Introduction:
Willem Johan Kolff was indeed one of the great creative geniuses of 20th century medicine. His signal achievement, the artificial kidney, made renal failure a treatable disease for millions of patients. From all that has been written about his revolutionary accomplishments in the field of artificial organ development, we know that Kolff was motivated by a passion to help and inspire others. Hemo Digest regards Dr. Kolff as a “Pioneer for all Times” and offers these personal accounts and recollections from four of the many who were inspired by him.
Comments from Sarah Prichard, MD
Comments from John Sweeny
Comments from Alfred Cheung, MD
Comments from Bernard Canaud, MD
Full text from Sarah Prichard, MD
My first personal encounter with Dr. Kolff was in 1977, when I was a first-year nephrology trainee, presenting at an Artificial Organs meeting in Montreal. When I learned that Dr. Kolff was in the audience, I was suddenly very nervous. The presentation went well, and after the session, a big, impressive figure with huge hands congratulated me. With a gentle voice he said, “It was a great presentation. I am very happy to see a young lady going to nephrology.” In spite of his very imposing stature, Dr. Kolff seemed to be a very gentle and kind, encouraging person.
He was one of the pioneers in nephrology. He was an inventor and innovator. He distinguished himself not only by his ideas, but also by his business acumen and his marketing mind. He saw the benefits of his invention and recognized its potential for commercialization. He engaged the industry to get involved and made the invention available to more patients. He also extended his creativity beyond the field of nephrology to include early mechanical hearts. He lived a modest, long life and left a lasting legacy.
Sarah Prichard, MD
Baxter Healthcare Corporation
Vice President
Medical, Clinical, Scientific Affairs and Research
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Full text from John Sweeny
Seldom will one encounter an individual who is not only a brilliant physician, but also able to conduct incredibly complex research during a time of war, while his country—the Netherlands—is occupied by enemy troops.
It's one thing to have an idea, and quite another to bring it to life. Following my graduation from college, I was involved in some research that required me to learn how to use a lathe to produce the parts we needed to perform our experiments. Imagine trying to do the same thing while practicing medicine and doing it under war conditions. Amazing!
When I think of Dr. Willem Kolff, the word "tenacity" comes to mind. Kolff started dialyzing patients on his rotating drum in 1943. From then until his success on September 11, 1945, he dialyzed 15 patients, none of whom lived. Not only did he have to deal with the loss of each patient during this period, but he also had to perform the therapy at night in the basement of the hospital. Of course, the patients he received were near death or he would not have been allowed to try his novel treatment on them in the first place. Through all of this, he never called it quits. I often wonder how many more breakthroughs there would have been if more experimenters had Dr. Kolff’s tenacity.
One other memory I have of Dr. Kolff is when I met him. I was at one of the major dialysis meetings back in the late 70's or early 80's. I can't remember which one. There was a TV crew creating a video of Kolff. Part of the video was Kolff visiting the various booths at the meeting and speaking with a representative at each. The marketing people were told that when Kolff came to visit, he wanted to talk about our dialysis machine and how it worked. Since he would be asking "machine" questions, I was chosen to be the person to do the interview. I was nervous, but the interview went well and I guess the video folks were pleased. What I always remember most occurred after the interview. As Kolff was leaving, he patted me on the head and said, "You're a nice young man." I was about 35 years old at the time. Of course, to someone born in 1911, I guess 35 year olds really are "nice young men."
John Sweeny
Baxter Healthcare Corporation
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Full text from Alfred Cheung, MD
I had the great pleasure and honor of meeting Dr. Kolff in 1983 for the first time when I came to interview for a faculty position at the University of Utah. I was at awe in his presence, knowing something about his accomplishments, his influence locally at the University of Utah and the State of Utah, and his giant status in the area of artificial organs nationally and internationally. He knocked on the sliding window next to his chair to ask his assistant sitting on the other side of the window to bring me a cup of tea. I was grateful for the hospitable gesture and yet did not feel very at ease with his formal style. He asked poignant and insightful questions about my professional and personal lives. He gave me the impression that he wanted to know me, not only as a worker, but also as a person. I soon found out that, throughout the preceding decades or so, he had had a number of workers from all over the world coming to work with him for variable durations at the University of Utah.
