History of Medicine

 BIRTH OF THE ARTIFICIAL KIDNEY

 

         On May 10, 1940, the German Army invaded the Netherlands. At the University Hospital in the city of Groningen, twenty-nine-year-old Willem Kolff, nicknamed Pim, was finishing his training in internal medicine. He realized that specialization made him less liable to be arrested or deported and quickly obtained certification in internal medicine. A new hospital in the small city of Kampen, out of the way of most German officials, hired him as chief of the medical service. Kolff, previously disturbed by a young patient dying of renal failure, had already been thinking of ways to substitute for kidney function.

Willem Kolff and his wife Janke, 1941 
(National WWII Museum and Marriott
Library, University of Utah)

         In Groningen, Kolff had befriended the professor of physiological chemistry, Robert Brinkman, who was attempting to dialyze plasma through a cellophane membrane. Attracted by Kolff’s thoughts on artificial renal function, Brinkman contributed ideas on using cellophane as a membrane to imitate the kidney's filtering activity. 
         The idea of artificial kidney function was not new. As early as 1912, the famous pharmacology professor at Johns Hopkins, John Jacob Abel, with colleagues Roundtree and Yurner, had run animal blood through tubes of celloidin, a semipermeable substance, submerged in watery solution, to remove urea. They demonstrated the process, in fact, at a Congress in Groningen in 1914. World War I, however delayed further work.

John J Abel, later years (Wikipedia)

         In the 1920s, after seeing many soldiers in World War I dying of renal failure due to a new condition called “trench nephritis,” German physician Georg Haas, at University Hospital in Giessen, knowing the work of Abel, assembled an artificial kidney apparatus consisting of several 1.5 meter collodion membrane tubes suspended in solution. He employed the newly discovered heparin as an anticoagulant, safer than hirudin, an anticoagulant used by Abel that was derived from leeches. Haas drew half-liter amounts of blood and pushed it through the tubing. Although urea levels dropped, the few patients so treated only marginally improved and soon died. This, and discouraging comments by colleagues led Haas to abandon the project.

Georg Haas, right, dialyzing a patient (Kidney Intl Repts 2025; 10: 964, Creative Commons License)

         In Kempen, Kolff, under German surveillance, teamed up with an engineer, Hendrik Berk. They used cellophane previously obtained from American supplies in Amsterdam, to make narrow tubing thirty meters long wrapped around an aluminum drum. The drum was lined with aluminum slats to elevate the tubing off the surface, allowing solution to surround it. The drum was suspended in an enamel tub that contained water with sugar and salt. The cellophane tubing wound diagonally over the drum so that as a sewing machine motor rotated it, the blood flowed through the thirty meters of tubing and back to the patient without a pump. Aluminum for the drum came from an airplane that had been shot down, some parts came from an automobile, and when the cellophane supply ran out, Kolff used sausage skins.       

    Work went slowly. Spare parts needed to be scavenged and Kolff had other pressures. Sometimes he admitted people on the run from Nazis, giving them false names or diagnoses to protect them. In one instance he gave a hunted man a diagnosis of intestinal bleeding. To make it look genuine, he bled a liter of blood from him and artificially colored his stools black.

        Kolff found a laboratory technician and a physician assistant. The assistant, Jacobus van Noordwijk, had spent eighteen months in jail for anti-Nazi activities as a medical student. On release, forbidden to enroll again in medical school, he found no rules against taking the examinations. He tutored himself and passed the licensing exam. Kolff had him wear a blue smock rather than a white one to disguise his role as a physician. Jacobus also typed for him, something Kolff, a dyslexic, found difficult.
        Kolff’s first use of the artificial kidney was on an elderly man dying with prostate cancer and failing kidneys. Kolff, with agreement from his staff, dialyzed him in a comatose state. The sewing machine motor malfunctioned, there were leaks, and the patient did not improve, dying days later. Repairs and tinkering improved the apparatus, however, and between March 1943 and July 1944, fifteen people underwent treatment with the artificial kidney. In many, the clinical picture and blood chemistries improved, but in time all but one died because they had irreversible kidney disease. The one survivor probably had a condition not benefitted by the dialyzer. As in Haas’ case, Kolff’s physician colleagues felt that putting patients through such an ordeal when they died soon after was not helpful. Kolff still saw a future for the procedure, though, and refusing to publish in a German journal, he published his results in both a Dutch and a Swedish journal, the latter in English, announcing the technique to a wider community. 

(From "History of Dialysis in the U.K," Witness Seminars, v 37, 2009, published by Wellcome Trust
for History of Medicine)

        In April 1945, the Allies freed Holland. In the aftermath, Kolff treated another patient, a woman imprisoned for Nazi collaboration. She was the first patient to have meaningful survival, having had a reversible kidney disease. She lived to the age of seventy-three.
        After the war, in 1950, Irving Page at the Cleveland clinic hired Kolff. There he developed a membrane oxygenator, a forerunner of the heart-lung machine, and became an American citizen. He went on to develop an artificial heart and, of course, to see many improvements in the artificial kidney. Developments in shunts were a vital step allowing repeated dialyzing with minimum discomfort and dialysis procedures gained in efficiency. 
        For his achievements with artificial organs, Kolff received numerous international awards, society memberships, and honorary degrees. He earned four Nobel Prize nominations, but not the Prize. Kolff passed away in 2009 at the age of 97. Georg Haas died in 1971 and was posthumously honored with the establishment of the Georg Haas Dialysis Center in Giessen. He is buried in the local cemetery near Wilhelm Conrad Röntgen.

SOURCES:
 
Broers, Herman, Father of Artificial Organs: The Story of Medical Pioneer Willem J. Kolff. 2020, AERIE Publishers, Kempen, NL.
 
Abel, J J, et al, “On the Removal of Diffusible Substances from the Circulating Blood of Living Animals by Dialysis.” 1914; J Pharmacol Exptl Therapeutics 5: 275-16 and 611-23.
 
Wizemann V, Benedum, J, “70^th Anniversary of Haemodialysis – The Pioneering Contribution of Georg Haass (1886-1971).” 1994; Nephrol Dial Transplant 9: 1829-31.

Husain-Syed, F, et al, "Celebrating 100 Years of Hemodialysis and the Legacy of Georg Haas." Kidney Intl Repts 2025; 10: 964-5.
 
 Kolff, W J, et al, “The Artificial Kidney: A Dialyser with a Great Area.” 1944; Acta Med Scand 117 (2): 121-134.
 
Haas, G, “Über Blutwashung.” 1928; Klinische Wochenschrift 7 (2): 1356-62.
 
Morrissey, M, “Willem J Kolff (1911-2009): Physician, Inventor, and Pioneer.” 2012; J Med Biog 20: 106-138.
 
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