Hopes and Limits of Bionic Parts
October 5, 2002
Dr. Willem J. Kolff, the inventor of the artificial kidney
and the leader of the team that created the first
artificial heart, was awarded the Albert Lasker Award for
Clinical Medical Research last week. He is now working on a
wearable artificial lung. Daphne Eviatar spoke with him.
Q: Is it true you made the first artificial kidneys out of
sausage skin and orange juice cans?
The first artificial kidney that worked indeed used
artificial sausage skin. It's a good dialyzing membrane. I
didn't fill the sausage with blood. I used just a little
bit. The blood has to move through a large rotating drum.
It falls to the lowest point, where it moves through
dialyzing fluid, which filters out the wastes. The blood
went from one end, around the drum to the other end. And
that was the first artificial kidney. Then in 1955 we
decided to make a throwaway disposable artificial kidney.
And that was made around a fruit juice can.
How did the medical establishment initially respond to your
invention?
Well, as an example, in Presbyterian Hospital here in New
York, there was a doctor who refused in principal to use
the artificial kidney. When the residents saw a patient
with renal failure, they referred him to other hospitals. A
young student was so worried about it that at his own
expense he bought an artificial kidney, set it up and
treated a dog with it so everybody could see it in the
hopes that he could convince this doctor to use it.
Why the resistance to these mechanical devices?
When
people hear about using something new that they haven't
thought about, they're usually against it. And doctors are
reluctant to use things on patients that have not properly
been proven.
What was the early reaction to the artificial heart?
First, there was no funding for it. Then once we created
it, the first patient who received a permanent artificial
heart was Barney Clark in 1982. He had heart failure, but
after they connected him with the artificial heart, his
circulation came back. He had a few very good days. And
then something happened which was much later explained. He
suddenly had a series of convulsions. People thought that
he had a stroke, but that wasn't so. He had been given an
overdose of a drug. But nobody recognized it. Barney Clark
died 112 days after receiving the heart. But it wasn't from
a stroke. Still, it gave the artificial heart a bad name.
Are there philosophical objections to an artificial heart?
The heart is the symbol of love, the habitat of the soul
and the site of life. And some people think that to replace
that is kind of revolting. I remember I was standing in the
men's room at the N.I.H., and one of the top men at the
N.I.H. looked back over his shoulder at me and said: "I
hope the artificial heart will never work." He thought you
shouldn't do a thing like that. That's also why it's
difficult to get support. Nobody wants an artificial heart.
Unless they're going to die two days from now.
Have you faced the same resistance with other artificial
organs?
We'll have the same thing with the wearable artificial
lung. But about a week ago I went to the head of nephrology
at the Downstate Medical Center in Brooklyn. He brought out
some patients in profound pulmonary failure. One was a
nurse, and one was a mother of three or four small
children, 4 to 14. We explained the wearable artificial
lung. That you'd have one tube permanently in your chest,
and that you had to wear the oxygenator outside your body
and you needed a tank of oxygen and to push around other
things on wheels. It's not easy, but you're mobile. And the
nurse said: "I'll consider it if I can go back to nursing."
And the mother said, "I will do it if it will make it
possible for me to see my children through school."
How far along is the bionic eye?
Dr. Dobelle [William H.
Dobelle] now has supervised the implantation of eight
patients in Portugal with the artificial eye. These people
were totally blind. Afterward, one of them looked with his
artificial eye out of the window. He said: "I see a car.
I'd like to drive it." And he drove a car. And three people
with the artificial eye have now been able to drive a car.
Carefully, slowly and on private property. But they put
mannequins in the parking lot and they didn't kill the
mannequins.
Will artificial organs ever be common?
The artificial heart will, because we don't have enough
human hearts for transplantation. And according to the
present rule, we're losing 25 percent of them. Because they
are implanting them in very sick people. It should be
forbidden to put a healthy donor heart into a very sick
patient. But now all over the United States, if a patient
comes in who is about to die, they give him a donor heart
instead of giving it to the person who's No. 1 on the
waiting list. They should be given an artificial heart. If
you give a patient on the verge of death an artificial
heart, chances are that tomorrow morning he will ask for
breakfast, and within a week he is walking around. Then
three weeks later when he is in excellent shape, you give
him a donor heart and he will live and mortality is close
to zero - 95 percent or better. So they should not waste
donor hearts on sick patients if it's possible to give them
an artificial one.
How far along is the bionic ear?
The ear is wonderful. At the University of Utah we
implanted 63 people with the artificial ear. You cut the
skin and screw an electrical connector to the brain. One
man has had this for 24 years. Of the 63 patients we have
had that received this type of artificial ear, 60 percent
could use the telephone. Not that they hear perfectly, but
they can use the telephone. As a minister from the South
said, it's not only that we can now communicate, but we are
relieved from this silent world. When he got his artificial
ear, he went to the men's room and he flushed the toilet,
and then he kept flushing it over and over because he loved
the sound so much. And then he felt the hand of the janitor
on his shoulder who said to him, "What the hell are you
doing?"
Could artificial organs significantly extend the human life
span?
I'm 91 and a half so I should be careful what I say. Very
few people live longer than 100 years, and the artificial
heart will not change that. It will perhaps lead a few more
people to become 105, but not 110 or 120.
http://www.nytimes.com/2002/10/05/arts/05QNA.html?ex=1034807104&ei=1&en=653a
3b9f953c56d5
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