Dr. Kolff was a Professor (I believe he held the title of Distinguished Professor) in the Department of Surgery and was Director of the Institute of Biomedical Engineering at the University of Utah at that time. The University of Utah had just implanted an artificial heart into a human—Barney Clark—for the very first time. The excitement was palpable after many years of hard work and the ingenuity and boldness of Dr. Kolff and his team. In the ensuing several years, the emphasis in the Dumke Building, where his office was housed and most of the ground work for artificial organ research was conducted at the University of Utah, the emphasis was the artificial heart. Despite his enormous contributions to the development of other artificial organs, such as the artificial heart and the artificial ear, his greatest impact to me and many nephrologists is his pioneer work in the artificial kidney.
I do not think that anybody would dispute that Dr. Kolff was the founding father of hemodialysis, a modality—then full of extraordinary challenges—that we take for granted today. He devised the rotating drum as the dialysis machine and cellophane sausage wrapping as the semi-permeable dialysis membrane. There was no heparin or convenient anti-coagulants for the extracorporeal circulation. There was no native fistula, synthetic graft or even the external Scribner’s shunt. The boldness and success of proof-of-concept of performing the first hemodialysis on the young patient with severe uremia was absolutely stunning.
Dr. Kolff was a very confident man, full of ideas, innovation, energy, and had absolutely no fear in trying out his ideas. He was very persuasive and had a very dedicated team of co-workers throughout most of his career who were highly motivated to invent and carry out the innovative ideas to practical clinical use. He was also very practical and had not much respect for the silos of academic disciplines. It seemed to make little difference to him if one was a world-renowned physician with multiple advanced degrees and badges of honor, or if one was an individual with no degree and no external recognition. What mattered to him was whether the person could do the work. I am certain that this strong sense of goal-orientation and conviction, rather than being restricted by protocols and bureaucracies, was part of the formula for his success.
Numerous patients around the world each year require acute or chronic hemodialysis. Just imagine the patients in the intensive care unit who suffer from acute kidney injury or the many diabetic patients with end stage renal disease who do not have access to hemodialysis or hemofiltration. I cannot help but wonder where general clinical practice and research in advanced kidney disease would be today without Dr. Kolff’s invention and work. If anybody has any doubt about this sentiment, I am certain that Eli Friedman, Joe Andrade and many others can erase it.
Alfred K. Cheung, M.D.
Dialysis Research Foundation Endowed Chair
Professor of Medicine
Division of Nephrology & Hypertension
Executive Director, Dialysis Program
University of Utah
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Full text from Bernard Canaud, MD
Willem Kolff represents the genius inventor of the “artificial kidney machine” and the “father” of a new medical discipline known today as extracorporeal “renal replacement therapy.” To better understand the importance of this creative genius physician, it must be placed in its historical context, which was the Second World War in an occupied country with limited resources, in a small countryside city of Netherlands without any technical facilities and at a time where medicine science was far from developing any form of extracorporeal therapy.
Sadly watching a young uremic patient die in agony—and knowing that kidney failure was characterized by an accumulation of urea and toxins—Willem Kolff conceptualized the brilliant idea of clearing a patient’s blood and regenerating the internal milieu by means of an extracorporeal therapy. A dialyzer made essentially with cellulosic skin sausage positioned in a long cylindrical tube was incorporated to separate blood and an exchange solution called dialysate. The diffusion of solutes through the semi-permeable membrane following the blood to dialysate concentration gradient was the driving force for clearing uremic toxins.
The rotating drum supporting the cylindrical cellulosic tube that was immersed into a handmade electrolytic dialysis solution was engineered to optimize the blood/dialysate concentration gradient. The artificial kidney concept was born and developed within a few days with local and primitive materials. Embarked in this new medical adventure of an artificial renal life-supporting system, several talented physicians including Belding Scribner have developed and popularized the artificial renal replacement therapy. This renal therapy is now used routinely by more than one and a half million chronic kidney disease patients.
The lessons and impact of W. Kolff are immense in the field of nephrology and artificial life-saving therapies. This success story also illustrates the fact that the creative genius of a physician is unlimited provided medical system and health regulatory authorities are not too restricting. Nowadays, it would appear virtually impossible to reproduce such a crude human experiment due to the rigidity of ethical and human protection committees and the complexity of regulatory health authorities.
Bernard J. Canaud, MD
Chef De Service
Nephrology-CHU Lapeyronie
Montpelier Cedex, France
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