Willem Kolff Interview (page: 4 / 9) Pioneer of Artificial Organs	Print Interview

Dr. Kolff, can you tell us about the first patients you treated with dialysis?

Willem Kolff: Of the first 15 patients I treated with dialysis in Kampen, only one survived. And that one might have survived if I had used another sequence of treatment, without the artificial kidney.

Get the Flash Player to see this video. Sophia Schafstad was the first patient where you can honestly say she would have died had she not been treated with dialysis. And she was in a prison right after the war, for collaborating with the Germans and many of my fellow countrymen would have liked to wring her neck. And, she was brought to us in renal failure. My duty is not to wring her neck, but to treat her. And, we treated her. And, she was comatose when she came in. And after so many hours of treatment I bent over her and said, "Mrs. Schafstad, can you hear me?" And she slowly opened her eyes and said, "I'm going to divorce my husband," and she did.

[ Key to Success ] Integrity

Well, this woman was a National Socialist, and when I talked about her a few months later in London I said, "It's now been proven that the artificial kidney can save a life, but it's not been proven that it's of any real use to society." The moral is that we have to treat patients when they need help, even if we don't like them.

I've been mortally opposed to the so-called life and death committees that were instituted. When there were many more patients that needed to be dialyzed, and not enough artificial kidneys available, you had the institution of the life and death committees. You had a medical committee, and the first question they asked is, "Is this patient an emotionally mature adult?" If he was not, he didn't qualify. And the next question was to the lay committee, in which sat two cleaning women, a minister, a banker, a union leader, and a lawyer. This lay committee had such questions as, "Does he go to church? Does he give to the community chest? Is he employed? Does he have children? Is he divorced?" Depending on the answer to these questions, he could be dialyzed. Otherwise, he could go to hell. I've been mortally opposed to that. When I set up a dialysis center here with a grant from some government agency, I was forced to put in a life and death committee, but it never met.

How was the artificial kidney received? Was there criticism? How did you handle it?

Get the Flash Player to see this video. Willem Kolff: When the artificial kidney had become in my eyes a reality that did not mean that the medical profession was going to say, "Hurrah! Now we have something!" And, there were some that were receptive, there were many more that thought that the idea to have blood outside somebody's body was a horrible idea, and they did whatever they could to prevent using the artificial kidney and some of them wrote articles that said the artificial kidney was not needed. I've done one very good thing. I have never responded to any of those articles, for the simple reason that I had seen the improvement in patients so clearly that if I could just keep going, and have a few other people do it too, I would win.

[ Key to Success ] Perseverance

If I had responded to unreasonable criticism, I would have made a lot of enemies. I would have become a paranoiac probably. Fortunately, I did not. On the other hand, when somebody tries to prevent me from doing something I want to do, I will do whatever I can to do it anyway.

Why do you think there been so much opposition to your work from the medical establishment?

Willem Kolff: A large number of people react in negative way to anything that is new, anything they have not heard about before, that is not what they were taught, in school or in the university. I decided early that I would never be negative when I hear of something new until I have heard the full story, and have had the time to look at it.

Right after the war, the artificial kidney which we had made in occupied Holland opened the world for me. I was in England, and I met with a wonderful man, a Professor Pickering. He told me about the operation on blue babies. At the time, you could not repair the defect in the ventricle. They would put blood from the aorta, or from the subclavian artery, into the lungs, so that more blood would be oxygenated.

My first reaction was negative -- I stuck out my tongue -- but when Pickering explained to me what was done, I made a decision that my first reaction to something I hadn't heard about would never be negative again. But this negative reaction is very common. The best thing you can do is not pay attention to it. If you're young and you invent something, you will find a negative reaction. People see this young guy and say, "How could he come up with an idea that I haven't had?" Stay with what you believe, and pay as little attention to that negative reaction as you can.

That's another thing you must remember. If you're sufficiently far ahead of the field, you don't get any support. I remember what Professor Borst in Amsterdam said when he heard that I was going to work on a heart/lung machine. He said, "But Mr. Kolff, this is impossible!" If something is impossible, these guys in the NIH are not going to give you high grades for your grant proposals, and no money.

Many of your early experiments and inventions were done with very ordinary materials. I read somewhere that you made something with beer cans.

Willem Kolff: Yeah. I'm glad you brought up that question. I came to this country in 1950, and I realized that nothing was very popular here unless it was disposable. So in 1955 I decided to make a disposable artificial kidney. I took up a thing that had been explored earlier by Inoyn and Engelberg. They put some coils of window screening and cellophane tubing into a pressure cooker, but they abandoned it. I made a twin-coil kidney with the cellophane tubing wound in the coils. The blood comes in through the inner tube, and it goes out through the outer tubes. First I tried a beer can to make these things but it was too small. All the early twin coil kidneys were made out of fruit juice cans or the equivalent. Later we used the plastic equivalent of a fruit juice can.

At that time, it was thought to be unethical for a doctor to make any money on an invention. That was the point of view of the American Medical Association; it was also the point of view of the Cleveland Clinic. So I gave this invention to Baxter Traveno, and they sold this type of artificial kidney worldwide. It put the artificial kidney on the map.

Get the Flash Player to see this video. Maybe I should show you now how much urea I have at one time removed from one patient. There was a patient who was comatose, absolutely comatose, He was a big man. And, this white powder is urea and all this urea was removed in one dialysis, which is incredible, isn't it? It goes very fast. And, in the beginning there were always people that said, "Well, urea is not toxic." I would say, "Eat it, and see how you feel."

That's 263 grams there.

How did you begin development of the blood oxygenator for the heart/lung machine?

Willem Kolff: We had seen in Kampen that blood that was blue became red when it came into the artificial kidney. It took up oxygen from the air. It was an oxygenator. I began to make blood oxygenators to be used in heart/lung machines, but the hospital in Kampen was too small for open heart surgery. One of the reasons I left for the United States was that I had to be in a hospital large enough to have a cardiac surgical department. When I came to Cleveland I brought three excellent heart/lung machines, but nobody in the United States was interested. I had to wait five years before the heart surgeon began to realize that he could not do all the surgery blindly.

How do you sustain yourself during that time when you're far ahead and you're all alone?

Get the Flash Player to see this video. Willem Kolff: The first years in Cleveland were very, very difficult. Fortunately, I have many interests, so if I cannot make progress with the heart/lung machine, I can improve the artificial kidney. And, I can also then begin this kidney transplantation, and that's what we did. At that time when we entered the field of kidney transplantation, people did not use cadaver kidneys anymore. And, we proved that if we would take a cadaver kidney, put it in a patient without kidneys and dialyze them with one of these machines, that we could keep them alive long enough so that the cadaver kidney would recover from the rigors it had gone through when its previous owner died. That was very important, and also very fascinating and very beneficial.

[ Key to Success ] Passion

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