Willem Kolff's Artificial Kidney: The Machine That Bought a Comatose Patient Time

Kampen, the Netherlands, 11 September 1945. Willem Kolff, a 34-year-old internist, connects a comatose 67-year-old woman to a machine he built during the German occupation with the help of a local enamel factory. It is cellophane tubing, the kind used for sausage casings, wound around a drum that turns with its lower part in a bath. Blood travels inside the tubing; small molecules such as urea cross its wall into the bath, and the blood returns to the patient. Years earlier Kolff had watched a 22-year-old man die of uraemia and set out to remove from the blood what the kidneys could no longer clear. Almost all of his first patients died. This time, after several hours of dialysis, he bent over her and asked whether she could hear him. She opened her eyes and said: "I am going to divorce my husband!" Her kidneys later recovered.

What do we know for certain? What Kolff himself wrote. The scene and the dialogue come from his own account, published in Nature Medicine in 2002 when he received the Lasker Award: a recollection written more than half a century later, not a case record from 1945. There he calls her Maria Schafstaat, his seventeenth patient and the first whose life, in his view, was saved by dialysis. He says she had hepatorenal syndrome and was in prison with other Dutch Nazi collaborators. Other authors spell her name Sofia Schafstadt; in the video she is simply "Maria". She was not the first person treated with the artificial kidney (the first, in 1943, was a 28-year-old woman who died), nor the first to survive: a 52-year-old man survived earlier, but Kolff himself never credited the machine with his recovery. Kolff mentions eight hours of dialysis before she answered and other accounts give a longer treatment, which is why the video gives no figures.

Kolff described his rotating drum as the first clinically effective artificial kidney. From it descend the haemodialysis machines that today keep people alive when their kidneys fail, often for years, while they wait for a transplant. Protecting the kidney is still the aim when we treat an obstruction, a stone or a tumour in urology.