Nephrol Dial Transplant (1989) 4:401-40?© 1989 European Dialysis and Transplant Association-European

Renal AssociationNephrology

DialysisTransplantation

The First Twenty-five Years

The Founding of the EDTA: Facts and Lessons

W. Drukker

Introduction

Thomas Graham [1], the originator of the concept of di-alysis, predicted in the mid-19th century that some of hisfindings could perhaps be applied to medicine, and JohnAbel [2,3] was anxious to try this 'vividiffusion* apparatusin patients with failing kidneys. But he never did.

The credit for the first human dialysis (1924) goes toGeorgHaas [4,5] from Gieszen, near Frankfurt, Germany.He convincingly demonstrated that extracorporea! dialy-sis in human patients was feasible but his dialyses were tooshort and his dialysers were rather inefficient. His resultswere therefore disappointing, and his work remainedlargely unnoticed and was soon forgotten.

Monsters to Tame

The rotating dialysis machine constructed by Kolff (Fig.1) and Berk in 1943 [6,7] was the first model of an 'artificial

Fig. l. Fig. 2.

Fig. 1. WiUem Johan Kolff(1964).

Fig. 2. Bruno Watschinger from Linz (Austria) with his prototype twin-coil dialyser( 1955).

kidney' that in practice appeared to be suitable for humanapplication, but the apparatus was extremely difficult tooperate. Its successor, however, developed in 1955 byBruno Watschinger (Fig. 2) from Linz, Austria togetherwith William Kolff [8,9] the twin-coil machine, (also 'amonster to tame' to use the words of David Kerr [10]),revolutionised the treatment of acute renal failure.

Dialysis Therapy in End-stage Chronic RenalFailure

For the successful treatment of irreversible end-stagechronic failure we had to wait another five years, untilScribner and his co-workers from Seattle, USA presented[11-14] their reports on regular dialysis treatment at theASAIO meetings at Chicago (1960) and Atlantic City(1961).

An Unannounced Visit from an UnknownGentleman

While dialysis in the early 1960s had already started torevolutionise therapy and prognosis of acute renal failureand of end-stage chronic renal disease, nephrology wasstill in its infancy.

It was in May 1960, one day before the start of a sym-posium on water, electrolyte and kidney disorders inAmsterdam [15] that an unknown gentleman pushed myfront doorbell button, rushed into the house, briefly men-tioned his name and apologised for his unannounced visit.He hurriedly asked for me and a slide projector. Thestranger found both in my study and with this he showedme his new invention (Fig. 3[16]), which he wanted topresent at the symposium, asking my assistance in gettingthis included in the programme. Of course StanleyShaldon (Fig. 4) got his way, and it was also the beginningof a lasting friendship.

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402 W. Drukker

Fig. 3, Stanley Shaldon's "new invention1; silastic heparin infusorsconnected to indwelling vena cava catheters (1960).

Fig. 4. Stanley Shaldon (1964).

In the meantime, nephrology and dialysis technologyhad started to grow and Stanley, then in charge of therenal unit at the old Royal Free Hospital in London,thought that a symposium on dialysis and acute renalfailure could be very instructive.

The Royal Free Symposium on ARF [17J

We met on the 2 September 1963 at the lecture theatre ofthe old Royal Free, by some called 'the Barn' or 'thewooden hut on the roof. It was a very successful meetingand at the end it occurred to me how profitable the sym-posium had been and it became clear how much an annualmeeting like this could contribute to our knowledge. Afterthe symposium a supper was held in the ancient hall of theSociety of Apothecaries. After enjoying several glasses ofexcellent Bordeaux and a glass of port, I introduced my-self to Professor Sheila Sherlock, Stanley's professor ofmedicine, who had chaired the symposium. I briefly toldher that I had a plan to found a European dialysis associ-ation, inviting her to chair a similar symposium inAmsterdam the following year. Her reply was brief—Sheila was a no-nonsense, Thatcher-type lady: *Sorry sir,you are talking to the wrong person. I am a liver professor.You should look for Stanley Shaldon and David Kerrfrom Newcastle who are both kidney men'. I found themin the after-dinner crowd and both seemed in favour of the

idea. After coming home we started to communicatewith each other and with several others from differ-ent European countries whom, we expected, would beinterested.

