Willem Kolff Interview (page: 3 / 9) Pioneer of Artificial Organs	Print Interview

Dr. Kolff, the kidney dialysis was one of your first major accomplishments. And you began working on that when you were quite young.

Willem Kolff: It was not the first thing, but it was the first really important thing.

Get the Flash Player to see this video. When I was this young assistant at the University of Groningen my responsibility was for four beds, or rather the patients in four beds. That was all I had to do. And, one of these patients was a young man, 22 years old, who slowly and miserably died from renal failure. He became blind, he vomited, and it was a miserable death. And I, as a very, very young physician, had to tell his mother, in a black dress and a little white cap like the farmers have, that her only son was going to die. I couldn't do a damn thing about it. So, I began to think, "If I could just every day remove as much urea as this boy creates, which is about 20 grams, then the boy could live." Well, he died, but I began to work on that.

[ Key to Success ] Vision

Also, while I was at Groningen, I got interested in blood transfusions. I was the first in the Netherlands -- and probably on the continent of Europe -- to apply blood by continuous drip. It was not my invention, it was done first in England.

When I came to the University of Groningen, you had the donor lying there, and the recipient next to him, and you pumped blood from one to the other. But I introduced these drips, in the Netherlands. And then it became apparent that you needed to store blood. That led me to read about the blood bank in Chicago.

Get the Flash Player to see this video. When the war broke out I happened to be in the city of The Hague, for the funeral of my wife's grandfather. That morning of the funeral the German planes came overhead and they threw out leaflets that the Dutch should surrender, and they bombed the barracks, and so on and so on. And, instead of going to the funeral, I went to the main hospital, where I had been before, and I said, "Do you have a blood bank?" And they said, "No." And I said, "Do you want me to set one up?" They said, "Yes." And they gave me an automobile with a soldier in front because there were snipers, and they gave me purchase orders so that I could go to every store in the city and buy whatever I had to. And, in four days time I had a blood bank ready.

[ Key to Success ] Courage

That blood bank is still in existence. That was my first major thing with blood.

Some of these circumstances changed the whole direction of your work and your life.

Willem Kolff: Yes. Having handled blood outside the body made dialysis less difficult for me.

Of all the inventions that you've explored yourself and that you've inspired others to investigate here, I wonder why you think you've succeeded in doing this. Where there are a lot of people out there with brains and potential, but they haven't been able to make this happen.

Willem Kolff: There are a lot of people that are a great deal smarter than I am. So I have to work very hard, but I'm extremely persistent. If I cannot get there one way, I try another way. If I had to give any advice to younger people who want to accomplish something, first try to simplify what you want to do, and see whether or not you can do it. No reason to bump your head against the wall if you don't see a little hole in it. But if you see a possibility, then take it on. If you cannot get there one way, try another way.

Also, be prepared that your new idea will not always be welcome. As a very young assistant at the University of Groningen, when I told the chief assistant that I was going to make an artificial kidney, he became very, very mad. What I should do, he said was just like every other young assistant: Do what he told us. But my old professor listened, and let me do it.

It seems that some of the experimentation and some of the thinking that you did in developing this technique was simple.

Willem Kolff: Yeah. Whenever I see a problem, I try to reduce it to simple terms. If the problem is very complicated, then look at whether or not there is a simple component to it. And if that simple component is an important part, then take that first, then you can forget about the other components. Reduce the complicated problem to something that you can understand, and that perhaps you can do something about.

How did you come to leave the University of Groningen for a small city like Kampen?

Willem Kolff: I didn't want to stay at Groningen because the Germans put a National Socialist (Nazi) at the head of the department. I stayed just long enough to get my certificate as an internist, a specialist in internal medicine. The night before this National Socialist appointed by the Germans came in, I left. I never saw him alive.

Then I had to look for a place, and I found one in Kampen. It was a very small hospital. They were very nice to me. They wanted to have an internist, and I was the first. I made the royal sum of 10,000 guilders per year in the first year. Divide that by two and a half, and you have the number of dollars that I made. I said, "Now I can afford to make an artificial kidney."

Professor Brinkman at Groningen was the man who first told me about cellophane and dialysis. Brinkman was a wonderful man, and he knew cellophane. Cellophane tubing looks like ribbon, but it's hollow. It's artificial sausage skin, and it's an excellent membrane for dialysis. If you have blood inside here, small molecules will go through the pores of the membrane to the outside where you have the dialyzing fluid. So urea and other products that the kidneys normally excrete will go out.

And another thing happens. Sodium chloride and other electrolytes will also go out. So, you add them to the dialyzing fluid on the outside, and they go out and in, and you get an equilibration through this membrane. If the sodium is too low, it goes higher; if it's too high, it goes lower. This normalizes the electrolytes in the blood plasma. The treatment with the artificial kidney is relatively simple.

You didn't succeed the first time you tried to figure out a solution to this, did you?

Willem Kolff: No, but I knew exactly what I wanted to do. I wanted to use dialysis to remove urea and other products that are excreted by the kidney. I filled a small piece of cellophane tubing, about 40 centimeters long, with blood. I added urea to it, I shook it up and down in a bath with saline, and from this I could calculate that I needed ten meters of this stuff, and that the blood had to be continuously in motion, and the dialyzing fluid also in motion. I also had Heparin to prevent clotting. All I had to do was to make a machine with sufficient surface area to make it worthwhile, and that's what I did.

I went to see the director of the enamel factory. I got him interested, and he helped me. That was the first rotating drum artificial kidney. When it came time to pay the enamel factory, it turned out that the Germans did not allow any Dutch company to work for anybody else but the German Wehrmacht, (that's the army) so they never could give me a bill, and I never paid for it.

Get the Flash Player to see this video. I had one patient with chronic renal failure that was in 1943, during the war. And, I dialyzed one-half liter of blood, and had it run through that artificial kidney and gave it back to her. And then waited two days to see if anything terrible would happen. Nothing happened. And so, I then took a little more blood, and so on. By that way, at that time if either an institutional review committee for research on human patients, or the FDA had been breathing down my neck, the artificial kidney would never have been made. Never.

[ Key to Success ] Courage

You mean you worked in circumstances that allowed you to do this.

Willem Kolff: Yes, without the FDA was in existence and before IRBs (Institutional Review Boards). My conscience was my only brake. Otherwise, I could do what I wanted. But I had to explain to the patient what I was going to do, and I always did.

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