He chose most of his victims at random, across a vast area of Northern Italy, and became a synonym for fear among the people living along the Italian Riviera.
With a sentence to 13 terms of life imprisonment, and no possibility of release, Bilancia has been defined by some newspapers as "the worst serial killer in the history of Italy".
[2][3][4][5] Despite confessing to the killings, Bilancia never explicitly regretted his crimes, claiming that he did not consciously commit them because he was "possessed" by a disease.
Spotting a young woman travelling alone, he followed her to the toilet, unlocked the door with a skeleton key, shot her in the head and stole her train ticket.
[4] In his last killing before his arrest, on 20 April, Bilancia murdered a service station attendant after refuelling his car, then took the workday's receipts, about 2 million lira (about $1000) and fled the crime scene.
Based on the description of the black Mercedes one of his sex worker victims was seen entering the night she was killed, police considered Bilancia "suspect number one" and followed him for ten days.
[4] Bilancia's criminal life and the events that saw him as a cruel serial killer had a major impact on the media of Italy.
His story inspired a television miniseries, called Ultima pallottola ("The last bullet"),[14] directed by Michele Soavi, broadcast for the first time in 2003 on Canale 5, with actors Giulio Scarpati, who plays the officer during the investigations, and Carlo Cecchi, as the serial killer.
In 2004 Donato Bilancia was interviewed live on Rai 1 during the broadcast on Domenica in, in that year conducted and hosted by Paolo Bonolis.
[15][16] In the early 2010s, then leader of the Five Star Movement political party, Beppe Grillo, admitted that he was neighbour of Donato Bilancia, as a child in Genoa.
[17] The same year Bilancia obtained his first temporary permit to leave the prison under armed police escort, in order to visit his parents' grave at Nizza Monferrato's cemetery in Piedmont.
[22] Also, Bilancia had never undergone a psychological rehabilitation program and never explicitly repented his crimes, believing that he was "possessed" by a disease in the years in which he committed them.
[22] Bilancia died on 17 December 2020, at the age of 69, after contracting COVID-19 in "Due Palazzi" prison, Padua, during the COVID-19 pandemic in Italy.