By David Brown
Washington Post Staff Writer
Friday, February 13, 2009
Willem J. Kolff, 97, the Dutch-born doctor who saved and prolonged countless lives as the inventor of the modern kidney dialysis machine and chief designer of the first mechanical heart implanted in a human being, died Feb. 11 in Newtown Square, Pa. He had congestive heart failure.
Dr. Kolff spent much of his career in the United States and became distinguished professor emeritus of internal medicine, surgery and bioengineering at the University of Utah. Sometimes called "the father of the artificial organ," he was a mentor to Robert Jarvik and other pioneers in that field.
Dr. Kolff tried to harness mechanical engineering to a few simple principles of chemistry and physics -- and then bring the product to bear on human illness. His search for machines to treat disease encompassed the solidly successful and the quirkily quixotic.
He made a major contribution to the surgical pump oxygenator, also known as the heart-lung machine. He invented the intra-aortic balloon pump, used to temporarily rest the heart of someone on the verge of death from congestive failure. Both devices are routinely used around the world.
He also invented an artificial ear and an artificial eye, each implanted in a few patients. They worked to a measurable degree, but not well enough to commercialize.
Medical historian Steven J. Peitzman of Drexel University called Dr. Kolff "an emblematic figure in 20th century medicine. His way of moving medicine forward was through technology. The first device that took over the function of a major organ in a reliable way was his 'artificial kidney.' "
Jarvik, who had been one of Dr. Kolff's students in Utah, became a medical rock star in the 1980s. Pictures and descriptions of the Jarvik-7 artificial heart filled newspapers around the world, although the device was only marginally successful.
That mechanical heart was an air-driven device whose power pack was wheeled around in a small shopping cart. In December 1982, surgeons at the University of Utah implanted it in the chest of a retired dentist named Barney Clark. He suffered many complications and died 112 days later.
Dr. Kolff was director of the university's Institute for Biomedical Engineering at the time. Don E. Olsen, a retired 79-year-old researcher who succeeded him, recalled yesterday that his predecessor always referred to the different versions of the mechanical heart by the name of the person under him who was doing the most work on it at the time.
"We had the Donovan heart, the Green heart, the Kwan Gett heart, the Jarvik heart," Olsen said. "But they all should have been called Kolff's heart."
The far more successful artificial kidney was Dr. Kolff's signal achievement, and it was that device that earned him the prestigious Albert Lasker Award for Clinical Medical Research in 2002.
The machine was based on the simple physical principle that substances dissolved in water will move from a place where they are highly concentrated to a place where they are not concentrated if given a chance. When blood containing high concentrations of acid, urea molecules and salts is put in a porous container and placed in a bath of water, those substances will move through the pores and out of the blood.
Dr. Kolff cobbled together his original dialysis machine in wartime Holland using an enamel tub, a wooden drum, metal, cellophane sausage casings and an electric motor.
He used the device to rescue people whose kidneys had temporarily ceased working because of infection, shock or poisoning. The theory was that if one could filter acid and waste products out of the blood for a few days or a few weeks, a person might survive until the kidney tissue regenerated and the organs started working again.
His first 16 patients died, although some briefly roused from uremic coma as his machine performed the work of their kidneys. His 17th patient, a 67-year-old woman who was a despised Nazi collaborator during the German occupation of Holland, survived for seven more years.
"People begged, 'Let her die,' " he told author Donald Robinson for the 1976 book "The Miracle Finders." "But no physician has the right to decide whether a patient is a good guy or not. He must treat every patient who has need of him."
Dr. Kolff's triumph was especially ironic.
In 1941, he had left an academic position at the University of Groningen in the Netherlands because he refused to work under a Nazi doctor named to head the medical department. He moved to the country and became a family physician. For a while, he and his family hid a 10-year-old Jewish boy in their home.
Dr. Kolff refined his dialysis machine in the years after the war. At one point, he sent versions of it to medical scientists in the United States, England and Canada.
"This was an example of early 'technology transfer' that was really quite important. This resulted in substantial improvement of the artificial kidney," said Peitzman, who is a practicing nephrologist in Philadelphia and the author of the 2007 book "Dropsy, Dialysis, Transplant: A Short History of Failing Kidneys."
Dr. Kolff immigrated to the United States in 1950 and worked for the Cleveland Clinic until moving to the University of Utah in 1967. He did not patent the artificial kidney, viewing it as a contribution to the improvement of medicine.
"At that time, it was thought to be unethical for a doctor to make any money on an invention," he said.
He made a portable dialysis machine, which worked but required too much professional care to be practical. He also tried to make a disposable one.
"I realized that nothing was very popular here unless it was disposable," he once told an interviewer. "First, I tried a beer can to make these things, but it was too small."
His standard versions of the device worked well enough to treat not only acute kidney failure but also the permanent loss of most or all kidney function, known as end-stage renal disease or ESRD. It transformed it from a condition inevitably fatal to one that could be lived with for years, albeit not easily.
Dialysis is one of the few medical treatments guaranteed to citizens by an act of Congress. Since 1973, anyone in ESRD automatically becomes covered by the federal Medicare program, which pays for dialysis regardless of the patient's insurance status.
In 2006, about 616,000 Americans had ESRD and 430,000 were getting dialysis, which consists of several sessions per week, each about three hours. Medicare spent an average of $61,164 on each ESRD patient.
Willem Johan Kolff was born on Valentine's Day 1911 in Leiden, the Netherlands. He was the oldest of five children. His father was a doctor who operated a sanitarium.
At the time, Dutch children attended school five days a week and half of Saturday. For seven years, Dr. Kolff spent his Saturday afternoons taking carpentry lessons, which made him an accomplished builder and tinkerer.
He said he was greatly affected by walking the sanitarium grounds, hearing his father worry aloud about failing patients and exulting over ones who improved enough to go home.
"I don't want to prolong life when it is misery," he told an interviewer. "I want to prolong it when it is an enjoyable life."
Dr. Kolff's son Jacob, a retired heart surgeon in Villanova, Pa., recalled yesterday that it was to the caretaker's house at the sanitarium that his father moved the Jewish boy he was hiding when police became suspicious. The boy survived the war and later became a dentist in the Netherlands.
Dr. Kolff received a medical degree at the University of Leiden in 1938 and worked as an assistant in the pathology department. He later received a doctorate at the University of Groningen.
He married the former Janke Huidekoper in 1937. They divorced when he was 90. She died in 2005.
In addition to Jacob, he is survived by four other children, Albert Kolff of Fairfield, Conn., Cornelius Kolff of Port Townsend, Wash., Therus Kolff of Atlanta and Adrie Burnett of Falmouth, England; 12 grandchildren; and six great-grandchildren.