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

Between 1953 and 1964, the Central Intelligence Agency (CIA) conducted secret experiments in the San Francisco area, using lysergic acid diethylamide (LSD) on the human brain. In so doing, the agency violated human rights. Another example of an egregious human rights violation was the Tuskegee Syphilis Study which left hundreds of African American men untreated for the fatal disease even though treatments were available. In another instance, the medical community repeatedly used the cancer cells of Henrietta Lacks, an African American woman, without compensating her. As Jones explains, doctors had extraordinary levels of prestige and authority in the 1950s and 1960s and thus practiced without supervision. Informed consent did not yet exist.

Shumway’s use of hypothermia made heart surgery safer and gave physicians more time to operate. Dr. Roy Cohn supervised Shumway and Lower’s work and encouraged the pair to work at Children’s Hospital in San Francisco, where they operated on several children. The problem of tissue rejection was persistent, but they used immunosuppressants to avoid triggering the reaction. They had mixed, sometimes tragic, results. In addition, they continued to test their theories using stray dogs. They found that dogs with transplanted hearts lived for several days. When Cohn spoke of their experiments on television in late 1959, they became famous nationally.

MCV’s leadership recruited Dr. David M. Hume to “lift the college out of its decidedly second-class doldrums” (73) in 1956. A Harvard man, Hume had conducted the first successful kidney transplant from one twin to another and, as a result, had won fame. He was ambitious and tended to act before asking questions. He hired his own doctors and took charge quickly. Jones notes Hume’s complex personality: Although loyal to his patients and staff and despite a strong work ethic, his colleagues perceived him at times as “arrogant, pushy, and often unconcerned about breaking the rules and ethics of his profession” (81). One physician was worried because Hume did not explain the risks of experimental procedures to patients who might opt out if informed.

Hume’s reputation grew at MCV. In some instances, he saved lives through experimental surgeries. However, tragedies also occurred, such as when Hume transplanted a monkey’s kidney into a man and the man died. After controversy over his dissection of corpses at MCV, the administration allowed him to use an abandoned labor and delivery room at St. Philip for such experimental purposes. He likewise prevailed in a dispute with Dr. Lewis Bosher in June 1962. The “hospital’s most senior heart surgeon” (84), Bosher challenged Hume’s attempts to take some of his surgical patients and publicly questioned the benefits of Hume’s research. The hospital allowed Hume to continue but issued clear rules about the lines of authority in the surgery department. By the 1960s, Hume was eager to conduct the first human heart transplant. To do so, he hoped to recruit Dr. Shumway. Shumway turned down the offer but suggested Dr. Lower.

In 1950, the US Supreme Court ruled in Sweatt v. Painter that the University of Texas Law School must admit African Americans. As a result, MCV began admitting African Americans into its classes in 1951. The St. Philip School of Nursing, however, remained segregated until 1962, when it closed. Additionally, MCV banned Black students from university-sponsored events until 1962, when the faculty voted to end that policy by a vote of 70 to 14. That year, the top medical student, Charles Christian, was barred from events because of his race, and that brought the issue to the forefront.

The institution had a long history of racism. In late 1943, Black leaders exposed the unsanitary and unsafe conditions (including rat infestation) at St. Philip, the MCV hospital designated for Black patients. To avoid public humiliation, MCV’s leadership agreed to make improvements. However, the white doctors continued to refer to St. Philip as “the Black Hole of Calcutta” (96) while deeming it an excellent place for student training.

In 1965, Dr. Lower accepted Hume’s offer and moved to Richmond with his family. While Lower and Hume were excited about transplants, they encountered several issues, such as the definitions of life and death. In 1953, the cardiopulmonary bypass machine, known as the pump, was invented. This machine, along with ventilators, could keep the heart and lungs working. Hume pushed leadership to gain permission for transplants if the victim of an accident was clinically dead, or brain-dead, and the donor’s family gave permission. Virginia law, however, recognized only biological death, which was defined as the cessation of the heart, pulse, or breathing. Lower was much more cautious than Hume, however, noting the damage to the reputation of a physician in Mississippi after he transplanted a monkey’s heart to a human, who quickly died.

In the summer of 1966, Dr. Christiaan Barnard visited MCV from South Africa for a three-month study program. While he flattered Hume and expressed an interest in learning about kidney transplants, he also wanted to learn as much as possible from Lower about transplanting animal hearts and tackling the problem of tissue rejection. An Afrikaner and son of a minister, Barnard was opposed to apartheid. However, he was abrasive and treated staff and colleagues poorly. Carl Goosen, who had worked with him in South Africa and was then at MCV, was not happy to see him there.

Barnard soon demonstrated his ambition. He suggested that a man dying of liver failure be hooked up to a baboon so that the baboon’s liver would cleanse the man’s blood. Requiring three heart-lung machines, the surgery was successful: Both the man and the baboon survived. Lower and Hume repeatedly pushed the boundaries of transplantation, costing numerous animals their lives (112). However, at home, both professed that they were animal lovers.

Hume continued to press Lower to perform a human heart transplant, since the first hospital to do one would receive millions in federal grant money. Lower had the opportunity to do one in the fall of 1966. However, he learned that the donor and recipient had incompatible blood types, and therefore, he refrained from performing the surgery. He was a cautious man. Barnard closely observed Lower’s work on animals, particularly his use of hypothermia to switch dog hearts successfully. Goosen warned Lower of Barnard’s intentions, but Lower welcomed the observation in the name of scientific inquiry.

In the 1950s, more African Americans moved to Richmond. As a result, civil rights organizers gained more influence. The white establishment, resisting any decrease in its power, created Richmond First. This organization attempted to suppress black voting via a “velvet glove” approach, serving up animosity “with a polite smile, a touch of passive aggression, and the sweetness of a country club daiquiri” (119). The Virginia Legislature passed a law to protect Richmond’s Civil War monuments by ceding control over them to the state’s attorney general.

Back in South Africa, Barnard completed the first successful kidney transplant in Africa, protected by South Africa’s lenient rules about organ removal. If the parents or relatives gave consent after a postmortem following a death from unnatural causes, organs could be removed. Additionally, South African law required the agreement of only two physicians to declare death in the case of brain injury before the heart stopped beating. Thus, “the door was wide open” (123) for Barnard to win the race to perform the first heart transplant. He did so in December 1967. Subsequent press coverage depicted MCV as a laggard in this race. Hume and Lower were disappointed and angry because Barnard had not only used the Shumway-Lower transplant technique he learned at MCV but had done so recklessly.

Following the surgery, Barnard was treated like a Hollywood star. He appeared on the covers of three major magazines and basked in the attention. His heart recipient, however, contracted pneumonia and was fading. Incorrectly assuming that the symptoms resulted from tissue rejection, Barnard prescribed immunosuppressants, which prevented the patient from battling the pneumonia. The patient therefore died. While saddened by this news, Barnard continued to tour the world and completed a second heart transplant. In one interview, however, a BBC reporter asked tough questions referring to eugenics and making “a valid point about the blurred lines of ethics and law that the heart surgeons were starting to cross” (135).