By Gill Paul
During the Second World War, Dr. Willem Kolff used parts from an old car motor, washing-machine components, orange-juice cans and sausage skins to create the world’s first artificial kidney. He was working in Nazi-occupied Holland where it was impossible to access fresh supplies of the metals and membranes required for his invention because all such raw materials had been requisitioned for the war. Most medical advances result from decades of work by a number of innovators, collaborating and building on each other’s discoveries, but Dr Kolff worked, by necessity, on his own. He refused to give up until he had solved the problem of how to filter his patients’ blood when their kidneys failed – a condition which until then had invariably proved fatal.
Finding a way to filter blood
In 1914, a team at Johns Hopkins University in Baltimore had invented a “membrane vividiffusion apparatus,” an instrument separating particles in the blood according to their ability to pass through a membrane, and used it to treat dogs. Hirudin, an anticoagulant produced by leeches, was used to prevent coagulation of the blood as it was filtered. Researchers encountered too many problems to make human trials feasible at that time, however, so the project was put on hold.
In 1938, Dr. Kolff was a young student working in Groningen in the Netherlands when he saw a 22-year-old patient suffering from acute renal failure. If it had been possible to filter his blood and remove urea, creatinine, salts and excess water while the underlying condition was treated, he might have survived; instead he died a slow and agonizing death from edema as the fluid levels built up in his body. This case made a strong impression on Dr. Kolff and he began to look for solutions that could save future patients from a similar fate.
His research was interrupted when German troops invaded the Netherlands in 1940. Nazi sympathizers were put in charge of the hospital in Groningen, which forced Dr. Kolff to move to a small hospital in Kampen where he could continue his research without collaborating with the enemy. A strong opponent of the Nazis, Kolff saved more than 800 Resistance operatives by helping them to simulate illnesses that required hospitalization, and thus hide in his hospital as a sanctuary.
Dr. Kolff’s research made crucial progress when he began to use sausage skins as a filtration membrane. He filled the skins with blood, expelled the air, added urea, and agitated the skins in a salt bath. The technique worked. Small urea molecules passed through the sausage membrane while larger red and white blood cells did not. Within five minutes, all the urea from the blood had moved into the external salt water. Following this principle, Kolff went on to produce his first artificial kidney machine. He wrapped 50 yards of sausage skins around a wooden drum sitting within a salt solution. Blood was fed in from the patient and the drum rotated to maintain a concentration gradient to remove toxic waste products. To pump the blood back into the patient, Kolff borrowed the design of a water-pump coupling found in Ford automobiles.
The first 15 patients on whom Dr. Kolff tried his kidney machine did not survive. He made a number of modifications, including changes to the anticoagulants he was using, and by 1945 he saved the life of a 67-year-old woman suffering a uremic coma. She was a Nazi sympathizer, but that seemed not to matter to Kolff. To him she was simply a patient in need. As she came out of her coma, her first words were, reportedly, “I’m going to divorce my husband.”
Altruism in action
Many scientists would have patented such an innovation, but Kolff wanted to share his discovery freely. After the war he donated copies of his artificial kidney machine to hospitals in London, Amsterdam, Warsaw and New York. Some doctors were skeptical of it at first, feeling it was unnatural to take blood out of the body, clean it, and return it, and they called this new machine “an abomination.” But they soon began to use it.
At first the machines were simply intended to keep patients with acute kidney failure alive while their kidneys recovered, but during the early 1960s, Belding Scribner of Seattle began to treat patients with chronic kidney failure by giving them repeated dialysis sessions. The treatment was very expensive in those days and patients had to come to the hospital twice a week for 16 hours at a time. The first machines that allowed kidney patients to undergo dialysis at home were trialed in 1964.
Willem Kolff moved to the United States after the war, and continued his research into various bioengineered machines that could take over body functions. He designed a new permeable membrane for the heart-lung machine that keeps oxygenated blood circulating during open heart surgery, and worked on the first artificial heart, which was implanted into a dentist, Dr. Barney Clark, in 1982. The prosthesis contained a multilayer diaphragm designed by Kolff’s assistant, Robert Jarvik; Kolff insisted, with typical modesty, that it should be named the “Jarvik heart.” Barney Clark lived only 118 days after the operation, but the operation was a valuable step forward. In 1999 Dr. Kolff was part of the team that produced an artificial eye, and he also worked on artificial legs, arms, and ears. His example inspired bioengineers all over the world to create machines to assume the roles of other organs – including my own father, Professor John P. Paul of Strathclyde University in Glasgow, Scotland.
Gill Paul studied Medicine at Glasgow University and now works as an author specializing in health as well as historical fiction and non-fiction. Her non-fiction includes A History of Medicine in 50 Objects (2016), the Eat Yourself series on nutrition, and TV tie-ins to the shows Food Hospital and The Biggest Loser. Her novels include The Secret Wife (2016), about the Romanov royal family, Women and Children First (2012), set on the Titanic, and No Place for a Lady (2015), about the women who accompanied soldiers to the Crimean War.
Homepage image: ‘Diseased kidney’, L0013468, Wellcome Library, London