In The Organ Thieves: The Shocking Story of the First Heart Transplant in the Segregated South, Chip Jones exposes the racism and questionable ethics behind the first heart transplant at the Medical College of Virginia (MCV) in 1968. The heart was taken from Bruce Tucker, an African American man, before he met the legal definition of death in Virginia at that time, and was given to a white man. Jones worked as a journalist in Richmond, Virginia for almost 30 years. The Organ Thieves was published in 2020, and the book won the Library of Virginia’s Literary Award for nonfiction.

All quotations and references in this guide are from the 2020 hardback edition.

Content Warning: The book and this guide discuss the brutality of slavery, racial injustice, and medical exploitation, which readers may find upsetting.

Summary

Founded in 1837, the Medical College of Virginia (MCV) in Richmond touted its ready access to cadavers for anatomical lessons in order to encourage aspiring physicians to enroll. Corpses were obtained primarily from the graves of African Americans, who were enslaved at that time. Indeed, medical education in the US and England during the 19th century depended on the unethical practice of grave robbery. Given the public anger that this practice triggered, however, Virginia passed a law in 1884 making grave robbery a felony punishable by five to 10 years in prison. The law was rarely enforced, and the practice continued, targeting the cemeteries of African Americans and impoverished white people. When pressed about its practices of dissection, MCV claimed that it performed no dissections on white cadavers.

In the 1950s and 1960s, physicians were experimenting with organ transplants in animals and humans. The biggest problem for recipients was tissue rejection. Although physicians used immunosuppressants to avoid that outcome, they had mixed results during those years. Seeking to make itself a top-tier institution, MCV appointed David Hume as Chair of Surgery in 1956. An energetic and ambitious physician, Hume had performed kidney transplants in Boston. He did not hesitate to take risks in cutting-edge surgeries and did not inform patients of those risks. Hoping to win the race to perform the world’s first heart transplant, Hume recruited Richard Lower to MCV in 1965. Lower had done experimental heart transplants on dogs with limited success. In the summer of 1966, Christiaan Barnard, a South African physician, came to MCV for a three-month study. After closely observing Lower’s technique, Barnard returned to South Africa and performed the first human heart transplant in December 1967. Previously, Lower had passed up such an opportunity because the donor’s and recipient’s blood types did not match. Barnard basked in the publicity following the transplant even though the recipient died soon thereafter.

MCV began admitting Black students in 1951 but did not allow them to participate in university-sponsored events until 1962. Continuing its long history of racism, MCV segregated patients—designating its St. Philip facility for Black patients—until 1962. Its conditions were deplorable. An African American man, Bruce Tucker, was taken to MCV after an unusual accident in 1968. He had fallen off a wall while enjoying drinks with friends after work. Bruce had held the same full-time job for years and routinely sent money to his mother, who was raising his son. When word spread of his poor condition, surgeons speculated about his candidacy as an organ donor. Patient Joseph Klett, under Lower’s care, badly needed a heart. Although this would not be the first heart transplant in the US, Hume wanted MCV to perform one and thereby enhance its status.

Bruce Tucker underwent two surgeries to treat brain trauma. However, his condition worsened within hours of those surgeries. Assistant Medical Examiner Abdullah Fatteh told Hume that he needed permission from Tucker’s next of kin to take his organs. When the police failed to find relatives, Fatteh permitted Hume to take Bruce’s organs once he was declared brain-dead. However, Virginia law at the time did not recognize brain death, only biological death, which is defined by the cessation of a heartbeat and breathing. Additionally, the law required a 24-hour waiting period before the use of unclaimed bodies for science.

William Tucker, whose business card was among Bruce’s possessions when he was admitted to the hospital, had called the hospital three times trying to get information about his brother but had received none. Given these facts, Jones questions the extent to which the surgeons tried to reach Bruce’s family and suggests that he was profiled as a charity patient because of his race. When William arrived at the hospital, he was told only that his brother was dead. He learned from the mortician that Bruce’s heart and kidneys had been removed.

Following the transplant, MCV enacted a press lockdown. Questions emerged about whether the surgery was properly authorized. Klett died one week after the surgery because of tissue rejection. In 1968, only 10 of 104 patients who had heart transplants survived for any meaningful time. MCV got a break from the negative publicity surrounding this first transplant when Lower performed a second transplant on Louis Russell, an African American man. Living for an additional six years, Louis Russell publicized the benefits of heart transplants.

To determine what had happened to his brother, William Tucker hired L. Douglas Wilder to represent him. Wilder, an African American attorney, filed a wrongful death case in 1970. Although the original lawsuit was broad in scope and sought $1 million in damages, Judge A. Christian Compton reduced the number of defendants and the potential financial payout. Wilder, a solo attorney with limited resources, faced off against a team of well-funded attorneys for MCV led by Jack Russell, who specialized in defending physicians.

When the case came to trial in the spring of 1972, Wilder was confident despite facing an all-white jury and white judge. The law defining death at the time of the transplant was on his side: Under Virginia law, Bruce Tucker’s organs were taken while he was still alive. Wilder scored points with the jury during his examination of William Tucker and Fatteh. The judge initially indicated that he would not allow the jury to consider the concept of brain death. However, defense attorneys called multiple experts, top surgeons in the country, all of whom testified that the cessation of brain activity constituted death. Consequently, Judge Compton changed his mind and allowed the jury to consider brain death. The jury wanted to hold Fatteh and MCV accountable but could only do so if they believed that Bruce Tucker was not dead when his organs were taken. Since the jury accepted the medical experts’ definition of death, they ruled in favor of MCV.

After this case, Virginia and other states changed the definition of death to the cessation of brain activity. In 1994, when MCV (now called Virginia Commonwealth University, or VCU) was expanding, human remains were discovered during construction. The discarded corpses from the 19th century had been taken from graves illegally, dissected, and thrown down a well. Although a team of archeologists at VCU worked diligently to gather as many remains as possible, VCU’s president gave them only a few days and then resumed construction. Not until 2018 was a ceremony held in honor of those whose bodies were desecrated. Even then, the stated history of the institution’s transplant program did not acknowledge Bruce Tucker and the institution never issued an apology to his family.