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tucker’s heart racial politics and heart transplantation in america susan e. lederer Organ transplantation, especially moving the heart from one body to another, exemplifies American investment in high-tech medicine. Although the first human heart transplant was performed in a South African, rather than American, hospital, by surgeon Christiaan Barnard, the 1967 exploit was made possible only by the training he received in transplant surgery programs in the United States. By the time Jesica Santillan underwent her consecutive heart-lung transplants in 2003, American transplant programs remained a destination for individuals and their families seeking such hightech interventions. As in Jesica Santillan’s story, the early American experience with heart transplantation was haunted by the specter of exploitation and inequality, dogged by questions of who should receive the ‘‘gift of life,’’ and colored by ethnic politics. In Santillan’s case, much of the debate revolved around the recipient. Her status as a Mexican immigrant disqualified her, in the eyes of some observers, for a scarce national resource, an American heart. Although Mexican labor was critical to the success of American farming and other economic endeavors, Mexicans were not welcome to reap the full benefits of citizenship. Four decades earlier, a similarly revealing controversy flared in the nascent field of organ transplantation—focusing principally on the donor side of the transplant equation. American racial politics provided a potent backdrop. African Americans had yet to secure their full rights as American citizens and as American patients. Until the enforcement of the Civil Rights Act of 1964, hospitals in the American South remained segregated. In Arkansas and Louisiana, blood banks were required by law to label blood by the race of the donor (‘‘Caucasoid,’’ ‘‘Negroid,’’ and ‘‘Mongoloid’’) and to obtain explicit written permission from the recipient for crossing the color line in transfusion.∞ In 1968, only four years after the passage of historic civil rights legislation, race remained a critical issue in American medicine. The harvest of a heart from an African American man named Bruce Tucker and its racial politics & heart transplantation 143 transplantation into a white recipient sparked controversy over who would benefit from this new kind of high-tech medicine and whose bodies would make it possible for them to do so. an american transplant tragedy In May 1968 surgeons at the Medical College of Virginia (mcv) performed the tenth heart transplant in the United States. Surgeons removed the heart from the body of a severely brain-damaged fifty-four-year-old man and placed it in the chest of a fifty-three-year-old man. Amid the intense media interest in heart transplantation, o≈cials from mcv did not initially identify either the donor or the recipient.≤ But on May 28, 1968, a reporter from the Washington Post labeled the mcv surgery as the first American interracial transplant: a Virginia ‘‘white’’ received a ‘‘Negro’s heart’’ in a Richmond hospital.≥ Although Joseph Klett, the retired white businessman who received Bruce Tucker’s heart, lived only seven days before he succumbed to massive rejection of the transplanted organ, the story surrounding Tucker’s heart lived on. It became the focus of a lawsuit, an eventual judicial decision about the nature and determination of brain death, and a spur to legislatures to craft new statutes for defining death.∂ As the first legal case in the United States to challenge the conventional ‘‘definition of death’’ in the context of heart transplantation , citations to Tucker v. Lower appeared (and continue to appear) frequently in the bioethics literature.∑ But a curious thing happened in many of these discussions; the issue of race disappeared.∏ Yet the fact that the heart of an African American man was removed and placed into the chest of a white man was not incidental in 1968, in Richmond, and to members of Bruce Tucker’s family. From the outset, organ transplantation has entangled questions of race with debates over the meanings of transplantation, the commodification of body parts, and the ethical implications of the political economy of high-tech medicine. Before Christiaan Barnard performed the first human-to-human heart transplant in December 1967, he had spent three months at mcv, working with transplant pioneer David Hume. During his stay in Richmond, Barnard assisted in kidney transplants and learned how to manage the postoperative care for transplant recipients, including the study of rejection and the use of drugs to suppress the immune system. When he returned to Capetown, Barnard began preparations for human...

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