The Case of Bruce Tucker and the First Heart Transplant in Virginia
Bruce Oliver Tucker, a 54-year-old African American man reportedly arrived unconscious and unaccompanied at the emergency room of the Medical College of Virginia’s West Hospital on May 24, 1968. Tucker had suffered a fall and sustained a severe head injury in the afternoon. After initially refusing assistance from both a Richmond police officer and an ambulance driver, he was delivered to the hospital at 6:05 pm.[i] Physicians determined that he had a lateral basilar skull fracture on the right side, a subdural hematoma, and a brain stem contusion as diagnosed by physical examination, x-rays, carotid angiogram, and echoencephalography. The neurosurgical team took him to the operating room at 11:00 pm. They performed a craniotomy, removing 1000 cc of subdural blood to relieve pressure on his brain, and a tracheostomy to assist him in breathing.[ii]
Tucker was moved to the recovery room by 2:00 am the following morning after the surgeons completed his operations. His physicians stated he was in slightly better condition than he had been prior to surgery. Over the next nine hours Tucker received medication and intravenous nutrition. By 11:30 am Tucker required a respirator and his attending physician, Dr. B. W. Brawley requested a neurological consultation. Tucker underwent an electroencephalogram (EEG) between 1:00 and 2:00 pm. The test revealed “flat lines with occasional artifact” and the neurologist, Dr. Hooshang Hooshmand, found “no clinical evidence of viability and no evidence of cortical activity.” Although Tucker’s body temperature, blood pressure, and pulse remained normal for a patient in his condition, he could no longer breathe on his own and Hooshmand considered him to be neurologically dead.[iii]
On the evening of Tucker’s admission to MCV, Dr. Melville Williams, a surgeon on the hospital’s transplant team, discovered the patient in the recovery room and thought he might be a potential organ donor. Seeing no next of kin listed on Tucker’s hospital chart, Williams contacted the Richmond Police for assistance in locating family members. The police reported that they found none. Williams also alerted Dr. Richard Lower, head of cardiac transplantation who had a patient awaiting a potential heart transplant. The two surgeons reviewed Tucker’s chart together in the early morning hours of May 25. Members of the Department of Surgery met later that morning to discuss the possible transplant of Tucker’s organs. Following this meeting Dr. David Hume, chair of the department of surgery, contacted the medical examiner’s office for advice. The acting state medical examiner Dr. Abdullah Fatteh advised the transplant team to obtain permission from Tucker’s family to use his organs. Once again, the police went to Tucker’s place of residence but failed to locate any family members.[iv]
As early as 11:45 am on May 25 Tucker’s physician had noted: “prognosis for recovery is nil and death imminent.” He was taken back to the operating room at 2:45 pm after the EEG confirmed no brain activity to prepare for the removal of his organs. Tucker received oxygen to maintain his vitals and sustain his organs. The medical staff turned off his respirator a second after 3:30 pm. Brawley pronounced Tucker dead at 3:35 pm. Hume contacted Fatteh once again to inform him of Tucker’s death and to ask for permission to take his organs. Fatteh authorized the removal. Dr. David Sewell began to remove his heart at 4:25 pm while Dr. H. M. Lee started to take out his kidneys eight minutes later. Lower made his first incision in his patient Joseph Klett to launch Virginia’s first heart transplant operation at 3:33 pm. He placed Tucker’s excised heart in his white patient to complete the 9th heart transplant operation in the United States and 16th in the world. Klett lived for just six days before his body completely rejected Tucker’s heart on June 1.[v]
Fatteh granted permission to the MCV transplant team to remove Tucker’s organs based on Virginia’s “Unclaimed Body Act.” This law authorized the state’s medical examiner to donate unclaimed bodies to the commonwealth’s medical schools or hospitals for scientific and educational purposes following a 24-hour waiting period to search for next of kin. There was, however, no waiting period for Bruce Tucker. Based on the information provided by MCV, Fatteh declared Tucker’s remains as being unclaimed. His body was prepared for surgery within an hour of the pronouncement of his death and surgeons removed his organs without waiting the requisite 24 hours or obtaining permission from his family.[vi]
