But the kidney did not take. The 41-year-old, from North Parramatta, has particular antibodies that make it difficult to find a donor. Nine months after her 2008 transplant she was back on dialysis, and has been on the waiting list again ever since.

The efficacy of Australia's organ donation system will be reviewed, the federal government announced this week, following concerns that extra funding had failed to deliver a sufficient increase in donations. Conflict within the system came to the fore when David Koch resigned as chairman of the Organ and Tissue Authority's advisory council, lashing out at "rich lobbyists" whom he accused of demanding an unnecessary review.

Donation rates have risen 50 per cent since the Rudd government invested an initial $151 million in a nationally co-ordinated attempt to raise awareness and shorten waiting lists. While advocacy groups such as ShareLife – and the assistant health minister Fiona Nash – have argued that progress has been too slow, that does not square with many experts.

"The truth is that the organ donation rate in Australia has risen faster than ever before," says Jeremy Chapman, head of the renal program at Westmead Hospital. He is also editor-in-chief of the international Transplantation journal and the immediate past president of the Transplantation Society, as well as an adviser to the OTA.

In 2009, there were 247 Australian organ donors, which equated to 11.3 donors per million population. That increased to 391 donors, or 16.9 per million, by 2013, aiding 1122 transplant recipients. "It's the fastest rate of rise that's been seen around the world," Professor Chapman says, and the "fantastic" result has seen other countries turn to Australia for advice on how to lift their own donation rates.

But there were 13 fewer donors in 2014, which sparked the debate about whether the government's investment and reforms had truly worked. Professor Chapman admits the rate has "flattened" but rejects any suggestion of systemic problems.

"What we need is reinvigoration of the strategies, and a reduction in this constant negative criticism," he says.

Yet criticism persists. Chief executive of Cystic Fibrosis NSW, Michele Adair, points out that the Australian harvesting rate still lags many countries, including the United States, Britain  and France. The vast majority of cystic fibrosis patients could be candidates for lung transplants and every year patients die on the waiting list, she says. She believes that while awareness about donation has spread, more can be done to convert good intentions into actual donations when death comes.

"Most people are very supportive and very open to the possibility," Ms Adair says. "The process has been falling down at the point of hospital conversations."

Families grieving for a loved one have a short window of time in which to consent to a donation. They are asked to sign a form stating that the deceased had no objection to being a donor, but frequently they are not sure. Even if the deceased is on the organ donation registry, the next of kin's consent is required.

Professor Chapman says the consent rate for hospital deaths where a patient is suitable for donation is about 50 per cent, but needs to rise to 90 per cent. He says extra training, based on successful strategies at the world-leading Gift of Life Institute in Philadelphia, will yield more donations from those make-or-break bedside conversations between hospital staff and families.

Despite her "rollercoaster" ride, Ms Zammit brims with hope. Her doctors are currently testing a live donor who could be a match. And she has faith that the donation system will continue to improve.

"Rome wasn't built in a day. You can't just expect people to hand over their organs without the hard work that goes into making people aware what a special gift this is to somebody," she says.

"I wake up every day thinking this might be my day."