With 11.3 donors for every million people, Australia is among the least altruistic nations, well behind Spain with 34 donors each million, Portugal with 31 and the US with 24. In Spain organ donation blossomed after the government set up a network of transplant co-ordinators in 139 intensive-care units across the country. Their job was to monitor emergency departments and tactfully discuss the donation process with the families of the dead. A survey found that of 200 families who declined to have their relatives' organs donated, 78 per cent changed their mind after the process was explained in detail. But in Australia the waters are still murky. Many people who wish to donate have their decision overruled by family members after their death, leaving scores of patients lingering on waiting lists. In 2008, 82 hearts were donated in Australia, but last year that dropped to 59 - most from people who died from strokes. Another 41 people, including Tigano, missed out. A quarter of those on the waiting list will die before a heart becomes available, usually within nine to 12 months. Another quarter need a mechanical pump to keep them alive while they wait for a transplant. The pumps cost up to $150,000 each, but once they are in place only about 5 per cent of the recipients die while waiting for a transplant.

Patients with heart failure usually fall into two camps. About 80 per cent have problems with their left ventricle, the main pumping chamber. In the rest, both ventricles have failed. Up to 30 people a year with left ventricular problems are given pumps known as left ventricular assist devices, valued at about $100,000 each, which are paid for with money donated by benefactors. But it is money well spent, says a cardiothoracic surgeon, Paul Jansz, one of the doctors who gave Tigano his new heart. ''Mechanical pumps are standard therapy in any transplant unit in the world now … and they're cost effective. If you don't have one you will either die or have multiple admissions to hospital, drugs and a temporary balloon pump,'' he said. ''Those in end-stage heart failure will do that up to four times a year, staying up to three weeks in hospital, which is a huge burden on the health dollar.'' Most of those with the devices fitted also do better when they receive their donated heart because they have had time to put on weight and recover from their heart failure, Jansz said.

He met NSW Health officials last week to explain that mechanical hearts were becoming so mainstream and clinically proven that the government needed to commit to funding heart transplant programs, as occurs in Victoria and South Australia. ''They were very receptive and accepting that this technology has come of age,'' Janz said. Tigano's artificial heart was also funded by benefactors, but if government funding was granted about 200 people a year could be helped. Total artificial hearts are not new. The brand implanted in Tigano has been available overseas since 2004 and given to more than 850 patients worldwide. But it is not without its drawbacks. The maker, SynCardia, says about 70 per cent of 95 recipients studied developed an infection in their lungs, urinary tract or around the surgical site. Almost half suffered bleeding around the heart or lungs; about 17 per cent had problems with the implant malfunctioning; a third developed kidney dysfunction, and 10 per cent suffered a stroke. But experts are quick to warn that only the ''sickest of the sick'' are given the heart in the first place - those who are expected to die within days or weeks. ''Yes, there are complications and most of them are related to having a drive line into the skin or clots forming, but the alternative is far worse,'' says Jansz.

During his operation, Tigano's heart was removed before the artificial replacement was sewn into place, attached to the four main vessels, the aorta, vena cava and the pulmonary vein and artery. Loading Two plastic chambers take the place of the ventricles and can pump 9.5 litres of blood a minute. The heart has only six moving parts and is driven by an external pneumatic pump, which is as big as a suitcase. The pump is portable and needs to be connected to a power supply but doctors think that within weeks Tigano can go home with a backpack version, giving him more quality of life as he awaits a donor.