Kidney Transplants and Artifical Kidneys

7 November 1963 and 18 December 1963

It’s hard to believe that less than sixty years ago, kidney failure was a virtual death sentence. Once the kidneys stopped their vital function of filtering toxins and excessive water out of one’s body via the bladder, death was inevitable owing to uremia, the condition where wastes back up into the blood system.  

In the early 1960s, hope for those with kidney disease arrived in the form of kidney transplants and dialysis machines, widely referred to at the time as artificial kidneys. The theory behind both procedures had been long known, but actually performing them successfully was another matter.

The first successful transplant reportedly occurred in 1950 when an American woman in Illinois received a kidney. It lasted for less than a year before it failed; this was a time before immunosuppressive drugs were available. However, the transplanted kidney lasted long enough for the woman’s remaining kidney to resume function. Four years later, a successful kidney transplant was made between twins. Owing to the close genetic similarities between twins, the transplanted kidney was not rejected. The recipient lived for eight years. However, transplants between unrelated persons were rarely attempted until the 1960s owing to rejection problems.

The first successful kidney transplant in Canada occurred in 1963 when a 55-year-old Ottawa man, Herbert Verne Trewin, of 2233 Braeside Drive in Alta Vista received a donated kidney at the Royal Victoria Hospital in Montreal. In late October 1963, Trewin had been told at the Ottawa Civic Hospital that his kidneys were failing and that his only hope was an experimental kidney transplant. He was transferred to the Royal Victoria to await the arrival of a suitable kidney.  That kidney became available on 7 November 1963, courtesy of an anonymous, 35-year-old man who had consented before dying to donating a kidney. Within an hour of the donor’s death, Trewin was on the operating table receiving his new organ. This time, a new immunosuppressive drug called Imuran would be used to counter rejection.

The operation was a success, as was the follow-up anti-rejection drug treatment. Unfortunately, there were complications, and Trewin was subjected to two further operations. He was in hospital for ten months before being well enough to return home. Throughout his ordeal, his wife Greta was at his side—contrary to hospital protocols that demanded him being kept in isolation. A bed was made up for her in his Montreal hospital room. Trewin’s hospitalization costs, amounting to $10,490, were covered by Ontario Hospital and Blue Cross insurance.

In August, 1964, a grateful Trewin, now back in his Alta Vista home, said that “It will be easier for others now. I understand they are already scheduling more kidney transplants – and someday it may even become a routine operation.” He hoped to return to his job as a Customs computing clerk at the Besserer St postal station at the beginning of October.

Newspaper clipping of Verne Trewin’s return home with his wife, Greta, Ottawa Citizen, 13 August 1964.

Sadly, Trewin continued to have serious health problems. In April 1965, he contracted pneumonia. Just weeks later, he was operated on to fix a bowel disorder. He died two days after the operation. His death was not directly attributed to the kidney transplant. But his body, weakened by successive operations and the anti-rejection drugs, had failed.

Within weeks of Verne Trewin’s receipt of a kidney in Montreal, the Ottawa General Hospital unveiled the first dialysis machine in the capital, and only the third in all of Canada, the other two being in Montreal and in Edmonton. On 18 December 1963, a small reception was held at the General for medical staff and a dozen donors who had contributed the $7,500 (roughly $66,000 in today’s money) to buy the machine. Press reports stressed that the machine could be used for both acute and chronic kidney problems. While it was not as efficient as a human kidney, some US patients had been kept alive for more than three years using similar machines.

The machine was made by a subsidiary of a Swedish company in Seattle, Washington, and was described as looking like a washing machine on the inside and a large soda pop dispenser or a fancy ice cream machine on the outside. The fact that the manufacturer of the machine also made soda pop dispensers and ice cream machines was perhaps not coincidental. It took several months of staff training before the machine was put into operation. The new hospital department was headed by Dr. Jaworski, with two urologists, four general surgeons and “a battery of nurses” said the Ottawa Journal.

