Opinions of a Wolf

Summary:
In 1968, Bruce Tucker, a Black man, went into Virginia’s top research hospital, the Medical College of Virginia (now Virginia Commonwealth University) with a head injury, only to have his heart taken out of his body and put into the chest of a white businessman. Covering the inequalities innate in cadaver harvesting through the mismanagement of discovered human remains on university property in the 1990s, journalist Chip Jones explores how organ transplant in the US reveals systemic inequalities and racism, not just in health care, but in other related fields as well.

Review:
Organ transplant science is something that can feel like it’s been around forever, but in fact it’s really still a fairly new form of treatment. The first transplant of any organ was in 1954, and the first heart transplant was in 1967. The Civil Rights Act was in 1964, so at the time this treatment was emerging, segregated health care was still present in the US.

In “Part One: Roots,” a total of four chapters, the book first gives context to the inequities seen in organ donation and reception by looking at the topic of where student doctors get cadavers to practice dissection upon. Although currently there is a system in place for the ethical donation of remains for educational use, at the time there was no such system in place. Medical schools turned to grave-robbing – and they preferentially robbed from Black graveyards. Black families called these “night doctors.”

Parents even used the specter of “night doctors” to make their children stay in bed. “You’d better go to sleep,” they’d say, “or the student doctors will get you.”

(loc 3353)

This was also a time period where there was some debate about what counts as death. This is what “Part Two: The Race” dives into. Legally, until 1968, death was the full cessation of the working of all organs. In 1968, with advancing science, the theory of brain death was proposed. This was partially due to new health care technology that allowed for a machine to keep the organs operating. In tandem, the science of organ transplantation was emerging. The fresher the organ, the better the chances for the transplant to succeed. With the emerging theory of brain death meaning organs were operating but the patient might be able to be considered dead, and I’m sure you can see where this was going.

“Part Three: Reckoning” digs into the case of Bruce Tucker. He was a blue collar worker. He was hanging out with friends having a few drinks of alcohol on a stone wall. He fell and suffered head trauma. He was brought to the hospital alone. In spite of having his brother’s business card in his pocket, no one called his brother. Police officers were sent to his home to try to find family, but he didn’t live with his brother. At the same time, a white businessman was waiting for a heart transplant at the same hospital.

The early conversations among the surgeons had little to do about his chances for survival but rather concerned using him for another purpose. No one was discussing whether he might recover and be rehabilitated….Men like Tucker, arriving with alcohol on their breath and seemingly no one to claim them were often written off as ‘charity patients.’ They weren’t expected to pay their bills, with the hospital absorbing any expenses.

loc 2064

Jones notes that Tucker thus suffered from what can be termed a social death. Arriving at the hospital with alcohol on his breath meant that he was looked down upon by society, on top of how he was already perceived as a Black man in a Segregated southern hospital. Add to that the fact that the hospital decided he seemed to have no loved ones, and he was viewed as disposable.

Tucker did have loved ones, though, and when his body was sent to the funeral home, the caretaker notified his family that he arrived without a heart. This is when Tucker’s brother started to pursue answers and justice.

Part Four of the book – “Troubles, Trials, and Tribulations” – deals with the lawsuit that came about and how the court case was ruled. I wasn’t surprised, but was still severely disappointed to see how the hospital and doctors got away with it, and the Tucker family was left without justice. Notably to me is the quote from the prosecuting lawyer,

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.

(loc 4397)

A clarifying note that the defense team used the argument of brain death, which was not the law at the time. The defense team also organized for as many transplant experts as possible to be in town at the time of the trial. They arranged for a transplant conference that just so happened to coincide with the scheduled trial. The conference was sponsored by Pfizer. The book notes just how much sway having transplant experts on the stand had on the judgment.

What stood out to me in reading this book is how societal inequalities and judgements can and do severely impact the quality of care that a patient might receive. I also was surprised to learn how recently brain death became the standard, and to read about the arguments on both sides of that debate. Brain death is not as clear-cut as I once thought it was.

The author does a good job of making history personal by focusing on Bruce Tucker and his family but also fleshing out with enough surrounding historical details that the complex situation made sense to read about. I do think his epilogue was unnecessary, where he details trying to speak with Bruce Tucker’s son, who did not want to speak to him. I feel that truly leaving Bruce Tucker’s son alone would have entailed simply a note that he did not wish to be interviewed and leaving it at that.

Overall, this is a fascinating and sad read about the history of organ transplants and brain death in the US. Recommended if these topics interest you.

4 out of 5 stars

Length: 400 pages – average but on the longer side

Source: NetGalley

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