The Washing Machine That Cleaned Blood: How a Dutch Doctor Built the First Artificial Kidney from Sausage Casings in Nazi-Occupied Holland

In a cramped laboratory above a hospital in Kampen, the Netherlands, a young physician named Willem Kolff stared at a wooden drum salvaged from a broken washing machine. It was 1943. The country was under Nazi occupation. Rubber, metal, and reliable electricity were scarce. But Kolff had a plan to build a machine that could clean human blood outside the body — a feat no one had ever accomplished.

The Problem That Had No Answer

Kidney failure was a death sentence. When the kidneys stop filtering waste, toxins accumulate in the blood, causing nausea, confusion, coma, and death within days. Doctors could do nothing but watch. The only theoretical escape was dialysis — passing blood across a semipermeable membrane so toxins could diffuse into a cleansing fluid while proteins and cells stayed behind. The principle had been known since the 1850s, when Scottish chemist Thomas Graham coined the term "dialysis" from the Greek for "to separate through." In 1913, Johns Hopkins researchers had kept dogs alive briefly with a collodion-tube device, but it clotted constantly and required hirudin, an anticoagulant from leeches, which was impossible to obtain in quantity.

Kolff, born in 1911 in Leiden, had watched a young man die of kidney failure in 1938. The memory haunted him. He spent evenings reading Graham's papers and experimenting with cellophane sausage casings — the only semipermeable material he could find in wartime Holland. Cellophane, made from regenerated cellulose, allowed small molecules like urea and creatinine to pass while holding back proteins. It was cheap, transparent, and came in long tubes.

Improvisation Under Occupation

Kolff's first dialyzer looked like a Rube Goldberg contraption. He wound 30 to 40 meters of cellophane sausage casing around a wooden slatted drum, which he mounted horizontally in a tin trough. The drum rotated slowly, driven by a small electric motor from a discarded washing machine. As it turned, the blood-filled casing dipped into the dialysate — a solution of salts and glucose — then rose into the air, allowing gravity to pull the blood along. The rotation kept the blood moving and prevented stagnation. Heparin, a new anticoagulant extracted from beef liver, kept the blood from clotting inside the tubing.

To pump blood from the patient and back, Kolff used a simple hand-cranked roller pump fashioned from orange juice cans and rubber tubing. The whole apparatus sat on a wooden frame. It was noisy, leaky, and required constant attention. A nurse had to turn the crank by hand if the electricity failed, which happened often.

Kolff's colleagues thought he was mad. The hospital director tolerated him only because he was a diligent internist who saw patients all day and tinkered at night. The German authorities, suspicious of any unusual activity, once searched the lab. Kolff convinced them the device was for "water purification research." They left.

Fifteen Failures, One Success

Between March 1943 and autumn 1944, Kolff treated 16 patients with acute kidney failure. Most were victims of crush injuries from bombing raids or complications of childbirth. The procedure took six hours. Blood was drawn from an artery in the wrist, passed through the rotating drum, and returned to a vein. Patients lay still, connected by glass tubes, while Kolff monitored their blood chemistry with a portable spectrophotometer he had built himself.

The first 15 patients died. Some succumbed to their underlying injuries. Others developed infections at the arterial puncture site. A few bled when heparin dosing went wrong. Kolff recorded each failure meticulously, adjusting the dialysate composition, the rotation speed, the heparin dose. He later wrote that he "learned more from the patients who died than from the one who lived."

Patient 16 was a 67-year-old woman comatose from kidney failure after a septic abortion. Her family had been told she would not survive the night. Kolff dialyzed her for 11 hours. She woke up. Her urea levels dropped. She asked for herring and bread. She lived seven more years, dying of an unrelated illness. Kolff wept when she walked out of the hospital.

From Sausage Casings to a Global Lifeline

When the war ended, Kolff published his results in Dutch. An English translation reached the United States in 1947. He was invited to Boston, where he collaborated with researchers at Brigham and Women's Hospital and the Cleveland Clinic. The rotating drum was refined: stainless steel replaced wood, a centrifugal pump replaced the hand crank, and cellophane gave way to cuprophan, a stronger cellulose membrane.

The remaining barrier was vascular access. Repeated arterial punctures damaged vessels. In 1960, Belding Scribner and Wayne Quinton at the University of Washington invented the Scribner shunt — two Teflon tubes implanted in an artery and vein, joined externally when not in use. Later, James Cimino and Kenneth Appel created the arteriovenous fistula, surgically connecting artery to vein to create a durable, high-flow site for needle insertion. With reliable access, chronic dialysis became possible.

By the 1970s, hollow-fiber dialyzers — bundles of thousands of tiny capillary-like tubes — replaced the rotating drum. Machines became automated, monitoring blood pressure, flow rates, and fluid removal. Today, over three million people worldwide survive on hemodialysis, most treated three times a week for four hours per session. The global dialysis market exceeds $100 billion annually.

A Legacy of Scraps

Kolff never patented his invention. He believed medical breakthroughs belonged to humanity. After the war, he turned to artificial hearts, helping develop the first implantable total artificial heart in 1982. He died in 2009 at 97, still tinkering in his basement workshop.

The first artificial kidney was not born in a gleaming lab with venture capital and regulatory consultants. It was hammered together from a washing machine motor, orange juice cans, and sausage casings by a doctor who refused to accept that kidney failure must be fatal. His patients were guinea pigs; 15 of them paid with their lives. The 16th walked out eating herring. That woman's survival proved a machine could replace a vital organ — and opened the door to every artificial organ that followed.

This is one episode in a much longer story. For the full account of the history of dialysis and artificial organs, read “Unlocking the Human Machine” by Dorothy Reyes on MixCache.com.