Dialysis machines had been used for acute kidney problems for some time. Successful dialysis dated back to 1945 when Willem Kolff of the Netherlands used a type of rotating drum and membranous tubes made of cellophane. As the blood passed through the tubes, which were wrapped around the rotating drum filled with an electrolyte solution, the toxins passed through the membranes into the solution thereby cleansing the blood of toxins. The procedure was subsequently improved by the Peter Bent Brigham Hospital in Boston (now part of the Brigham and Women’s Hospital). The new Kolff-Brigham dialysis machine was used during the Korean War to save the lives of servicemen suffering acute kidney failure. Once their kidneys resumed normal function, the men were disconnected from the machine.

Later developments improved the ability off the kidney machine to remove excessive water in addition to the toxins. But a key advance that made the machine usable for cases of chronic kidney failure was the 1960 development by Dr. Belding Schriber of the University of Washington of a means of connecting a patient’s circulatory system to the dialysis machine via a shunt. The shunt was implanted in an artery and a vein of a patient which could then be opened repeatedly for dialysis. This shunt, initially composed of two thin, Teflon tubes, was subsequently manufactured out of flexible, plastic material. In 1962, a new connection procedure was established using an arteriovenous (AV) fistula whereby an artery was surgically connected to a vein. During dialysis, a nurse inserts two needles into the fistula, one needle removes the blood and sends it into the dialysis machine, while the other returns the cleaned blood back into the patient’s body.

In 1960, the American Clyde Schields of Seattle was the first chronic kidney disease sufferer to receive dialysis using Dr. Schriber’s new technique. He survived eleven years before succumbing to heart disease.

Newspaper clipping of Rachel Dicarie receiving dialysis at Ottawa General Hospital, Ottawa Citizen, 24 February 1964.

The first chronic sufferer of kidney disease to receive dialysis in Ottawa was Rachel Dicaire, a 25-year-old mother from Alexandria, Ontario. She had suffered from kidney disease from her youth, but matters became critical after her pregnancy. The procedure, undertaken in late April 1964, was a success. From then on, she returned to the General on a weekly basis for dialysis that took from six to eight hours per visit.

Dicarie was one of the lucky ones. The new dialysis machine could only accommodate five persons.

The hospital established a committee to choose candidates for the life-saving procedure. The criteria were stiff. A person needed to be between 20 and 40 years of age, be married, have children, and be of general good health other than for their kidneys.  In early 1965, only twenty patients in all of Canada received dialysis.

Choosing eligible candidates for dialysis must have been extraordinarily difficult for the committee as those rejected faced a bleak future. Mirroring reality, in early November 1965, CJOH television aired the first episode of a seven-part drama of Dr. Kildaire, entitled “The Life Machine.” In this show, Drs. Kildare (Richard Chamberlain) and Gillespie (Raymond Massey) must choose four candidates out of fifty for dialysis.

With demand for dialysis vastly outstripping supply, there was a campaign to raise funds for a second machine at the Ottawa General Hospital. In 1965, the Rotary Club of West Ottawa put up $2,000 towards the purchase of a second dialysis machine in honour of the 60th anniversary of the founding of the Club, while fifty Rotary members gave a promissory note for the remaining $5,000 that was needed. The Rotary Club hoped to raise these funds from the general public.

Dialysis machines were something very close to the hearts of Rotary Club members. A former president of the Ottawa branch, Cecil K. Wolff, was one of the lucky five chronic kidney disease sufferers who received regular dialysis on the first machine at the Ottawa General Hospital. Wolff was to become a member of the provisional committee that established the Kidney Foundation of Ottawa. Another member was Mr. Ken Hamilton, who was also a dialysis recipient. His wife Dorothy was another provisional committee member. In addition to raising funds for a second dialysis machine, the new Foundation hoped to raise $15,000 for special laboratory facilities as well as a further $7,000 for the training of medical staff.

The Ottawa community quickly took up the challenge. Within a week, more than $5,200 was received in cash donations. The Cradle Leaguers hockey players even turned over the proceeds of their final games of the season to the collection.