The Founding Meeting in Amsterdam

It was on Thursday 24 September 1964, that some 30delegates from different countries were invited to afoundingmeeting which washeld at the Queen WilhelminaHospital of the University of Amsterdam (Fig. 5). This,therefore, is the reason why now we celebrate the 25thanniversary of our Association.

A Wrong Name, and a Lesson ...

Initially the idea was to establish a small association witha limited number of active members from a few countries.A provisional name of West European Dialysis Associ-ation (WEDA) was coined. Professor Richet (Fig. 6) ofParis, however, suggested that a WEDA would raise sus-picions of being politically biased and that was of courseunacceptable. A decision was then made that a scientificEuropean society for dialysis and transplantation shouldbe founded, with a membership open to medically andnon-medically qualified scientific workers in the field of

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The Founding of the EDTA: Facts and Lessons 403

Fig. 5. Participants in the first EDTA congress at Amsterdam (1964).

interest of the association who were working in Europeand adjacent territories.

The First Meeting [18,191

About 200 delegates and a number of guests met the nextday in the lecture theatre of the department of medicine atthe Queen Wilhelmina Hospital. Some 34 papers, anumber of demonstrations and films were presented, anda technical exhibition was arranged in an adjacent area.

William KolfT [20] presented a paper on 'Life withoutHeart and Kidneys'; according to many this was some-what too futuristic. Currently, however, life withoutkidneys offers few problems, although living without anatural heart is possible only for a limited period of time.

Sergio Giovannetti (Fig. 7) from Pisa reported on hisstudies on the treatment of uraemia with a special low-protein diet [21]; it is interestingthat even today the debatecontinues regarding the place of protein restriction inslowing down the progression of renal failure.

Jean Louis Funck-Brentano (Fig. 8) and co-workersfrom Paris described the importance of nerve conductionvelocities as an assay of the adequacy of regular dialysistreatment [22].

Hippocrates Yatzidis (Fig. 9) from Athens gave hisclassical presentation on direct haemoperfusion [23]. Inall, the meeting was a considerable success, and in

Fig. 6. Fig. ?.

Fig. 6. Professor Rtchet of Paris (1964): 'WEDA [West European Dialy-sis Association] raises suspicions of being politically biased'

Fig. 7. Sergio Giovannetti (Pisa. Italy (1964)): a special low-protein diet.

addition to those already mentioned was attended byother celebrities (Fig. lOa-c) such as Sir Douglas Black(Manchester), Sir Hugh de Wardener (London), JimRobson (Edinburgh), Jules Traeger (Lyons), and EmilioRotellar (Barcelona).

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464 W. Drukker

Fig. 8. Fig. 9.

Fig. 8. Jean Louis Funck. Brentano (Paris (1964)): motor nerve con-duction in dialysis patients.

Fig. ?. Hippocrates Yatzidis from Athens, Greece, who originatedhaemoperfusion.

The Dinner at Amsterdam in 1964:Another Lesson

Following the symposium, delegates and their accompa-nying guests were invited to dinner at the aristocraticGroote Club in Dam Square, Amsterdam. The dinner wassponsored by the Dutch Ministry of Education and Sci-ence. It was an evening full of rattling fun, possiblybecause the inexperienced organiser had failed to limiteither the number of drinks or the number of bottles ofwine. Several years later, the auditors of the Ministrychecked the accounts of the young society and noticedthat the cost of the dinner had considerably exceeded thebudget and we had to refund the excess. This nearlycaused the premature bankruptcy of the financially stillvulnerable association.

