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

The central figure in Jones’s book, Bruce Tucker worked at a Richmond factory for years. He routinely sent money to his mother, who was raising his son Abraham in a rural Virginia county. While sharing drinks with coworkers after work, Tucker fell off the wall they were sitting on and hit his head. When first responders brought him to the emergency department at MCV, he was immediately the subject of racist stereotypes as an African American with alcohol on his breath. Physicians at the hospital performed two surgeries to enable him to breathe better and to relieve pressure on his brain. Although he improved somewhat after these surgeries, his condition quickly deteriorated.

When word spread of his poor condition at the hospital, surgeons began considering his potential as an organ donor. Dr. Richard Lower had a white heart patient in need of a transplant, presenting the opportunity for MCV’s first human heart transplant. To obtain the required consent from next of kin, police traveled to Bruce’s home but found no relatives, so the assistant medical examiner gave the surgeons permission to take Bruce’s organs upon his death. However, MCV declared Bruce dead based on the cessation of brain activity, which did not qualify as death per Virginia law at that time, and failed to observe the legally required 24-hour waiting period. Consequently, Bruce’s brother filed a wrongful death lawsuit. Jones argues that Bruce was socially dead to MCV from the time he was admitted to the emergency room. Efforts to locate his family were cursory, and the organ transplant records omitted his details. No transcript was kept of the landmark civil trial. Jones notes that while other medical schools committed egregious forms of medical racism in the 19th century, this occurred during the civil rights era. Additionally, Jones views MCV’s treatment of Bruce and his family as ethically poor; MCV valued Bruce only for his organs.

Bruce’s brother, William Tucker had polio as a child and walked with crutches. He owned and operated a cobbler’s shop in Richmond. When he heard of Bruce’s accident, he had to finish work at his shop before heading to the hospital. Tipped off by a caller that something was amiss with his brother’s treatment, William called the hospital three times but got no information. Thus, MCV not only made little effort to reach Bruce’s family for consent but failed to check with those answering the hospital’s phones about whether a relative had called inquiring about him. At the hospital, William was told only that his brother had died; MCV did not inform him that Bruce’s organs had been taken. He only learned from the mortician that Bruce’s heart and kidneys were missing.

Outraged, William resolved to find out what had happened to his brother. He contacted an attorney, L. Douglas Wilder, who agreed to take the case. William was the named plaintiff, Tucker’s Administrator. He testified at the trial, providing a timeline of his efforts to locate his brother. That testimony caused the jury to wonder how hard MCV had looked for Bruce’s next of kin. Indeed, William’s business card was among the personal belongings that Bruce had when he was checked into the hospital. When the jury ruled in favor of MCV, William was bitter and disappointed. No one ever apologized to his family for what happened to Bruce.

The grandson of enslaved individuals, L. Douglas Wilder grew up in segregated Virginia. In 1968, Wilder was a young attorney representing African Americans in a racist legal system. He was accustomed to arguing cases before all-white juries and did so with success. When William Tucker called, he agreed to take the case despite knowing that he would face a powerful and well-funded defense. Wilder had his own practice and could not work solely on Tucker’s case. Nevertheless, he filed suit within the two-year statute of limitations for wrongful death. He was confident at the start of the trial because the law, in its definition of death, was clearly on his side.

As Jones highlights, Wilder was involved in the political fight for racial justice as well as the legal one. As a state legislator, he attempted to have a racist state song removed. He voiced his objections to a change in the law regarding organ donations that made it easier not to have a relative’s consent. Citing the long history of using African Americans for experimental purposes, Wilder voted against the bill. That bill nonetheless passed.

During the Tucker trial, Wilder spoke passionately and reminded the jury of how men of science had supported ethically reprehensible actions in Nazi Germany. He attracted media attention. However, he could not compensate for the parade of medical experts that came to the defense of the MCV physicians. Wilder lacked the resources to hire his own experts or to appeal the verdict against his client. Jones interviewed Wilder after he had risen through Virginia state politics and became the nation’s first African American governor. The Tucker case still bothered him because the law at that time was on his side.

Recruited from Harvard Medical School in 1956 to become MCV’s chair of surgery at age 38, Dr. David M. Hume strove to elevate the institution’s profile and was successful. He had performed nine kidney transplants in Boston and sought to do cutting-edge surgeries at MCV. He hired his own team of doctors, including Richard Lower. Jones depicts the various sides of Hume’s personality: He could be bossy and arrogant as well as loyal to those working for him. He unquestionably had “outsize ambition” and performed experimental surgeries without informing patients of the risks. Jones characterizes Hume as a physician who prioritized scientific experimentation over ethics. Although many of MCV’s staff revered Hume, his take-charge attitude ruffled the feathers of some of the more experienced physicians.

Hume pressured Lower to perform the first heart transplant at MCV. While he contacted the police to help locate Bruce Tucker’s next of kin, he took no additional steps to find relatives when the police failed. Instead, he informed Fatteh that reasonable efforts had been made to find next of kin and asked for permission to remove Bruce Tucker’s organs once he was declared brain-dead. When he and others from MCV were sued for wrongful death, Hume was confident of a verdict in his favor. He organized a conference of the country’s top transplant and neurosurgeons to take place at the same time as the trial. As a result, the defense called several medical experts to testify who convinced the judge to permit the jury to consider the concept of brain death. Hume died prematurely in a plane crash in 1973.

