By Thomas H. Maugh II
February 14, 2009
"Dr. Kolff was a pioneer in the truest sense of the word," said Michael K. Young, president of the University of Utah, where Kolff concluded his career. "His groundbreaking work on the artificial kidney in the 1940s made him a household name and a hero to millions of people around the world who benefited from this life-saving technology."
Kolff was a young physician in Groningen in the Netherlands before World War II when he saw a 22-year-old man die of kidney failure. "I felt that if I could remove every day 20 grams of urea from this man, then he could live," he later recalled.
Physicians had encountered two primary problems in trying to achieve this: filtering urea and other toxins from the blood and keeping the blood from clotting while it was outside the body.
During World War I, a German physician, Dr. Georg Haas, had some success with a newly developed anticoagulant called heparin, but he could not filter the blood fast enough and the supply of heparin was limited. Strangely, he left his work half-completed, and the medical community largely forgot about it.
Kolff began experimenting with sausage casings made of cellophane, a form of plastic made from wood or cotton. The material is porous, and Kolff suspected that it might suit his purposes.
He found that when the casings were filled with blood and agitated in a solution of salt water, the urea and excess water diffused out while essential blood components were trapped inside the tube. Heparin, moreover, had become commercially available.
Kolff wrapped the tubing around a drum and, using parts from a water pump that he obtained from a Ford dealer and some empty orange juice cans, built a mechanism to turn the drum.
The first 16 patients he treated died. Then, shortly after the end of World War II, he was asked to treat the comatose Maria Schafstadt, a 67-year-old widow imprisoned for collaborating with the Nazis. Although he felt that many of his countrymen "would have liked to wring her neck," he agreed.
After a week, Schafstadt came out of the coma. As she slowly opened her eyes, her first words were, "I am going to divorce my husband," who was opposed to the Nazis. She lived seven more years before dying of problems unrelated to her kidneys.
Today, more than 200,000 Americans undergo regular dialysis each year to keep themselves alive, often as a temporary measure while they await a kidney transplant.
Kolff later developed a portable version of the dialysis machine that could be used to perform at-home dialysis, which is now becoming more common.
For his achievement, he received the 2002 Albert Lasker Award for Clinical Medical Research, a prize that is often a precursor to the Nobel. Many of his colleagues have argued that he should have received the Nobel as well because of the effect of his research, attributing the fact that he did not to politics.
But Kolff was not finished. After immigrating to the United States in 1950, learning English and reinstating his medical degree here, he began concentrating on the heart.
Building on lessons he had learned in making the artificial kidney, he developed a membrane oxygenator to add the vital gas to blood while it was outside the body. The oxygenator is a crucial component of the heart-lung machines that are used to keep patients alive during open-heart surgery.
He also was the crucial player in designing the first successful artificial heart -- which was known as the Jarvik-7 because of Kolff's habit of attaching the name of a colleague or student to devices under development.
On Dec. 2, 1982, Dr. William DeVries implanted the heart in the chest of retired Seattle dentist Barney Clark, who survived for 112 days. Dr. Robert Jarvik became famous as a result, but colleagues agreed it was Kolff's heart. Refined versions of the device are still used as a bridge to heart transplants.
In his later years, Kolff worked on other artificial organs, including an eye and an ear, but those proved to be much more difficult organs to replicate.
Willem Johan Kolff was born in Leiden, the Netherlands, on Feb. 14, 1911, the son of a doctor. Although his childhood goal was to become the director of a zoo, his father convinced him to study medicine instead, and he received his degree from Leiden University in 1938.
He was a staff physician at the University of Groningen in 1940 when Germany invaded the Netherlands. After the Jewish hospital director was replaced with a Nazi sympathizer, Kolff moved to a small hospital in Kampen, on the Zuider Zee, where he sat out the war.
Kolff aided the local resistance movement, providing medical "alibis" to help many escape detection. When the Germans attempted to take in one local resistance leader for questioning, Kolff withdrew two pints of blood from the man's arm and had him drink it. Laboratory tests then showed that the man was anemic and had copious blood in his stool -- signs of a severe ulcer.
The Germans did not question him because they assumed he would die shortly.
When the Germans invaded on May 19, 1940, Kolff happened to be at The Hague for a funeral. When he saw the German bombers, he excused himself from the ceremony and went to the city's main hospital, where he volunteered to set up a blood bank.
With an armed escort, he drove through the city streets, dodging bombs and snipers and collecting bottles, tubing and all the other paraphernalia needed for storing blood. Within four days, he had established the first blood bank in Europe. It is still operating today.
After he immigrated to the United States, Kolff spent 17 years at the Cleveland Clinic Foundation before moving on to Utah in 1967. He finished his career there, formally retiring in 1986. He continued working in his laboratory until bad health overtook him in 1997.
Kolff was divorced by his wife of 63 years, Janke, in 2000, reportedly because she could no longer stand his constant tinkering. She died in 2006. He is survived by four sons, Therus, Jacob, Albert and Kees; a daughter, Adrie Burnett; 12 grandchildren; and six great-grandchildren.
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