The First Year

Stanley Shaldon, David Kerr and Jern Hess Thaysenfrom Copenhagen (Fig. 11 a-c), the latter representing theScandinavian countries, and I met later that year inthe basement of the Regent Palace Hotel in London. A

Fig. lOa-c. Celebrities at thefounding meeting: (a) SirDouglas Black, (b) Sir Hughde W'ardener, (c) Dr JimRobson. (right)

Fig. II a-c The other foundingmembers: (a) David N. S. Kerr(1986); (b) Jorn Hess Thaysen(1985): (c) William Drukker(1985).

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The Founding of the EDTA: Fads and Lessons 405

constitution was drafted and Stanley contrived a newname: the new Society became the European Dialysis andTransplant Association (EDTA). A logo was designed forthe new Association a few weeks later at my desk at home.It was neither beautiful nor original. The somewhat cryp-tographic antique symbols were from a book by Weisbergfrom Chicago which indicated:

V = water, 6 = salt, Q=acid, ft = alkali

The Second Congress

The new Association held its second congress inNewcastle-upon-Tyne in September 1965 under the presi-dency of Mr John Swinney, a noted Newcastle urologistand a renewed pioneer in the field of transplantation; the'T in the society has always been important, even fromthe earliest da vs.

Childhood Diseases

At that time Jean Hamburger, head of the powerful andinfluential Necker Hospital nephrology group in Paris,was busy establishing the International Society ofTransplantation and he feared competition from the newAssociation, but his vigorous attempts to remove the T 'of Transplantation from EDTA failed. However, in 1967the new International Transplantation Society, by sur-prising coincidence, had scheduled its first Congress inParis on exactly the same days as the fourth Congress ofthe EDTA in Copenhagen. This clearly could have ad-versely affected both associations, and a hectic timeensued for the President, Jorn Hess Thaysen, and theSecretary-Treasurer, travelling between Amsterdam,Copenhagen and Paris. Fortunately, at the last minute acompromise was reached as the EDTA relocated its Con-gress to Paris and changed its dates to avoid a clash ofinterests.

Surprisingly, at this Congress, Jean Hamburger pre-sided at the annual dinner in the Pavilion d'Armenonvillein the Bois de Boulogne. At dinner, he invited my wife,Mabel Mary (Molly) Lely to be his partner and Mina HessThaysen to be the other guest of honour (Fig. 12). Mina, aprofessional singer and singing teacher to the DanishRoyal Family, and Molly enjoyed the food but found theoccasion rather formal. Mina, without warning, took amicrophone and invited everybody to join her in commu-nal singing, starting a popular song. But nobody joined in. . . Molly then tried to liven the evening by pinning apopular nonsense badge—'Kiss me I'm sweet'—on JeanHamburger's lapel, but again nobody responded. Many,Mabel Mary's husband included, were shocked and some-what embarrassed, but no harm was done: Hamburger

Fig. 12. At the 1967 annual dinner at the Pavilion d'Armenonville in theBois de Boulogne in Paris. Left to right: Mabel Mary Lely (the spouse ofthe Secretary-Treasurer). Jean Hamburger and Mina Hess Thaysen (thespouse of the then president of the EDTA).

took the joke like a good sport and calmly removed thebadge from his jacket.

An Important Decision

Notwithstanding some financially critical years and somecontroversies and disagreements, political and other-wise—more or less the common childhood diseases—theAssociation survived its infant years and began to growand gain prestige. At its first Congress in 1964 a mostimportant decision was taken, that there should be estab-lished a registry of all European patients on replacementtherapy for renal failure. In this way the EDTA Registry-became a unique enterprise in the medical world and arare example of international co-operation. In 1965 thefirst Registry Report was devised in a rather primitive wayin my home in Amsterdam: all returned questionnaireswere spread out on the floor of our front room. We had towalk carefully on our toes or to creep on all-fours betweenthe precious data sheets, keeping our beloved dog out ofthe room. Tony Wing, who later became the Registry'sdirector, still considers the floor of that room an holyarea.