Working with Dr. Norman Shumway at Stanford, Dr. Richard Lower experimented with heart transplants in animals. Shumway taught him about the benefits of extreme cold to treat and preserve organs. When Shumway turned down Hume’s offer to come to MCV, he suggested Lower. In 1965, Hume offered Lower the opportunity to lead MCV’s transplant program, and Lower accepted it. In contrast to Hume, Lower was a cautious man who declined to perform the first heart transplant when the donor and recipient blood types did not match. He was committed to his patients and to scientific inquiry. Consequently, he allowed Dr. Christiaan Barnard to observe the technique of preserving a heart via extreme cold and restarting it. Barnard then used that technique to perform the world’s first human heart transplant in South Africa.

Lower placed Bruce Tucker’s heart into his patient, Joseph Klett, thereby performing MCV’s first human heart transplant. When Klett died a week later, Lower concluded that higher levels of immunosuppressants were necessary for heart transplants than for kidney transplants. His second human heart transplant was successful: The patient, Louis Russell, lived another six years. Nevertheless, Lower later considered the initial optimism for transplants overstated given the low survival rates in the early years. Unlike Hume, Lower was terrified when named in the Tucker lawsuit. Failing to distinguish criminal from civil proceedings, he feared imprisonment and was extremely relieved when the jury ruled in favor of the defendants. Jones highlights Lower as a physician who tolerated risk for the sake of advancing science but later questioned the ethics of doing so.

The assistant medical examiner, Dr. Abdullah Fatteh gave Hume permission to remove Bruce Tucker’s organs once he was declared brain-dead. The medical examiner, Dr. Geoffrey Mann, was out of town and could not be reached. Acting on the prior advice of Mann and an attorney, Fatteh initially required Hume to locate Bruce Tucker’s next of kin and gain permission to remove his organs but, when those efforts failed, approved the transplant. The law allowed an unclaimed body to be used for science but required a 24-hour waiting period following the time of death. Because Tucker’s organs would no longer be usable if they observed that waiting period, however, Fatteh did not require the surgeons to wait.

Fatteh was a defendant in the trial, and Wilder scored points with the jury when questioning him, so the jurors wanted to hold Fatteh accountable for his decision. However, the statute of limitations had run out on all but the wrongful death claim, so the jury would have had to rule that Fatteh had conspired to kill Bruce Tucker. Such a finding would be viable only if the jury did not accept that Bruce Tucker was dead when his organs were removed. In noting the jury’s frustration, Jones highlights the poor legal oversight of medical practice in place at that time.

The presiding judge in the civil trial, A. Christian Compton issued pretrial rulings limiting the number of defendants to four and reducing the potential monetary damages. He assessed one claim as falling not under wrongful death but under another law, which was subject to a one-year statute of limitations. That time had passed. Initially, Compton ruled against MCV and intended to allow the jury to consider only the legal definition of death in place at the time that Bruce Tucker’s organs were taken, which would have most likely led to a verdict for Tucker. However, after hearing all the medical experts testify that the cessation of brain activity constituted death, Compton changed his mind. In allowing the jury to consider that definition of death, he all but guaranteed a verdict for MCV. He may have been swayed by the prestige of the country’s top physicians and mindful of the effects of a decision against MCV on medical progress. Compton later served on the Supreme Court of Virginia.

The leader of MCV’s legal defense team, Jack Russell had expertise in defending physicians against malpractice charges. Jack Russell had working-class roots and was understated, so he disliked flashy attorneys. Well-versed in medicine, he settled cases quickly if his client was negligent. He respected physicians and appreciated the contributions of Richmond’s medical community. Given his experience, Jack Russell immediately recognized the need to convince the judge and jury to adopt a definition of death that was not enshrined in Virginia law at the time of the heart transplant. Jones argues that Jack Russell’s knowledge and experience were the MCV defense team’s most important asset. In noting the resources, both in personnel and expenses, at Jack Russell’s disposal, Jones highlights the legal advantage that the defense had over the plaintiffs.

The second recipient of an MCV heart transplant, Louis Russell helped restore MCV’s reputation in the aftermath of the negative publicity about the removal of Bruce Tucker’s organs. An African American with a winning personality, Louis Russell welcomed the media and, through multiple speaking engagements, became the national face of heart transplants. He helped MCV’s reputation overcome the poor racial overtones of the first transplant. Although Wilder did all he could to keep Bruce Tucker’s case in the news, Louis Russell’s transplant not only created dual accounts in the press but also showed the potential for this new and experimental surgery to save and extend someone’s life. Louis Russell returned to his home in Indiana, resumed teaching, and lived for six years after the transplant.

When Dr. Christiaan Barnard came to MCV for a three-month study program in the summer of 1966 from South Africa, he had an “ulterior motive”: to learn all he could from Lower about heart transplants in animals. After returning to South Africa, he used that knowledge in December 1967 to perform the world’s first human heart transplant. His winning the race to do so irritated the MCV surgeons not only because he used Lower’s methods but also because of his loose ethics. The laws in South Africa were not stringent, giving Barnard the leeway to prioritize scientific experimentation over ethics.

Reputedly hard on staff and colleagues, Barnard sought fame and soaked up the publicity surrounding his achievement. Even the transplant recipient’s death did not deter Barnard from his publicity tour of the world. The patient died because Barnard misdiagnosed his pneumonia as a form of organ rejection.