During the afternoon of May 25, a close female friend of Tucker’s made inquiries at the information desks of the East, North, and West Hospitals at MCV but learned nothing about Bruce’s accident, surgery, or demise. Tucker’s brother William, who worked some 15 blocks away from MCV, arrived at the hospital around 7:00 pm on May 25 only to learn that his brother was dead, and his body would be released the following day. Among Tucker’s personal effects at the hospital was his brother William’s business card. Neither the medical staff nor the hospital administration informed William that Tucker’s organs had been taken for transplant operations. It was an undertaker in Bruce Tucker’s native Dinwiddie County who informed the family of their loved one’s role in the well-publicized and pioneering transplant operation.[vii]
William Tucker filed a suit in the Law and Equity Court of the City of Richmond on behalf of Bruce’s son Abraham and the estate of his late brother (Tucker’s Administrator v. Lower). The suit charged Drs Lower, Hume, Sewell, Lee, and Fatteh with “wrongful death.” The case went to trial after a six-month postponement on May 16, 1972. As the trial began Judge Christian Compton instructed the jury to apply the existing legal definition of death in Virginia. At that time Virginia law defined death as the cessation of circulation and respiration. Following expert testimony that included medical professionals attending the first international symposium on clinical organ transplantation occurring in Richmond during the trial, Compton modified his view and instructed the jury to consider both the legal definition of death and the medical profession’s concept of brain death defined by the complete and irreversible loss of all brain function. Using these instructions the seven-member, all-white, male jury returned a verdict in favor of the MCV surgeons.[viii]
[i] In writing the memorandum opinion, Judge A. Christian Compton stated: “The facts thus far are, in the main, uncontradicted. The decedent, Bruce O. Tucker, age 54, was brought unconscious to the emergency room of the Medical College of Virginia Hospital by personnel of a local ambulance company on Friday, May 24, 1968, and was registered therein at 6:05 p.m.” Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972. The local press reported Tucker arrived unconscious, see “Heart Donor Identified” Richmond Times-Dispatch 28 May 1968; John Hopkins, “Questions Arise on Heart Donor” New Leader 28 May 1968; Barry Barkan “Say Heart was Snatched for Virginia Transplant Afro-American 1 June 1968. Medical Examiner. However, Abdullah Fatteh noted in his autopsy report that: “according to MCV chart this man was brought to MCV at 6:05 p.m. on 5-24-68, in an intoxicated state. The allied ambulance driver stated that he had a seizure ‘earlier today’ and refused to come to emergency room he had another seizure ‘this afternoon,’ fell down and was brought to E.R. On admission he was disorientated, combative with flaccid right arm and leg and B. P. of 215/100, P-76 and R-28.” Report of Investigation by Medical Examiner (copy) 27 May 1968 in case file of Tucker v. Lower, Law and Equity Court of the City of Richmond.
[ii] Report of Investigation by Medical Examiner (copy) 27 May 1968 in case file of Tucker v. Lower, Law and Equity Court of the City of Richmond; Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972.
[iii] Quotes from Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972; Operating Room Record (copy), Transplantation Record of Dr. Richard R. Lower (copy), and Report of Investigation by Medical Examiner (copy) all from case file of Tucker v. Lower, Law and Equity Court of the City of Richmond.
[iv] John Woodson “Doctors Say Effort Made to Find Kin” Richmond Times Dispatch 19 May 1972; Abdullah Fatteh “A Lawsuit that Led to a Redefinition of Death” Journal of Legal Medicine 1973 1 (3): 30-4; Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972.
[v] Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972; Commonwealth of Virginia Certificate of Death Joseph George Klett 11 June 1968; “Heart Patient Joseph Klett Dies at MCV” Richmond Times Dispatch 2 June 1968.
[vi] Abdullah Fatteh “A Lawsuit that Led to a Redefinition of Death” Journal of Legal Medicine 1973 1 (3): 30-4; Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972.
[vii] Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972; Beverly Orndorff “Transplant Donation Held Legal, Ethical” Richmond Times Dispatch 29 May 1968; Answers to Interrogatories of William E. Tucker 1 November 1971 in case file of Tucker v. Lower, Law and Equity Court of the City of Richmond; Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972; “Trucker’s Heart Use Cited” New Leader 30 May 1968.
[viii] Tucker’s Administrator v. Lower et al. Law and Equity Court of the City of Richmond, Case No. 2831, 23 May 1972. “Medical Definition of Death Upheld in Transplant Case” Richmond Times- Dispatch 26 May 1972; “’Heart Snatch’ Case Doctors Win but Victim’s Brother to Appeal” Afro-American 3 June 1972.