Twenty-five years ago electronic data processing wasstill beyond the horizon. None the less, a report wasderived: a rented mechanical calculator was a noisy buthelpful piece of equipment. At the second Congress inNewcastle in 1965 the first report on dialysis was pre-sented [24], with data on 271 chronic patients from 41European centres. Of these 271 patients, 160 were alive. In

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W. Drukker

Fig. 13. Frank Parsons from Leeds. UK presented the first Registryreport on transplantation in 1965.

Fig. 14, Fig. 15.

Fig. 14. Hans Gurland (1965) from Munich FRG, computerised iheannual Registry Reports and was chairman of the Registry from 1.97! to1976.

Fig. 15. Vittorio Andreucci (1976) from Naples, Italy, a long-termdedicated member of the Association.

addition Frank Parsons (Fig. 13) reported that 258 renaltransplant operations had been performed in Europe anddetails regarding 187 patients were presented [25].

In 1971, after some disastrous efforts to computerisethe Registry data with the assistance of mathematiciansfrom IBM, both dialysis and transplant reports were suc-cessfully integrated and computerised by Frank Parsonsand Hans Gurland assisted by Dr Harlen, who was aprofessor of mathematics at Munich University.

Hans Gurland (Fig. 14) chaired the Registry' Com-mittee from 1971 to 1976, when Tony Wing took over andbecame the first director of the Registry. Neville Selwoodfrom Bristol provided computing expertise. Under Tony'sdirectorship the EDTA Registry became the proud ownerof a powerful computer, which, in 1986, provided data onpatients from 2065 European centres, 82% of all centresknown to the Registry, having a database of more than111 300 European patients living with the support ofeither dialysis or a functioning transplant.

Fig. 16. The two secretaries at the Queen Wilhelmina Hospital on 24September 1964, 7.30 a.m. during the calm before the storm. Ms IdaPaumen (left} and Ms Gerda Kaandorp (right).

It is with admiration that I acknowledge the fourwizards, Frank Parsons (Leeds), Hans Gurland(Munich), Tony Wing (London), and Felix Brunner(Basel) who, with the other members of the RegistrationCommittee and with the assistance of Miss Sheila Dykes,made the annual Registry Reports so successful andworld-famous.

Perhaps more than any other scientific medical societythe EDTA has, from its very early days, been a largefamily and I think that it remains so. I would like to men-tion a few members but I recognise that this is selectiveand by no means exhaustive. David Kerr (Fig. I la) hasremained a very staunch supporter of the Association. Heis a man dedicated to his patients, to medical science andresearch, to teaching and training and in particular to theEDTA. Stanley Shaldon is a most versatile man with asharp tongue, having brilliant ideas and often feared inour scientific discussions and business meetings. VittorioAndreucci (Fig. 15) has given long and loyal service to theAssociation, both as Secretary-Treasurer and subse-quently as President. I should like to mention many, manyothers and to include their pictures, but space does notpermit.

Associations, however, need more than just members.Without Molly, my wife and my two secretaries from themid-sixties, Ida Paumen and Gerda Kaandorp (Fig. 16),the founding of the EDTA would have been impossible. Iwould advise that if ever you plan to found anotherassociation, look for two excellent secretaries who areessential and indispensable for the work, and obtain thesupport and enthusiasm of your wife.

It occurs to me that the EDTA-ERA is in good handswith its present President and Secretary-Treasurerassisted by experienced members of Council. I wish the

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The Founding of the EDTA: Facts and Lessons 407

Association continued healthy growth and progress in allits scientific activities. And I end this brief historicalreview by congratulating the Association on reaching itssilver jubilee.

