Kidney failure, or end-stage renal disease (ESRD), occurs when the kidneys function at less than 10 to 15 percent of their normal capacity. When this happens, the kidneys are unable to remove waste products and excess fluid from the blood, leading to a toxic buildup in the body. This condition was almost universally fatal until the development of a mechanical solution. Dialysis is a procedure designed to filter the blood outside the body, performing the purification functions the diseased kidneys can no longer manage. The dialysis machine transformed a death sentence into a manageable, chronic condition, representing one of the most important life-saving inventions in modern medicine.
Early Scientific Groundwork
The theoretical foundation for blood purification through a machine was established in the early 20th century. In 1913, American pharmacologist John Abel and his colleagues, Leonard Rowntree and B.B. Turner, developed an apparatus they called a “vividiffusion” machine. This device routed an animal’s blood outside the body through tubes made of collodion, a semipermeable membrane derived from cellulose, to filter out small molecules like urea. To prevent the blood from clotting as it passed through the external circuit, the researchers used hirudin, an anticoagulant extracted from the salivary glands of leeches. Abel’s experiments proved that the principle of hemodialysis—using a membrane to separate waste from blood—was scientifically sound. However, the apparatus was large, highly technical, and often resulted in the death of the animal subjects. A decade later, German physician Georg Haas performed the first human dialysis treatments in the 1920s, but his patients did not survive, demonstrating the technique was not yet effective for clinical use.
The Breakthrough: Designing the First Artificial Kidney
The first machine that could successfully sustain human life was developed by Dr. Willem Kolff, a Dutch physician, during the occupation of the Netherlands in World War II. Working under challenging conditions in Kampen, Kolff was forced to improvise heavily due to wartime shortages. His design, known as the rotating drum kidney, was constructed from materials like a washing machine drum, a motor, and a 20-meter length of cellophane sausage casing that served as the semipermeable membrane.
Kolff’s crude 1943 prototype circulated the patient’s blood through the cellophane tube, which was wrapped around the rotating drum and constantly dipped into a tank of dialysate fluid. The rotation helped maximize the diffusion of waste products across the membrane and into the surrounding fluid. His initial attempts were unsuccessful, and the first 15 patients treated with the machine died due to the severity of their illness and technical limitations. The first true success came in September 1945, when Kolff used the device to treat a 67-year-old woman suffering from acute kidney failure, who regained her kidney function and was discharged from the hospital.
Making Dialysis Clinically Practical
Following the war, Kolff brought his invention to the United States, and technical refinements transitioned the device from a wartime measure to a medical instrument. The bulky rotating drum design was gradually replaced by more efficient, compact parallel-plate and coil dialyzers that required less blood volume and were easier to operate. The major barrier to long-term survival remained the inability to repeatedly access the patient’s bloodstream without damaging veins and arteries. Each treatment required a painful, temporary surgical procedure.
This limitation was overcome in 1960 by Dr. Belding Scribner and his team at the University of Washington in Seattle. They developed the arteriovenous shunt, a U-shaped tube made of Teflon that connected an artery and a vein, allowing blood to continuously flow between the two vessels. When a patient needed dialysis, the shunt could be easily disconnected, attached to the artificial kidney machine, and reconnected afterward. The invention of the Scribner shunt provided a permanent, reusable access point for repeated treatments, making chronic maintenance dialysis for patients with end-stage renal disease a practical reality.
Integrating Dialysis into Standard Medical Care
The clinical success of the Scribner shunt and improved dialyzers in the early 1960s created an ethical dilemma: the demand for life-saving dialysis far outstripped the supply of available machines and trained personnel. The world’s first outpatient dialysis facility, the Seattle Artificial Kidney Center, opened in 1962 with very limited capacity. This scarcity forced the creation of an anonymous lay committee tasked with deciding which patients would receive the treatment.
This “God Committee” was criticized for using non-medical criteria, such as a patient’s perceived “social worth” or community value, to ration the limited resource. The ethical controversy and the financial impossibility for most patients to afford the costly, ongoing treatments led to a national push for universal coverage. This movement culminated in the passage of the Social Security Amendments of 1972, which established the End-Stage Renal Disease (ESRD) program in the United States. By extending Medicare coverage to virtually all Americans with kidney failure, regardless of age or income, this legislation integrated dialysis into standard medical care and eliminated the need for rationing committees.