Nephrol Dial Transplant (2009) 24: 2299–2301
doi: 10.1093/ndt/gfp298
Advance Access publication 18 June 2009
Obituary
‘Bioengineering for life’: a tribute to Willem Johan Kolff
Jörg Vienken
BioSciences, Fresenius Medical Care, Else Kroener Strasse 1, D 61342 Bad Homburg, Germany
Correspondence and offprint requests to: Jörg Vienken; E-mail: [email protected]
Professor Willem (Pim) Johan Kolff, the first real bioengineer and pioneer of artificial organ technology, passed away
at his home in Newtown Square, PA, USA on 11 February
2009 at the age of 97.
Pim Kolff is best known to the nephrology community
for his landmark development of the rotating drum artificial
kidney. With this imposing device, haemodialysis moved,
gradually, from an experimental to a routine therapy that
today keeps more than 1.5 million kidney patients alive
worldwide. Pim Kolff was more than a physician who just
took care of patients with kidney disease. Until his death, he
worked, thought and speculated as a bioengineer with a focus on a number of artificial organs including the artificial
lung, the total artificial heart and the artificial eye. Rightly
so, he is regarded as the father and creative pioneer of artificial organs, enthusiastically stimulating and supporting
numerous inventions in this spectacular area of medical
device technology. Throughout his life, Kolff followed his
inner drive to improvise and improve medical devices. He
continuously appealed to his students, co-workers and scientific friends to be creatively engaged in technological improvements whilst not forgetting the obvious—the care of
the patient. Kolff himself listed some 247 co-workers who
helped him develop the permanent artificial heart, many of
them coming from several countries outside the USA. He
gave them the opportunity to participate in all kinds of artificial organ research and work on their own new ideas. They
all became part of a highly motivated worldwide network
of enthusiastic students and well-established researchers, a
web that Kolff established and that influenced the success
of many of them in their career.
Kollf’s attitude and never-ending creativity for innovations can be summarized by a title he used for several of his
presentations: ‘Bringing the fun back into bioengineering’.
His creativity derived from inner drive and was accompanied by genuine intuition that was not always necessarily
based on knowledge. In fact, sometimes knowledge of accepted rules and principles puts the brakes on creative ideas
because we may think ‘It is impossible!’. During his entire
life, Pim Kolff has challenged such scholastic assumptions
by repeatedly ‘turning the impossible into reality’, as remembered by his co-worker and long-lasting colleague in
Salt Lake City, Horst Klinkmann. His credo, as pointed
out by Paul Teschan in 1998, was always ‘New ways of
thinking!’ [1]. The father of artificial organs used his ingenuity to design concepts and elaborate on them, allowing
the dream of manufacturing artificial organ ‘spare parts’ to
come true.
Wilhem Johan Kolff was born on 14 February 1911 in
Leiden, Holland, as the eldest son in a doctor’s family. At
that time, his father, Dr Jaap Kolff, served as director of the
sanatorium in Beekbergen, a small village in the north of
Arnhem. While strolling with his son in the neighbourhood,
he used to make young Pim familiar with the responsibility
that he himself felt as a doctor towards his patients [2]. Kolff
often recalled his youth and commented in an interview: ‘I
didn’t want to be a doctor when I was a boy, because I
didn’t think that I could bear to watch people die, and I am
not so sure that I am resigned to it yet. With my father, I
could walk for hours in the pine woods, unravelling some
particularly difficult problems. His example finally swayed
me from my original conviction that I was cut out to be a
zoo keeper!’ [3].
It might be interesting for some young physicians to
learn that the young Kolff found most subjects he had to
learn rather boring. Only after repeating his examinations
in three subjects was he able to start studying medicine at
the University of Leiden, where he qualified as a physician
in 1937. Looking for a position, he ran up against the ruling,
which we may find hard to imagine nowadays, that neither
the University of Leiden nor other institutions in the vicinity
admitted married physicians to specialization in internal
medicine, probably with the argument that a doctor must be
available 24 h a day [2]. It was only the Clinic of Internal
Medicine in Groningen that accepted married doctors and
therefore, Kolff switched to the University of Groningen.
Kolff profited at that time from the support and cooperation of Robert Brinkman, a professor of medical biochemistry. Brinkman and Kolff took a cellophane tube of about
45 cm, closed one end with a knot and filled it partially
with only 25 ml of an aqueous solution of urea, expelled
the air from the remainder of the tube and closed that end
also with a knot. They then placed the flat sack on a board in
a tank of water. An electric motor slowly moved the board
up and down so that the water in the tank was in constant
motion. The urea in the sack originally had a concentration
of 4 g/l. After half an hour’s dialysis, they could not recover
any urea from the Cellophane sack. Dr Kolff attributed this
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2300
Fig. 1. Dr Wilhem (Pim) Johan Kolff (1911–2009) and his rotating drum
in 1999 (photo by the author).
success to the favourable ratio between the surface, the volume of the cellophane sack, as well as to the agitation of
the sack. For this purpose, the hollow drum of his first artificial kidney had a fin inside to keep the water in constant
motion. Anticipating the need for safety conditions, Kolff
put specific emphasis on removing all traces of pyrogenic
remnants of bacteria from rubber tubes and glassware.