The second dialysis machine was up and running by the summer of 1965. One of its first patients was Mrs. Ann Gervais. While she waited for the second machine to become operational, she had received emergency dialysis through her stomach, submitting seventeen times to the procedure which at that time was very painful. It also could not be done indefinitely. Afterwards, Gervais wrote an open letter to the Ottawa Journal expressing her thanks to the Kidney Foundation, to the people of Ottawa who contributed so generously towards the purchase of a second dialysis machine, and to her doctors, nurses and technicians.

While dialysis offered life to kidney patients, it was not a cure. Many dreamt of the day they would receive a kidney transplant that would liberate them from long weekly stints at the hospital, and enable them to live normal lives. While Verne Trewin’s operation and his post-operative immunosuppressive drug treatment showed what was possible, it took some years before kidney transplants become routine in Ottawa. In the four years following Trewin’s transplant, the Ottawa General performed only two successful kidney transplants while the Ottawa Civic did three.

Things began to change in early 1968. In March of that year, two persons received kidneys from the same donor owing to a remarkable bequest of Jacques Patenaude who worked at the Besserer Street postal station, coincidentally the same place Verne Trewin used to work. After collapsing on the job, the victim of an aneurysm, his wife gave permission for Patenaude’s kidneys to be donated. Pregnant with their third child, the grieving woman said that this was something that her husband would have wanted. They had in fact discussed this very possibility.

Within minutes of Patenaude’s passing at the Ottawa General Hospital, surgeons removed his kidneys, one of which was taken across the city in a special organ preservation unit to the Civic Hospital. There, a team of eleven physicians, twelve nurses and two laboratory technicians transplanted the organ into W. James Harris from Vancouver. A similar team at the Ottawa General transplanted the other kidney into Jean Wright of Pembroke, Ontario. Both transplants were successful. A month after her operation, Jean Wright was back home. James Harris followed a week later. The dual, inter-hospital kidney transplant was a first in Canada.

Less than a month later, a second dual inter-hospital kidney transplant was performed in Ottawa. This time, the donor was leading seaman Roy McFarland, who had died at the Ottawa General Hospital following a traffic accident on Sussex Drive. After permission was received from McFarland’s mother, a 40-year-old man received a kidney at the Ottawa Civic Hospital while a woman received McFarland’s second kidney at the Ottawa General.

Today, Verne Trewin’s wish that some day a kidney transplant would be a routine operation has become a reality. More than 100 kidney transplants are undertaken annually in Ottawa alone. Roughly 1,700 kidney transplants were undertaken in Canada in 2018. As well, the Ottawa Hospital operates three dialysis centres at the Civic, General and Riverside campuses and at five satellite units. The centres provide dialysis services to more than 650 patients, with more than 200 receiving dialysis at home.

To help ensure that chronic kidney disease sufferers like Verne Trewin can receive a kidney, please sign your organ donor’s card to guide your family in the event of your untimely death. Organ donation is an act of love that will bring some joy amidst the grief. And who knows, you may be the lucky recipient.

Sources:

Fresenius Medical Care, 2021. The History of Dialysis.

Mapes, Diane, 2021. Shunting Death, University of Washington Alumni News.

Ottawa Hospital, 2021. In-Centre Hemodialysis.

Ottawa Citizen, 1964. “Kidney Machine offers mother new life,” 24 April.

——————, 1964.  “Surgery, wife’s love gave him a new life,” 13 August.

——————, 1965. “His Life Was Saved By A Medical Break-Through,” 9 January.

——————, 1968. “2 kidney patients in good condition,” 18 March.

Ottawa Journal, 1963. “Artificial Kidney Machine Unveiled,” 19 December.

——————-, 1963. “Kidney Machine Gives Woman New Lease on Life,” 24 April.

——————-, 1965. “Lucky Five Get New Life-Saving Kidney Treatment,” 6 February.

——————, 1965. “Gifts for Hospital, Crippled Children,” 24 February.

——————, 1965. “Cradle Leaguers Join Kidney Drive,” 26 February.

——————, 1965. “Funds, Forces Mount in War on Kidney Disease,” 8 March.

——————, 1965. “Thank You,” 25 September.

——————, 1965. “Dr. Kildare,” 6 November.

——————, 1968. “Second Inter-Hospital Kidney Transplant,” 27 April.

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