Willem Kolff Interview (page: 5 / 9) Pioneer of Artificial Organs	Print Interview

When people have criticized you, Dr. Kolff, do you think the criticism has been unjust?

Willem Kolff: It has very rarely, or never been personal. I mean, even people that disagree with me totally, and said there was no place for the artificial kidney did not say, "Kolff is an idiot."

At the Cleveland Clinic, I was a member of the Department of Research and I was also a member of the Department of Surgery. If I couldn't get what I wanted through Surgery, I got it through Research, and vice versa. But around 1966, it became apparent that they didn't want a guy straddling two departments, and wanted me to make a choice, either one or the other.

By 1967 I had worked at the Cleveland Clinic for 17 years. I wanted set up an institute for biomedical engineering that would be second to none. I couldn't do it at the Cleveland Clinic, so I began to look elsewhere, and I came to Utah. There was no money, so I had to write grant proposals to the government, and collect money from other people, but they did help me.

One of our projects was the artificial eye project. We were not the first to do that, but William Dobelle, who I attracted to come to Salt Lake City, proved beyond a shadow of a doubt that if you stimulate a point on the brain here, a totally blind person can see a point of light there. And if you stimulate another point here, he sees a point there. And if you had, as we had, 61 points that could be stimulated, this man could recognize a simple letter "l", or an "a" on a black screen, if you gave him a television camera in his hand. That's going to be very important for blind people someday, but it is not at all ready yet.

The artificial ear, which was an offshoot of our artificial eye program, is much simpler. You do not stimulate the brain, you stimulate the acoustic nerve. We all have a snail's house here in our head, and the acoustic nerve is beautifully arranged in that cochlea or snail shell. We can thread electrodes into the cochlea, and when you stimulate one point you hear a high tone, and when you stimulate another point you hear a low tone. Of the patients treated here at the University of Utah with this artificial ear, 60% can have a telephone conversation. They're totally deaf otherwise. There's good proof that it works. Now, that's very important for the deaf.

We've made artificial arms, and that is kind of a sorry project. A lot of people with artificial arms are veterans, but for a long time the Veterans Administration didn't want to spend enough money to provide these people with decent arms. Our artificial arm is so good that it can peel an orange, and so strong it can crack a nut. It can move very fast, but when it comes close to your mouth it goes slowly suddenly, because otherwise you would knock your teeth out.

You've met with a number of setbacks, but you didn't accept them as setbacks.

Willem Kolff: No. In the long run, setbacks have often worked to the benefit of my program. Let me give you a few examples.

One time, in Salt Lake City, one of the secretaries found out that we were charged for 22 sheep that did not exist. It turned out when the thing was investigated that one of my employees had been buying imaginary sheep. Everything a university buys goes through the purchasing department and is cleared there, but it's too cumbersome to do that with sheep and animals and hay. So they came directly to the laboratory. This employee was in cahoots with the guy that sold the sheep and they embezzled $36,000 that way.

The University of Utah is bonded -- insured against that kind of stuff. The year the sheep were stolen, I had enough money from the NIH. I got the bonded money back in a year that I had no support from the NIH, so it saved my laboratory.

The same guy put a torch to my building, and burned it out. The insurance company paid $125,000 to replace the equipment. Instead, I had it rebuilt by my own personnel. The lab is still brown from the smoke and the fire, but that money saved my department. You don't see it the minute it happens, but sometimes disasters work to your advantage.

Dr. DeVries, how did you come to play such a role in the artificial heart program after your student years? You must have got the hang of this kind of work very quickly, because you were invited to head up the University of Utah's heart surgery division at a very young age. How did that come about?

William DeVries: After I graduated from the University of Utah medical school, I was interested in going away. I wanted to come back to Salt Lake City someday, because I was raised there, but I wanted go somewhere else to see what I was made out of.

I chose Duke because it was in the East, and it had a great reputation. Dr. David Sabiston, who was probably the premier teacher, was there. I was at Duke nine years, learning to be a heart surgeon. At the end of that time, I remember going to him and saying, 'Well, Dr. Sabiston, it's time I start looking for a job." Dr. Sabiston said, "What do you mean? You are going back to the University of Utah. We've already talked to Dr. Kolff and he wants you back." It was some kind of a deal they had made. Dr. Kolff had told Dr. Sabiston, "You can have him but I want him back in nine years." So I got in my car and went back to Utah.

