Critical & Organ Care · 1943
Kolff's rotating drum artificial kidney
In the winter of 1943, with German forces occupying the Netherlands, Willem Kolff began assembling a machine from whatever materials wartime allowed. He wrapped sausage-casing cellophane tubing around a horizontal rotating drum, suspended it in a bath of dialysate solution, and connected it to a patient's circulation. The cellophane membrane, selected because its pore size matched the molecular weight of urea and creatinine, allowed small-molecule toxins to diffuse out of blood while larger proteins were retained. It was improvised engineering under occupation, conducted at the Municipal Hospital in Kampen with scavenged parts.
The clinical results were initially discouraging. His first 15 patients all died, most already too far into uremic crisis to benefit. On September 11, 1945, a 67-year-old woman with acute renal failure and oliguria was connected to the drum. After 11 hours of dialysis she regained consciousness, and her blood urea fell to levels compatible with survival. That single case, the first documented recovery attributable to the machine, validated years of failed attempts.
After the war Kolff emigrated to the United States, carrying his designs. Modified versions of the drum dialyzer reached Peter Bent Brigham Hospital in Boston in the early 1950s, where John Merrill and his colleagues used them in soldiers returning from Korea with crush injury-related acute tubular necrosis. The machine could support patients through temporary renal failure, but it offered nothing to patients whose kidneys would never recover. A second limitation was vascular access: each session required surgical cutdown, and veins were exhausted after a few treatments.
The access problem was solved by Belding Scribner and Wayne Quinton at the University of Washington, who in 1960 described a Teflon-silicone arteriovenous shunt that could be left in place permanently. That development converted dialysis from acute rescue to chronic maintenance therapy and created a patient population that had not previously existed. By the mid-1960s, outpatient dialysis centers were operating in Seattle and spreading across the United States.
Kolff applied the same extracorporeal membrane principles to a series of artificial organs, most notably contributing to the development of the artificial heart. His 1943 drum design, conceived under occupation with cellophane and orange juice cans, is the direct mechanical ancestor of the hollow-fiber dialyzers used in every dialysis unit today. More than 2 million patients worldwide currently receive maintenance hemodialysis.
Key People
- Willem Kolff — Dutch internist who designed and built the first functional dialysis machine
- John Merrill — Boston nephrologist who adapted the Kolff dialyzer for clinical use at Brigham Hospital
- Belding Scribner — Seattle physician who developed the permanent arteriovenous shunt enabling chronic dialysis
- Wayne Quinton — Engineer who co-designed the Teflon-silicone shunt with Scribner
Acta Medica Scandinavica, 1944
Related landmarks
- 1937 · First clinical use of heparin as an injectable anticoagulant (Critical & Organ Care)
- 1960 · Scribner shunt and long-term hemodialysis (Critical & Organ Care)
- 1968 · Harvard Criteria for Brain Death (Critical & Organ Care)
- 1916 · Rous and Turner's citrate-glucose method for storing red blood cells (Critical & Organ Care)