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The ethics of a second chance: Pig heart transplant recipient stabbed a man seven times years ago

David Bennett Sr., who received a heart implant from a genetically modified pig, with his University of Maryland Medical Center surgeon Bartley Griffith. (University of Maryland School of Medicine/AFP)
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Leslie Shumaker Downey was at home babysitting her two grandchildren Monday when a message pinged on her cellphone.

Her daughter had sent a link to a news article about a 57-year-old man with terminal heart disease. Three days earlier at the University of Maryland Medical Center, he had received a genetically modified pig heart. The first-of-its-kind transplant was historic, saving the man’s life and offering the possibility of saving others.

What a great breakthrough for science, Downey thought, reading the headline. Then her phone pinged again.

“Mommmmmmm,” Downey’s daughter wrote. She told her to look at the man’s name.

Downey froze. The man being heralded as a medical pioneer, David Bennett Sr., was the same man who had been convicted in 1988 of stabbing her younger brother seven times, leaving him paralyzed. Edward Shumaker had spent the next 19 years using a wheelchair, before he had a stroke in 2005 and died two years later — one week before his 41st birthday.

“Ed suffered,” said Downey, who lives in Frederick, Md. “The devastation and the trauma, for years and years, that my family had to deal with.” After Bennett got out of prison, she said, he “went on and lived a good life. Now he gets a second chance with a new heart — but I wish, in my opinion, it had gone to a deserving recipient.”

On Jan. 7, a 57-year-old patient with terminal heart disease got a transplant of a genetically modified pig heart at the University of Maryland Medical Center. (Video: Julie Yoon/The Washington Post)

More than 106,000 Americans are on the national waiting list for an organ transplant, and 17 people die each day never receiving the organ they need. In the face of such a shortage, it can seem unconscionable to some families that those convicted of violent crimes would be given a lifesaving procedure so many desperately need.

But most doctors don’t share that view. There are no laws or regulations prohibiting someone with a criminal history from receiving a transplant or an experimental procedure like the one Bennett had.

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“The key principle in medicine is to treat anyone who is sick, regardless of who they are,” said Arthur Caplan, a bioethics professor at New York University. “We are not in the business of sorting sinners from saints. Crime is a legal matter.”

While that is the official stance of federal officials and ethics committees in charge of transplant regulations, wide discretion is given at the local level to hospitals, who decide which individuals qualify to be added to the national waiting list.

At that level, other considerations are often taken into account, including a person’s history of substance abuse or a prisoner’s risk of developing an infection while in incarceration, along with access to follow-up care.

Medical ethicists argue that the criminal justice system already imposes jail time, financial restitution or other punishments on those convicted of violent offenses. Withholding medical services is not a part of that punishment.

That division between the legal and medical systems exists for good reason, said Scott Halpern, a medical ethics professor at the University of Pennsylvania.

“We have a legal system designed to determine just redress for crimes,” he said. “And we have a health-care system that aims to provide care without regard to people’s personal character or history.”

University of Maryland Medical Center officials declined to say whether they knew about Bennett’s criminal past.

In a written statement, officials said the Baltimore hospital provides “lifesaving care to every patient who comes through their doors based on their medical needs, not their background or life circumstances.”

“This patient came to us in dire need,” the officials added, “and a decision was made about his transplant eligibility based solely on his medical records.”

‘I want to live’

In interviews immediately after the historic nine-hour surgery, Bennett’s doctors said they proposed the experimental procedure after their hospital, and others, deemed Bennett ineligible for a normal human heart transplant.

Bartley Griffith, who performed the surgery, told reporters the patient’s condition — heart failure and an irregular heartbeat — made Bennett ineligible.

His son David Bennett Jr., who works as a physical therapist in North Carolina, also said several hospitals had declined to accept his father onto the waiting list because he had failed in the past to follow doctors’ orders and attend follow-up visits. He also didn’t take his medication consistently.

Bennett Sr. started having symptoms of heart failure in October — swelling in his legs, fatigue, shortness of breath. On Nov. 10, he was taken to the University of Maryland. As Bennett confronted his mortality, his son said, he wondered about his ability to help others by possibly donating his organs or helping to advance medicine in some way.

But Bennett was also still enjoying his life. He lives in a duplex, next door to one of his three sisters. He liked working as a handyman, cheering for the Pittsburgh Steelers and spending time with his five grandchildren and his dog, Lucky.

Griffith told the New York Times that he floated the option of a pig heart to Bennett in mid-December.

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“I said, ’We can’t give you a human heart; you don’t qualify. But maybe we can use one from an animal, a pig,” Griffith recounted. “It’s never been done before, but we think we can do it.’ ”

“I wasn’t sure he was understanding me,” Griffith added. “Then he said, ‘Well, will I oink?’ ”

On New Year’s Eve, federal officials granted an emergency authorization for the experimental procedure.

“It was either die or do this transplant,” Bennett said in a statement the day before his surgery.

By then, he had already spent weeks bedridden in the hospital.

“I want to live,” he said. “I know it’s a shot in the dark, but it’s my last choice.”

‘Extreme violence’

Nearly 34 years ago, on April 30, 1988, Bennett walked into the Double T Lounge in Hagerstown, Md., where 22-year-old Edward Shumaker was drinking and talking with Bennett’s then-wife, Norma Jean Bennett.

The two men had gone to high school together.

Shumaker was a handsome guy, his sister said, with blue-gray eyes and hair so dark it was practically black. His arms were muscled from working in construction, and he had a weakness for expensive cologne and nice clothing.