Following the Nazi occupation of the Netherlands and
the appointment of a national socialist as a new head of the
Groningen clinic, Dr Kolff left Groningen for the city of
Kampen in 1940, where one can trace his further attempts at
the concept of the artificial kidney, following those already
published by Abel and colleagues in the USA, by Georg
Haas in Germany and Heinrich Necheles in China. Kolff
continued his first experiments on blood washing with cellophane tubes by using heparin as an anticoagulant. Without
performing any prior animal trials, he applied his rotating
drum device for the first experimental haemodialysis on a
young uraemic patient, named Gustav Boele in the winter of
1942/1943, whereas the first ‘official’ haemodialysis treatment with his revolving drum (Figure 1) was performed
on a young woman on 17 March 1943 [2,4]. It saved the
life of Sophia Schafstadt, a patient suffering from acute
renal failure, on 11 September 1945. Her dialysis lasted
11.5 h. The clinical report of this first dialysis is shown in
Figure 2.
Kolff defended his achievements in his PhD Thesis entitled ‘De kunstmatige Nier’, on 16 January 1946. It was
J. Vienken
awarded ‘summa cum laude’ by the University of Groningen [5].
Following this successful treatment, Dr Kolff aimed to
make the therapy available elsewhere.
The rotating drum was thereafter successfully used outside the Netherlands, in the United Kingdom and in the
United States. Today, models of his rotating drum are on
exhibit in Kampen and in Germany. Another breakthrough
in the development of the artificial kidney was the construction of the first disposable coil dialyser in cooperation with
Dr Bruno Watschinger from Vienna, Austria. The company
Travenol marketed this device as one of the most commercially successful devices in the early days of dialysis.
The Kampen hospital authorities were unable to provide
the necessary resources for Kolff’s experimental work. As
a consequence, he followed an invitation to the Cleveland
Clinic, today one of the leading hospitals in the world for
(artificial) organ and tissue transplantation. Here, based
on his experience in blood oxygenation in Kampen, he
continued to work on pump-oxygenators.
Together with Peter Salisbury, Kolff founded the
American Society for Artificial Internal Organs (ASAIO)
in 1955 as a forum to discuss the problems of technical
devices for medical application in this budding discipline
of medicine. He served as the first president of ASAIO,
before he moved from Cleveland to Salt Lake City, UT,
USA. Here, he first received the position of a professor of
experimental surgery and served as director of the Institute
of Biomedical Engineering at its medical college. Under
his supervision, a team of surgeons, chemists, physicists
and bioengineers developed an artificial heart and made it
ready for industrial serial production. Based on lengthy animal trials, this first total artificial heart was then implanted
into the thorax of Dr Barney Clark in December 1982.
Apart from the total artificial heart, Kolff’s interest also
focussed on the development of an artificial eye in cooperation with William Dobelle. Further, he maintained his
original passion to try to improve devices for the treatment
of kidney failure. During his visit to Germany in 2001,
and based on early experiments in Kampen, he proposed
the ‘two-kettle’ technology for the preparation of fluids for
peritoneal dialysis. Sterilizing solutions containing CaCl2 ,
MgCl2 and glucose separately from solutions containing bicarbonate and NaCl on an oven in two different kettles and
then mixing the fluids with the help of a connecting tube
offers the chance of an online preparation of fluid without
the risk of having glucose-degradation products (GDPs,
Figure 3).
Summarizing his lifetime achievements, Dr Kolff received 13 honorary doctoral degrees, numerous international prizes and decorations; among them are the Japan
Award in 1986, the highly prestigious Albert Lasker Award
for Clinical Medical Research in 2002 and the National
Award of Engineering (NAE) in the USA in 2003. In 1990,
Life magazine listed him among the 100 most important
Americans of the 20th century. In his home country the
Netherlands, he ranked 47 in the ‘Liste De Grootste Nederlander’, which was published in 2004. Since 1984, he
has been represented in the ‘The National Inventors Hall
of FameTM ’ for his invention of the ‘Soft Shell Mushroom
Shaped Heart’ (US Patent Number 3 641 591). The Hall
‘Bioengineering for life’: a tribute to Willem Johan Kolff
2301
Fig. 2. First clinical report of a dialysis patient suffering from acute kidney failure and treated with the artificial kidney by Dr Kolff in 1945 (taken
from Dr Kolff’s PhD thesis [4]). Remarks in colour have been supplemented by the author for better clarity.
His friends, pupils and colleagues say farewell with
wholehearted admiration and gratitude to a true, humble
medical revolutionary.
The medical device industry owes him much respect and
appreciation for his many achievements that successfully
initiated a worldwide branch of medicine that keeps millions of sick patients alive by replacing lost functions of
key body organs.
Conflict of interest statement. JV is a fulltime employee of Fresenius
Medical Care, Bad Homburg, Germany.
References
Fig. 3. The ‘two kettle’—system for the preparation of a solution for peritoneal dialysis without glucose-degradation products (GDPs) presented
by Dr Kolff in September 2001 on the occasion of his visit to Germany
(photo by the author).
of Fame honours the women and men responsible for the
great technological advances that make human, social and
economic progress possible.
1. Teschan P. Kolff’s credo: new ways of thinking Artif Organs 1998; 22:
934–937
2. Van Noordwijk J. Dialysing for Life: The Development of the Artificial
Kidney. Dordrecht, Boston, London: Kluwer, 2001
3. Zenker W. Die Entwicklungsgeschichte der extrakorporalen
Hämodialyse von den Anfängen bis zur Routinetherapie der Inneren
Medizin. München: Verlag Volker Keller, 1994
4. Broers H. Inventor for life, the story of W. J. Kolff, father of Artificial
Organs. Kampen, The Netherlands: B&Vmedia, 2006
5. Kolff W. De kunstmatige Nier. (PhD Thesis), J.H.KOK, Kampen
Holland, 1946
Received for publication: 4.5.09; Accepted in revised form: 27.5.09