The Organ Thieves: The Shocking Story of the First Heart Transplant in the Segregated South

“Richmond became a popular place for aspiring white physicians to live, but it was a terrible place for their potential dissection subjects to die. Grueling, physically demanding jobs often led to early death through exhaustion or accidents.”

Referring to the antebellum era, Jones describes the history of racism in US medical schools, referring to the theme of Medical Racism. The corpses of enslaved people and, later, free Black people were most commonly used in the training of white physicians. MCV advertised its ready supply of cadavers in its medical school brochure.

“Neither frostbite nor riots nor even the threat of arrest and jail could keep ambitious medical students from plundering the most vulnerable graveyards.”

Despite laws prohibiting grave robbery, medical students and those employed at medical schools still did it. Jones notes that the medical community commanded respect and oversight was therefore poor, underscoring the theme of Legal Oversight of Medical Practice. Wealthy citizens were buried close to churches, and such graves were secured. The graveyards of African Americans and destitute whites were most frequently raided.

“As it was with anti-lynching provisions, the anatomy laws had mixed success—especially when it came to notifying families before a dissection was performed.”

Even when provisions in law were enacted to protect African Americans, such law was poorly enforced in the 19th and early 20th centuries. This history of ignoring the law provides context for Bruce Tucker’s case. Wilder was furious because in 1968 physicians simply ignored the current law to take Bruce’s organs.

“It would take centuries—well into the twentieth—to understand why such attempts to graft skin or other organs onto the human body failed for various reasons.”

When the first heart transplants were performed, the survival rate was very low. Organ rejection was the main cause, and the problems often began soon after surgery. Jones maintains that the early optimism about transplants was misplaced. It was a form of scientific experimentation unguided by ethics.

“In the 1950s and 1960s, doctors and academic medical centers enjoyed so much prestige and authority that they often operated virtually unchecked from outside supervision. The notion of ‘informed consent’ was nonexistent.”

Highlighting the theme of Legal Oversight of Medical Practice, the lack of systems to enforce or even establish oversight allowed doctors to perform high-risk, experimental procedures on unsuspecting patients. Jones cites examples in which animal organs were transplanted into humans, who died quickly thereafter. Hume was notorious for not explaining the risks of procedures to patients.

“Such was the status quo at Medical College of Virginia as David Hume followed his instincts. It was a kind of medical Wild West, with no sheriff in town to keep order.”

Hume’s enthusiasm for cutting-edge surgeries resulted in many high-risk operations in which patients essentially became guinea pigs. This again refers to the theme of Legal Oversight of Medical Practice. In addition, accepted ethical guidelines did not exist in the medical profession in the 1960s.

“It didn’t take long for Hume to tell [Lower] just how determined he was that a history-making heart transplant would happen first in his surgery department.”

Jones highlights Hume’s ambition. Some physicians, like Hume, prioritized a race to perform the first heart transplant. Even after MCV lost that race, Hume was eager for the hospital to perform one, which prompted the rush to harvest Tucker’s organs without proper ethical and legal procedure. The focus was on scientific accomplishment; ethics and the welfare of patients received less attention.

“There was more than professional pride at stake: millions of dollars in federal grant money likely would flow to the winner of the heart transplant race.”

Physicians were aware of the stakes in winning the heart transplant race: Their reputations would soar, and their institutions would benefit financially. The concerns for scientific accomplishments and the resultant gains were the motivating factors in the race. Thus, surgeons often did not inform patients of the risks or the poor survival rates.

“From Cape Town to London, and Paris to New York, Christiaan Barnard began receiving the kind of accolades usually reserved for Hollywood stars.”

After learning Lower’s technique for keeping a heart viable, Barnard returned to South Africa and performed the world’s first heart transplant. Unlike Lower, his motivation was fame, and he basked in the extensive coverage. He did not stop his publicity tour even when his patient died. The fact that he won the race was a sore issue for the physicians at MCV. Lower, who had more concern for his patients, had declined to do the world’s first heart transplant because of a mismatch of blood types.

“Since Norm’s brush with history more than five months earlier, it seemed like everyone was jumping on the transplant bandwagon. This was happening despite the low odds for survival; most lived only for a few weeks or less with their borrowed hearts.”

Norm Shumway performed the first heart transplant in the US. It attracted a media frenzy, and surgeons increasingly wanted to do heart transplants despite the poor survival rate, prioritizing experimentation with this cutting-edge surgery over ethics.

“Actually, one legal box had been left unchecked: the provision in Virginia’s Unclaimed Bodies Act requiring a twenty-four-hour waiting period before a body could be used for research purposes.”

MCV’s assistant medical examiner (acting on behalf of the medical examiner, who was away) had the authority to allow the scientific use of an unclaimed body, but law stipulated there be a 24-hour waiting period before a body could be used. In taking Bruce Tucker’s organs immediately, MCV violated the law. Changing needs, as defined by physicians, took precedence.

“The sound of Emma Tucker’s loss had sounded like an alarm across the fields.”

When the morticians phoned Emma Tucker, Bruce’s mother, to inform her about the removal of her son’s organs, she let out a blood-curdling scream. Her family and friends ran to the house to comfort her. Emma’s reaction highlights the themes of Medical Racism and Legal Oversight of Medical Practice, since Bruce’s family was not informed about the procedure and MCV clearly violated the law by not providing consent and immediately removing Bruce’s organs.