Bennett’s wife sat on Shumaker’s lap, according to an Oct. 6, 1989, article in the Daily Mail, a Hagerstown newspaper. After that, Bennett, then 23, attacked Shumaker as he was playing pool. According to court testimony, Shumaker had reached down to grab some coins when he felt a blow to his back, causing him to lose feeling in his legs. Bennett then stabbed him repeatedly in the abdomen, chest and back.

After fleeing, Bennett was arrested in a high-speed chase and charged with intent to murder and openly carrying a concealed weapon with intent to injure, among other charges. Because the crime occurred more than three decades ago, court officials said that the case file had been destroyed, although The Washington Post obtained remaining summary documents that confirmed his conviction.

A jury ultimately acquitted Bennett of intent to murder but found him guilty of battery and carrying a concealed weapon.

At his sentencing, then-Washington County Circuit Judge Daniel Moylan called the stabbing a case of “extreme violence,” the Daily Mail reported.

Bennett was sentenced to 10 years in prison and ordered to pay $29,824 in restitution to Shumaker. The state’s Division of Corrections said Bennett served six of those years and was released in 1994.

Shumaker and his family also sued Bennett, who was ordered to pay $3.4 million in damages. Records show that for years — even after Shumaker’s death in 2007 — the court kept renewing its judgment and ordering Bennett to pay what he owed.

Downey said her parents never received a dime from the lawsuit. Her father was a forklift operator; her mother worked in the fraud department of a bank. They took out loans to purchase a handicapped-accessible van and other equipment for their son.

“No disabled person likes to make a big deal of it, but life from a wheelchair is exhausting, mentally and physically,” Shumaker told the Hagerstown Journal in an Oct. 31, 1990, article.

The attack, Downey said, reverberated within her family for years, tearing them apart. Her youngest brother, who worked as an EMT, had been the one to drop Shumaker off at the bar that night, before reporting to his shift on an ambulance. He had been the first to respond to the scene.

By that point, Shumaker had lost four pints of blood, Downey said, and suffered nicks to his stomach, spleen and other organs.

“Ed was saying, ‘Don’t let me die,’ " she said.

After the stabbing, her younger brother struggled with guilt. He watched as Shumaker endured staph infections, sepsis and bedsores on his back that were so large Downey could fit her fist inside of them. He watched as his brother cycled in and out of nursing homes. He blamed himself for having dropped Shumaker off at the bar that night and for being unable to prevent his paralysis.

Eventually, he became addicted to opioids, dying in 1999 of an overdose. He was 28.

“It was just pure hell until the day Ed died,” Downey said.

Now, as Downey read about the man being lauded for his bravery, she thought about the untold pain he had brought to her life.

Bennett’s son would not discuss his father’s criminal record.

“My dad has never, ever, in his entire life talked to me about that,” he said. “I will not say anything about it.”

Later, through the hospital, he issued this statement: “My intent here is not to speak about my father’s past. My intent is to focus on the groundbreaking surgery and my father’s wish to contribute to the science and potentially save patient lives in the future.”

He described his father as a private, selfless man. He had thought deeply about the risks involved with the operation — and how it might help others.

“This was something that made me proud as a son,” Bennett Jr. said of his father’s decision to go ahead with the transplant. “This tops everything, in terms of what makes me proud. He has a strong will and desire to live.”

Bennett Jr. told his father that he was praying for him. He responded, “I’m praying for you and your family, too.”

David Bennett Jr. provided an update on his father's health Jan. 12 after he received a genetically modified pig heart at University of Maryland Medical Center. (Video: The Washington Post)

An uncertain prognosis

For decades researchers have chased the tantalizing prospect of using animal organs to save humans. Making such procedures — called xenotransplantation — a reality would save untold lives.

More than 6,000 people die every year waiting for a tragedy to strike others — a car accident or homicide that suddenly frees up a desperately needed heart, lung or kidney. About 20 percent of those on the heart transplant wait list die or become too sick to receive one.

The ability to use animal organs — aided by advances in cloning and gene editing — would change that. The pig heart has long been viewed as an ideal substitute because of its many similarities to the human heart, and pig heart valves are already used in humans procedures.

Bennett Jr. said his father had already received a pig valve in an operation more than 10 years ago. In a conversation with his doctor, he had said, “Doc, I already have part of a pig in me.”

Doctors have practiced implanting genetically edited pig hearts into baboons. But no human has been kept alive before with a heart from a gene-edited animal, making the prognosis for Bennett’s survival unknown.

On Monday, Bennett was breathing on his own but still connected to a heart-lung machine. By Tuesday, doctors were able to take him off the heart-lung machine.

The hospital declined to say how much the procedure cost, but plans to cover the expenses because it is experimental.

“That new heart is still a rock star," Bennett’s doctor Griffith said Wednesday in a video recorded by the hospital. “It seems to be reasonably happy in its new host, beating strongly. I would say it has more than exceeded our expectations.”

A few days after the operation, Bennett was able talk again. “Obviously a soft voice but doing better than I think just about anybody could hope,” his son said.

Downey doesn’t deny the importance of the transplant. But she said it hurt to see people calling Bennett a hero. To her family, he was anything but that.

“He’s being given another shot at life,” Downey said. “But my brother Ed wasn’t given a shot at life. Ed was given a death sentence.”

She read story after story about the transplant. Her brother’s name was mentioned nowhere.

Alice Crites contributed to this report.

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