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Explaining the racial tension at the time of MCV’s first heart transplant and the history of racism in Richmond, Virginia, Jones provides context for the theft of Bruce Tucker’s organs. He specifically describes the racism embedded in the origins and history of MCV. That racism was evident in the treatment of Bruce Tucker upon his admission to the hospital and in the cursory efforts to locate next of kin or communicate information about his condition to his brother.
At the time of Bruce Tucker’s accident in 1968, no African American judges served in Virginia’s courts, and juries often lacked African American members. Although landmark civil rights legislation had passed earlier in the decade, resistance to its implementation was widespread in the South. As an example, Jones describes how a burning cross was thrown into an African American citizen’s backyard in Richmond during this time. The first Black student was admitted to MCV in 1951. However, Blacks were not allowed to attend social events at MCV until 1962. The hospital remained segregated until 1962, relegating Black patients to St. Philip Hospital, where conditions were atrocious and rat infestations were common. However, the physicians at MCV considered St. Philip a good training ground for white medical students.
Given that Bruce Tucker’s organs were taken without next-of-kin consent, Jones delves into the early history of MCV. Founded in the days of slavery, MCV routinely stole African American corpses for experimentation and anatomical training. When the public complained about this practice, which also targeted white paupers, MCV simply said that it performed no dissections on white cadavers. This practice continued after abolition and into the early 20th century. After using cadavers in experiments, physicians in the 19th century dumped the bodies in a dried-up well. In 1994, the remains of those individuals were uncovered during a construction project. Even at that late date, the institution’s president gave archeologists only a few days to gather what remains they could and then resumed construction. Not until 2018 was a ceremony held in honor of those individuals whose graves were desecrated and whose bodies were dissected and discarded.
In light of this history, African American citizens feared MCV well into the 20th century. When Bruce Tucker was admitted to the emergency department in 1968 with alcohol on his breath, he immediately became the subject of racial profiling. Instead of viewing him as a hard-working man who had enjoyed a few drinks with friends at the end of the week, he was tagged as a drunk. Jones holds that Tucker was socially dead to the hospital staff. MCV’s efforts to find his next of kin were cursory. The staff overlooked that upon admission to the hospital, Tucker was carrying his brother William’s business card. William called the hospital three times inquiring about his brother’s status but was not given any information, and the surgeons did not check with reception about any inquiries. When William arrived at the hospital, he was treated disrespectfully. He was told Bruce had died but was not informed that Bruce’s organs had been taken. Only when the mortician told him that organs were missing did he have any idea. Jones notes that not only did the Tucker family never receive an apology from the institution, but the medical school’s communications and records never acknowledged Bruce’s contribution to the transplant program.
Jones highlights a lack of ethics in the history of scientific experimentation. In the 19th and early 20th centuries, medical training relied on the practice of grave robbery for cadavers. Even in the mid- and late-20th century, egregiously unethical experiments occurred, yet no one was held accountable for the harm done to unsuspecting patients. In the early days of organ transplants, survival rates were low. Jones questions the motivations and practices of the top physicians in this field at the time that Tucker’s heart was donated to Klett.
In multiple US cities, the public demonstrated its outrage over the theft of corpses for dissection and medical training in the 19th century. Instead of respecting the wishes of the public, however, medical schools hid their activities. Jones describes the design of the medical school in Richmond. High windows prevented the public from viewing the activities within, and exterior symbols and fences helped keep people out. The remains of dissected bodies were dumped in a dried well so that the smell would not give the practice away. Thus, despite the Hippocratic Oath, the education of aspiring physicians in the 19th century ironically depended on an unethical practice.
By the mid-20th century, physicians had developed a high status. Governments asked few questions about their practices. Jones cites infamous cases of experimentation that violated ethical norms as a result. For example, physicians failed to treat hundreds of African American men who had syphilis, and as a result, those men died unnecessarily. In addition, Jones documents several high-risk transplant procedures performed in the early days that resulted in deaths. For example, animal organs were placed in humans. Patients were not informed of the risks of these procedures, which were performed before physicians had solved the problem of organ rejection. In the early days, trial and error was normal. Even Klett, the recipient of Tucker’s heart, died a week after his heart transplant because of organ rejection. Lower learned from this case that recipients of heart transplants needed more immunosuppressants than those of kidney transplants. The survival rate for heart transplants was low. From 1968 through 1971, 34 of 274 heart transplant patients survived.
Given this low rate of success, Jones questions the motivations of physicians in the “race” to perform this groundbreaking procedure. A desire for fame clearly motivated the winner, Christiaan Barnard. Demonstrating his lack of ethics, he did not credit Lower for showing him the technique of keeping a heart viable. Basking in the attention after his achievement, Barnard continued on his publicity tour even after his transplant recipient died as a result of Barnard’s misdiagnosing pneumonia as organ rejection. Likewise, Hume was ambitious and pushed Lower to perform MCV’s first heart transplant. While Hume was interested in the science, he craved the prestige that MCV could garner following this procedure. In addition, he failed to inform his patients of the risks of experimental surgeries and tended to “act first” and “seek permission later” (71).
Until the late 20th century, when laws were passed in the US to protect patient rights, legal oversight of medical practices was poor. Few laws protected patients and families when organ transplants were in their infancy. Jones describes it as the “Wild West” (84). Historically, even when laws existed to oversee the practice of medicine, they were often ignored or not enforced. In Bruce Tucker’s case, the definition of death in Virginia law at the time he died was not applied in his brother William’s civil lawsuit. Because of that failure and other legal requirements, MCV was not held accountable for taking Bruce’s organs without his family’s consent. Nowadays, informed consent is required and enforced, but at that time, MCV not only failed to contact William Tucker for consent but also failed to inform him that Bruce’s organs had been taken.
Grave robbery, on which medical training depended in the 19th century, was made illegal and punishable as a felony. However, that legal prohibition did not stop MCV medical students from robbing graves. When MCV janitor Chris Baker and a few medical students were caught red-handed, the governor pardoned them. Deference toward physicians and medical schools continued well into the 20th century. Physicians were given wide authority to act, and no laws requiring informed consent or protecting patients’ privacy existed until the 1960s and 1970s.
In the Tucker lawsuit, prosecutor Wilder noted that MCV physicians disregarded Virginia’s biological definition of death (cessation of a heartbeat and breathing) at the time that they removed Tucker’s organs. For this reason, Wilder was confident that he would win: The law was on his side, and if this law was applied, Bruce Tucker’s death was wrongful. Initially, Judge Compton disallowed the jury to consider another definition of death. However, after hearing multiple experts testify for the defense, the judge changed his mind and allowed the jury to consider brain death, essentially guaranteeing a verdict for the defense. MCV had the resources to host a conference and provide testimony from top physicians in the field. Thus, they ensured that the law on the books did not apply. Using the prestige of the medical community, the defense attorneys warned the jury that a verdict for Tucker would harm medical progress. Literally, the jury was told, people would die if the ruling was for Tucker. Wilder, as a solo attorney, lacked sufficient resources to bring in his own experts to challenge these physicians. Because a statute of limitations had passed, the jury was unable to hold Fatteh or MCV accountable for their actions at all. The only way to rule against them hinged on the definition of death. After the case concluded, the Virginia legislature changed its definition of death to comply with the defense’s medical opinion that cessation of brain activity constituted death. In reaction to this change in law, Hume quipped that someone is deceased when a doctor says so. This reaction reveals the air of privileged conceit prevalent among some in the medical community at that time.
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