References

1. Graham T. Liquid diffusion applied to analysis. Phil Roy SocLondon 1861; 151: 183

2. Abel JJ, Rowntree LG, Turner BB. On the removal of diffusiblesubstances from the circulating blood by means of dialysis. TransAssoc Am Physicians 1913; 28: 51

3. Abel JJ, Rowntree LG, Turner BB. On the removal of diffusiblesubstances from the circulating blood of living animals by dialysis. JPharmacol Exp Ther 1913-1914; 5: 275

4. Haas G. Dialysieren des stromenden Blutes am Lebenden. KlinWochenschr 1923; 2: 1888

5. Haas G. Ueber Versuche der Blutauswaschung am Lebenden mitHilfe der Dialyse. Naunyn Sckmiedebergs Arch Pharmacol 1927;120:371

6. Kolff WJ, Berk HThJ. De kunstmatige nier: een dialysator met eengroot oppervlak. Ned Tijdschr Ceneeskd 1943; 87:1684

7. Kolff WJ, Berk HThJ et al. The artificial kidney, a dialyser with agreat area. Acia MedScand 1944; 117:121

8. Watschinger B, Kolff WJ. Further development of the artificialkidney of Inouye and Engelberg. Trans Am Soc Artif Intern Organs1955; 1:37

9. Kolff WJ, Watschinger B. Further development of a coil kidney. JLab ClinMed \956; 47:969

10. Kerr DNS. Twenty-five years of haemodialysis, a tribute to thepioneer work of the Belfast renal unit. Ulster MedJ 1985; 54 [Suppl]:586

11. Scribner BH, Caner JEZ et al. The technique of continuous hemo-dialysis. Trans Am Soc Artif Intern Organs 1960; 6: 88

12. Scribner BH, Buri R et al. The treatment of chronic uremia bymeans of intermittent dialysis: a preliminary report. Trans Am SocArtif Intern Organs 1960; 6: 114

13. Quinton W, Dillard D et al. Cannulation of blood vessels for pro-longed hemodialysis. Trans Am Soc Artif Intern Organs I960; 6:104

14. Pendras JP, Cole JJ, Tu TH, Scribner BH. Improved technique ofcontinuous flow hemodialysis. Trans Am Soc Arlif Intern Organs1961; 7: 27

15. Stewart CD, Strengers TH ed. Symposium on Electrolyte and WaterMetabolism. Amsterdam, London, New York, Princeton: Elsevier,1961

16. Shaldon S, Rosen SM. Technique of refrigerated coil preservationhaemodialysis with femoral venous catheterisation. Br MedJ 1960;2:411

17. Shaldon S, Cook GC, ed. Acute Renal Failure. Oxford: BlackwellScientific, 1964

18. Drukker W. Annual business meeting. Proc Eur Dial Transplant/ 4MOC1965;2 :346

19. Drukker W. The birth of the EDTA revisited. Nieren und Hoch-druckkrankheiten 1986; 15: 309

20. Kolff WJ. To live without heart and kidneys. Proc Eur Dial Trans-plant Assoc \964; I:97

21. Giovannetti S. Low nitrogen diet in severe chronic uraemia; clinicalexperience of 20 months duration. Proc Eur Dial Transplant Assoc1964; 1: 147

22. Funck-Brentano JL, Chaumont P, Mery JPh et al. Interet de lamesure de la vitesse de conduction nerveuse (V.C.N.) dans la surveil-lance des malades uremiques soumis a des hemodialyses repetees.Proc Eur Dial Transplant Assoc 1964; 1: 23

23. Yatzidis H. A convenient haemoperfusion micro-apparatus overcharcoal for the treatment of endogenous and exogenous intoxi-cations. Its use as an artificial kidney. Proc Eur Dial TransplantAssoc 1964; 1:83

24. Alberts Chr, Drukker W. Report on regular dialysis in Europe. ProcEur Dial Transplant Assoc 1965; 2: 82

25. Parsons FM, Clark PB. Report on renal transplantation in Europe,based on replies to questionnaire. Proc Eur Dial Transplant Assoc1965; 2: 157 by denis fouque on A

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