were sleeping, and a second bullet smashed the driver’s window.
‘How that bullet missed us I will never know,’ Mr Green, now 88, told The Telegraph.
It emerged that the attackers were involved in a jewellery heist and mistook Mr Green’s rental car for the motor that was delivering the jewellery.
After the horrifying attack, the car sped off again into the night.
Not realising that Nicholas was injured, the family stopped by an ambulance attending a road accident.
His selfless parents Maggie and Reg (top left)donated Nicholas’ heart to Andrea Mongiardo (third from top left), a Roman teenage boy in desperate need of a transplant
‘We pulled in and when the interior light came on, I saw that Nicholas’s hand was sticking out slightly and there was a trace of vomit on his chin. He was not moving,’ Mr Green recalled.
The sleeping youngster had been hit in the back of the head by one of the bullets but he had not made a sound.
‘In death, as in life, he was no trouble to us,’ Mr Green said.
‘For the first time we realised something terrible had happened. The shock of seeing him like that was the bleakest moment I’ve ever had,’ he told the BBC.
‘I think it was Maggie who said: ‘Now he’s gone, shouldn’t we donate the organs?’,’ Mr Green told the Telegraph.
‘Until that moment, I saw only bleakness. How was I going to get through the rest of my life without him?’
He said he saw it as a way to ‘alleviate the horror’ of their son’s death by helping save the lives of others.
Four of the recipients of his organs were teenagers and two others the parents of young children.
The act of kindness kept Mr Mongiardo alive for 22 more years until he died in February
Andrea, a 15-year-old boy, had had five operations on his heart, all of which had failed and could barely walk.
Domenica was going blind and had never seen her baby’s face clearly. Sportsman Francesco was also blind and could not see his children play games.
Two of the teenagers, Tino and Anna-Maria, had lived on dialysis machines for years and did not know if they would make it to adulthood.
Silvia, a diabetic who had suffered many comas, was going blind and couldn’t walk on her own.
Maria Pia, 19, had liver failure and was in her final coma. Her mother and brother had died of liver disease and her family expected the worst.
The Italian media tracked each ice box containing a transplant organ to its recipient as the country rallied to support the donations in tribute to Nicholas’ tragic death.
‘Nicholas was a kindly boy who always looked for the best in things so, when you were with him, you always wanted to be your best,’ his father explained to the BBC.
Nicholas’ heart went to Mr Mongiardo, who was just 15 at the time. Living in Rome, he had been in and out of hospitals because of a defective heart.
Several operations had failed to help, and at the time of Nicholas’ death, he was receiving transfusions of blood products twice a week and ‘struggling to survive’.
His desperate parents knew a transplant was his only hope – but in those days, the rate of organ donations in Italy was among the lowest in Western Europe.
It’s still not clear whether Nicholas’ killers men were robbers, or hitmen who attacked the wrong car in a case of mistaken identity.
It has been reported that one of the men may have Mafia connections.
‘The killing of a seven-year-old American boy in a country where violent death is commonplace has plunged Italy into national soul-searching,’ the Times reported.
Nicholas was shot in the back of the head in a carjacking gone wrong while his family were driving on the motorway in Calabria (pictured) back to their holiday apartment in Sicily
Mr Green told the BBC that Italian criminals rarely kill children as it often leads to a huge police investigation to catch the murderers.
In Nicholas’ case, a national manhunt led to the arrest and conviction of two men – Francesco Mesiano and Michele Iannello.
Mr Green believes that the idea of an innocent child being shot while on holiday struck a chord with many Italians, who felt organ donation would be a way to make amends.
‘Perhaps they do not realize how rare that gesture is in our country,’ said Gregorio Botta, a columnist in the newspaper La Repubblica.
‘Perhaps they do not realize that half the children with heart ailments in Italy do not make it and die while awaiting a transplant.’
In 1993, the year before Nicholas was shot, 6.2 people per million donated an organ – but by 2006 that number had reached 20 per million.
In 1999, Italy moved to an opt-out system – which means that when someone dies it is presumed that their organs will be donated unless they have specified otherwise.
Portugal, France, Greece and Spain also use an opt-out system, while the US and UK (apart from Wales) continue to operate an opt-in system.
Mr Green, who returns to Italy each year to raise awareness for organ donation, called the meteoric rise in donations ‘astonishing’.
He went on to meet the people whose lives were saved by Nicholas’s organs, which he described as ‘overwhelming’.
Mr Green recalled that some were smiling and other were emotional – and admitted it was gratifying knowing that they had changed someone’s lives for the better.
Mr and Mrs Green, who married in April 1986, went on to have twins Laura and Martin – who will turn 21 in May – to ensure their daughter Eleanor did not grow up alone.
Despite always feeling a ‘sadness’ that would never go away, Mr Green felt grateful that the seven organs his son donated led to thousands of people being alive today.