Willem J. Kolff: A great man

Abstract

Willem Kolff, often called the father of the artificial kidney, died in January 2009, 3 days before his 98th birthday. During his long life he received numerous honors and accolades for his work. Many people thought he should have received the Nobel Prize, but as he once said himself, they do not honor people who build mouse traps. Yet because of the mouse traps he built, almost one million people are now alive who otherwise would have died. True, he did not invent dialysis. Others worked before him, and some developed dialyzers concurrently with his. But Dr Kolff combined a dogged determination with a flair for salesmanship, resulting in dialysis becoming a practical worldwide method of treating uremia. The details of Dr Kolff’s life are well known. He published his early experiences in March 1965 in the Annals of Internal Medicine in an article that as a fellow I was assigned to edit. At the outbreak of World War II he left his job at the University of Groningen in protest against the actions of the Nazis, and took up a position at the local hospital in the small town of Kampen. There he developed his dialysis machine in collaboration with Mr. Berk, an engineer, availing himself of the recent advent of cellophane (used to make sausage skin) and of heparin. After several attempts he settled on an apparatus consisting of 20 m of cellophane tubing wrapped around a horizontal drum half submerged in a bath filled with dialysate. He had to use rubber tubes and glass connections, because plastics were not yet available. A pump was used to rotate the drum, but on bad days Mrs Kolff had to take turns cranking the machine. As no other funds were available, Dr Kolff used his own money to build the device. Fifteen patients were dialyzed in the spring of 1943 before the first survived—a woman who had been a Nazi collaborator. Upon waking up, she reportedly said she was going to divorce her husband, which she did. Later 8 dialysis machines were built, of which Dr Kolff sent one to London, one to New York, and one to Montreal. He also sent one to Poland, but it disappeared somewhere behind the Iron Curtain. In 1947 Dr Kolff moved to the Cleveland Clinic. These were difficult years, working on the mechanism of renoprival hypertension and doing nephrectomies on dogs under the stern stewardship of Irving Page. Exemplifying Dr Kolff’s travails was one episode when he came into Dr Page’s office with the final version of a much-retyped manuscript ready to be sent off. But Dr Page objected to the gender of the pronoun by which the dogs were referred to, and marked the paper from top to bottom. An eyewitness described later how Dr Kolff went into the next room and broke into tears. Later he began again to work on dialysis. He said that as everything in America was disposable so had to be his dialyzer. With Bruno Watchinger, they rolled cellulose tubing around soft drink cans (alcohol not being permitted at the Cleveland Clinic), then had Baxter Travenol build the ‘‘Twin Coil’’ and the steel tank, and gave them the patent—as doctors in those days did not patent their discoveries. He used to say that he could build a kidney faster than Bruno Watchinger could calculate a clearance—and that he learned nothing from a clearance that he did not know already from the serum creatinine, an unfashionable point of view but one for which he might be vindicated some day. By the end of the 1950s the Cleveland Clinic created for him a Division of Artificial Organs. It consisted of a Correspondence to: G. Dunea, 222 East Chestnut Street, Chicago, IL 60611, USA. E-mail: gdu222@yahoo.com Hemodialysis International 2009; 13:150–152