Let's trace the history of your breakthrough experiments with the artificial heart. What led up to your historic 1982 operation? Where had you been?

William DeVries: I happened to be at the right place at the right time. I got back to Utah and walked into a rich and fertile field. The artificial heart program had not progressed that much, except in animals. When I left in 1970, it was in its embryonic stages of development. We had a sheep that lived 50 hours with an artificial heart, but that animal couldn't even lift its head, it was so weak. That was the state of the art. 50 hours of an animal that just lay on the floor.

When I came back in '79, animals were walking around, moving. They looked normal except that they were connected to a machine. Hundreds of people had devoted much of their lives to develop this. We had worked for years and years on the artificial heart in animals and were ready to put it into a patient. All of the necessary things were ready to go. My job was to move it from the animal lab into the people. I started talking about putting it into patients and I noticed everybody was afraid.

Get the Flash Player to see this video. I went up to the guy that made the artificial hearts for animals, and he had made thousands of artificial hearts. And, he made the best artificial hearts in the world, and I said to him, "Tom, I want you to make a heart that we are going to put into a patient." And, he just froze. He said, "My God, you can't do that. These are just for animals. I can't do that. I mean, I can't make one good enough." I said, "Tom, I want you to do things exactly like you've always done them before and I don't want you to make it too tight, or too loose. I want it just perfect, just like you are making them."

It's the same way with everything. They were going along well with animals, but to say the next step is a person, that was way out.

Get the Flash Player to see this video. When I went back to the University of Utah in '79 and saw the tremendous development of this device, it worked and it pumped blood and these animals looked great. And then, on the other hand, I'd look over and see these patients that were dying around me for want of a heart. It was a natural. It was just natural. I mean, there was nothing unusual or strange about it to me. And, so we got ready to put that in with Barney Clark. It was amazing, those early days before putting the heart in Barney Clark and dealing with all of the questions, the ethical problems and the emotional aspect of it. And, I just saw that we have the device, and we have a need for the device, and let's put them together. But, there was a tremendous block in that. And, as we got ready to implant the heart in Barney Clark, these people were just very afraid.

Suddenly all the successful work in animals was just something of another kind that wasn't related to this human implant. That fear was one of the things we really had to work with, within the group. The hurdle seemed insurmountable at times. Once we overcame that and did it with Barney Clark, the door opened up. "Hooray, it works!"

How was Clark chosen? Why was he chosen?

William DeVries: We chose Barney Clark for many reasons. We spent almost two years developing the criteria for Barney Clark. We considered all kinds of factors. Many times when your heart fails, your brain, your intestines, your lungs will fail too. So first of all we had to find a patient whose heart was bad but the rest of him was good. That's hard to do. We also had to find was a patient who was not a candidate for transplant. We couldn't take a patient and remove his heart and put in a machine if there was another treatment that was more effective or better. At that time, we weren't giving heart transplants to anybody over 50 years of age. Nowadays, interestingly enough, he probably would have had a heart transplant.

Get the Flash Player to see this video.

The next indicators that were a little bit different than usual, such as a strong family background and an understanding of the situation. We looked about nine months for Barney Clark. We were getting very discouraged. We thought he would never come along. One day I was in the shower down at the gym and I got a telephone call. It was Dr. Jeff Anderson, a cardiologist, who called. He said, "I've got a patient you may be interested in. He's a dentist, he's intelligent, he's bright, he's got a great family, very supportive." Everything just fell into place. It started moving very fast at that point.

Why does the Food and Drug Administration accredit you and you alone to do this surgery?

William DeVries: When we got ready to do this in a patient, the FDA was really starting to feel its wings. I was a young guy. No one knew who I was or anything about it, and I decided we were going to do everything by the rules. We had to go through the institutional review boards, we had to do animal experimentation. We gave the FDA a very thick research protocol. They were dragging their heels, and saying, "This shouldn't be done. Who are you guys? We never heard of you."

At that time, Denton Cooley went ahead and put an artificial heart in a patient without FDA approval. At that point, the FDA had to say, "Denton, you did it wrong. You shouldn't have done this. You should have gone through the approval process." It also certified us as having something that might be valid. They either had to punish him or give us approval. Shortly after his implantation, they slapped him on the wrist and told us we could go ahead. So he really did help us move forward. After Barney Clark was implanted, Denton acknowledged the fact. He knew that was something he had helped us with. But we decided we were going to do everything the FDA wanted us to do, and we did. We complied with their every wish.

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