“Such was the labyrinth of issues facing the nation’s fledgling system of transplantation and organ donations in the late 1960s. It was a baffling place where rules were made on the fly. More often than not, patients’ rights were not paramount.”

Emphasizing the theme of Legal Oversight of Medical Practice, Jones documents the inconsistent policies of MCV about public disclosures. MCV, fearing a public relations disaster after the Tucker-Klett transplant, withheld the name of the donor and gave very limited information about the recipient. Jones implies that these limited disclosures were intended to protect MCV, not the recipients or donors.

“The published accounts of Joseph Klett’s life and death created a parallel narrative to the story of the man whose heart was now destined for another man’s grave.”

Both Joseph Klett and Bruce Tucker were hard workers who cared for their families and both died at 54 years old. Only the African American press fairly described Bruce’s character, however. When his story was told at all by other media, racism tainted the coverage.

“Even after he left Richmond, Louis Russell’s uplifting story continued to provide public relations fodder to MCV. Nonetheless, the doubts and questions about the first transplant showed no signs of abating.”

An African American man with a gregarious personality, Louis Russell was MCV’s second heart transplant recipient in a surgery performed by Lower. Russell lived another six years, becoming the face of heart transplants and speaking about his story all over the country. This success story, especially given the recipient’s race, helped blunt the damage to MCV’s reputation from its first transplant.

“But for the lawyer-legislator, the pending organ-sharing measure was no laughing matter. He’d seen and heard too much about what can happen to a black man when he gets run over by the wheels of the medical machine.”

In 1970, Wilder, who was beginning his service as a state senator, objected vociferously to the Uniform Anatomical Gift Act, which gave the chief medical examiner the authority to have organs removed without next-of-kin consent unless next of kin voiced objections. Underscoring the theme of Medical Racism, Wilder feared that the law would be abused. However, it passed despite his pleas.

“That is, when had Bruce Tucker actually died in the scientific sense of the term? For by the early 1970s, the concept of life itself, like so many long-held beliefs, was being widely questioned.”

The definition of death became the central issue in the civil trial against MCV. Wilder, the attorney for the Tucker family, argued that the definition in Virginia law at the time applied, while MCV’s attorneys maintained that medical developments made that definition outdated, claiming that cessation of brain activity now marked death.

“Compton’s pretrial ruling about six months before the trial began dismissed some of the most shocking—and potentially lucrative—allegations Wilder made by claiming the transplant team committed an ‘unlawful invasion of a near-relative’s rights with respect to a dead body.’”

The judge’s ruling greatly reduced the potential payout in Tucker’s case had the prosecution won the lawsuit. The judge claimed that this was a personal right of William Tucker and was thereby subject to a statute of limitations of one year, which had passed. The ruling was significant also because it ultimately eliminated an option for the jury to rule against MCV.

“The doctors and professors couldn’t have known it at the time, but they were making their plans at the same hotel where the lawyer for the plaintiff, Doug Wilder, once worked as a waiter in the 1940s. In those days of segregation, no blacks were allowed to eat, drink, or sleep at the hotel.”

At the same time as the trial, Hume arranged a conference of the top transplant experts in Richmond. These elite physicians provided expert testimony to tilt the trial in favor of MCV. Jones highlights the disparity in power between the defense, a team of well-paid attorneys and physicians aligned with MCV, and the prosecution, Wilder, a solo African American attorney taking on the establishment.

“All William wanted to know was what happened to his brother. For all their talk about life and death, these learned men never told him they were sorry for what happened to Bruce.”

During his brief stay at the hospital and after his death, Bruce Tucker was of only instrumental value to the physicians at MCV. Jones refers to Bruce as being socially dead to them. As a result, MCV staff never fully explained to William what had happened to his brother or apologized for taking his organs without consent.

“Allowing the concept of brain death to enter into their deliberations changed everything.”

After hearing the testimony from a parade of the top transplant experts, Judge Compton changed his mind and allowed the jury to consider the concept of brain death. This ruling virtually ensured that MCV would win the case. It infuriated Wilder because Virginia law did not legally recognize brain death when Bruce’s organs were taken. The defense successfully raised the specter of negative repercussions for medical progress had the jury ruled against MCV.

“And yet, Wilder added, ‘It doesn’t change the fact that when they took his heart from him he was not dead according to the law. So they broke the law and never would admit it, and that’s what bothered me more than anything else.’”

Years later, the case still bothered Wilder. The unwillingness to apply the law to the facts of the case smacked of injustice and a lack of oversight, while physicians made the rules in 1968 against a backdrop of racism, foregrounding the themes of Legal Oversight of Medical Practice and Medical Racism.

“The grief and disappointment he’d seen etched in William Tucker’s face when they lost their lawsuit nearly two decades earlier was replaced by tears and joy of black Virginians and white supporters who never thought they’d live to see this day.”

In 1989, Doug Wilder became the first African American elected to the office of governor in the US. He had spent his career fighting for the underdogs in society and against racism. A popular vote in Virginia gave Wilder a victory that had eluded him in a courtroom, influenced by the establishment, two decades earlier.