A Multibillion Dollar Industry, But Not for Poor Countries (2003)

This morning, the 15th of July, 2003, I woke up about 6 o’clock, and I suddenly realized that on the 17th of March, 1943, that is 60 years ago, the first patient was treated with the rotating drum artificial kidney in Kampen, the Netherlands. It was the beginning of artificial organs, and I could not remember that I have heard anywhere or seen anywhere a statement that says that this was also the beginning of a multibillion dollar industry worldwide. I started to try to make an artificial kidney in 1939 in Groningen, the Netherlands, but I had very little money. When early during the war in 1941 I was appointed the first internist at the hospital in Kampen (at a salary of $3,000 per year, or a total income of about 10,000 guilders per year), I decided that financial need would no longer keep me from making an artificial kidney. I went to the Kampen enamel factory and spoke with Mr. Henk Berk, who made the rotating drum artificial kidney for me. Actually, I never paid for it because they were only allowed to work for the German Wehrmacht. When I had seen the obvious effect of dialysis in patients, I decided to make more artificial kidneys so that I would be able to send them to other countries right after the war. The Wagenmaker (which I believe is translated as “wheelwright”) in the Granfschap in Kampen made the wooden drums. The first series of four artificial kidneys consisted of a large wooden drum that rotated through a 100 liter tank of dialyzing fluid, which is basically saline. I did not have to pay for the 100 liter enamel tanks; they were donated by Berk’s enamel factory. The metal frames were ordered somewhere else. To pay for the motors that were standing on the floor to rotate the wooden drums, we had to fill out numerous forms, as the motors were made in Germany. The artificial kidneys were hidden in several places in the city of Kampen so that they would not be destroyed if bombs fell, but no bombs fell. Three artificial kidneys were sent abroad after the war: one to Hammersmith Hospital in London, one to Mount Sinai Hospital in New York, and one to the Royal Victoria Hospital in Montreal. I did not realize at the time that when wartime industry was changing to peacetime industry, there would be no time for such a thing as an artificial kidney. The first patient I treated with the artificial kidney was Miss Schriver, a 28 year old housemaid, daughter of a small farmer. When after 12 dialyses she died, her father came up to pay the bill, and I charged him 6 guilders per dialysis, or a total of 60 guilders. He had seen the enormous care and effort we had spent on his daughter. Once our transaction was completed, he stood up and thanked me, and I immediately went down to pay the bill. In 1950 I came to the Cleveland Clinic, and payment for dialysis became an immediate problem. Dialysis Does Not Need to Be Expensive We took a Maytag washing machine and made a small dialysis machine for which a patient could wind his own coil kidney, provided cellophane and dialyzing fluid salts for 3 months, and sent the patient home, for $243. In 1972, when the government began to pay all expenses for patients with end-stage renal disease, nobody was interested anymore in inexpensive dialysis. Realizing that poor and developing countries cannot pay for commercial fluids for peritoneal dialysis, I came up with a system for peritoneal dialysis using two kettles. It was presented at the 2002 Nephrology Seminar in Bamberg and published by Dr. W. Schultz. 1 One way to get dialysis started in poor countries would be for dialysis patient associations in rich countries to adopt a poor country. They would find one dialysis patient originally from the poor country who is now in the United States. They would offer the patient a 6 week vacation in his or her native country provided that he or she would teach the two-kettle dialysis system to kidney patients in that country. So far, I have had no takers.