Seattle Sun Newspaper - Vol. 8, Issue 2, February 2004

Copyright 2004 Seattle Sun. Please feel free to use the article below in your research. Be sure to cite the Seattle Sun as your source.

Scribner Center carries on name,

work of medical pioneer

By JAMES BUSH

More than 40 years ago, a University of Washington professor awoke in the middle of the night with an idea for saving lives.

Dr. Belding Scribner's concept was a U-shaped tube (known as the "Scribner shunt") which connected a patient's vein and artery and extended outside the body to allow for easy connection to a kidney dialysis machine.

Today, near Northgate Mall, dialysis patients receive their treatment in a facility which bears his name. The Scribner Center is one of 12 Puget Sound area facilities operated by the nonprofit Northwest Kidney Centers, providing on-site and home dialysis services to 1,200 people.

The kidneys, which cleanse the blood and maintain blood pressure, can be damaged by diabetes or high blood pressure. Degeneration can be caused by hereditary conditions.

Kidney dialysis was invented in the 1940s, but more than a few repetitions damaged blood vessels, so it was used as a stop-gap measure to allow a patient's kidneys to heal. Total kidney failure was invariably fatal.

In early 1960, a young man from Spokane checked in to University Hospital. Near-death, he was hooked up to the artificial kidney machine and made a seemingly amazing recovery, but testing confirmed his irreversible kidney damage. "So I sat with his wife and told her that he'd have to die a second time," Scribner told Today's Health magazine in 1971.

Scribner couldn't forget the miraculous, if temporary, effects of dialysis on his patient. If he could figure out a way to allow access to the bloodstream without arterial damage, he knew the process could be repeated, and the patient's life preserved indefinitely.

Awaking from a fitful sleep one night, he realized the solution: a connection between a vein and artery which would function as part of the circulatory system. He began experiments with the aid of UW colleagues, including Dr. David Dillard and medical engineer Wayne Quinton. The challenge of keeping clotting blood from clogging the shunt was surmounted when Dr. Loren Winterscheid suggested it be constructed of Teflon, a new man-made material which was resistant to sticking.

The new device was implanted in the left forearm of Clyde Shields, a 39-year-old Boeing machinist. Just weeks from death, Shields would live another 11 years with the aid of dialysis.

In January 1962, the Seattle Artificial Kidney Center was created. But success brought with it a more troubling issue. The organization's tiny dialysis facility could treat only nine patients on an ongoing basis. Although expansion boosted its capacity to 47 patients in 1964, dialysis services were limited enough to require that medically suitable candidates be screened by an anonymous selection committee which, according to the Northwest Kidney Center Web site, chose patients based on "medical and financial criteria, ability to adjust to dialysis, family status, and the patient's potential contribution to or burden on society."

The Seattle Artificial Kidney Center added a home dialysis program in 1967 and peritoneal dialysis in 1970. It also got a new name. With its patient base now spread across Western Washington and into Alaska, and as peritoneal dialysis doesn't use an artificial kidney, the name Northwest Kidney Center was adopted.

By 1973, a combination of private insurance and Medicare funding made dialysis available to all patients who needed it, a joyful milestone for Scribner, a longtime proponent of nonprofit dialysis services.

The center also set up the Northwest Organ Procurement Agency to retrieve and distribute organs to hospitals for transplantation.

Scribner continued his medical research at the UW, developing a system to provide nourishment via catheter to patients who have lost stomachs and intestines to disease. He also kept working with dialysis patients at the Coach House, a UW research facility near University Village. In 1983, the Northwest Kidney Center took over operation of the Coach House. Two years later, the facility was renamed the Scribner Center and moved to its current Northgate location.

This was just one of many honors bestowed on Scribner for his research. In 2002, he received the Albert Lasker Award for Medical Research, second in prestige only to the Nobel Prize for a medical researcher. Scribner, who retired in 1991, died last June at age 82.

Diane Heron, a registered nurse and associate director of the Scribner Center, began working with Dr. Scribner at the Coach House in 1981. She oversees operation of the center's 22-station unit which serves some 132 patients. The three-times-a-week dialysis sessions (which include blood cleansing and withdrawal of built-up fluids), each lasts an average of four hours. The work is performed by nurses and dialysis technicians under the supervision of Scribner Center medical director Dr. Suhail Ahmad.

Successful dialysis is dependent on many factors. As loss of kidney function is often related to other serious conditions or diseases, patients typically have multiple medical problems. The dialysis process can adversely affect heart function and lead to heart failure. Some patients simply don't adapt well to dialysis, either physically or mentally. "A lot depends on how well people take care of themselves when they're on dialysis," says Heron.

Dialysis patients should only take in about three cups of fluid per day. Foods high in potassium such as bananas and orange juice should be avoided, as an excess of potassium can cause cardiac irregularities. Patients must also avoid phosphorous-rich foods such as dairy products.

Most dialysis patients are on the waiting list for a kidney transplant, although a majority don't end up getting a transplant, says Ingrid Goodwin, a spokeswoman for Northwest Kidney Centers. "There are just not enough organs to go around."

A donor kidney is matched to a potential recipient by blood type and several other factors, using a sophisticated testing procedure. Although most donor kidneys are taken from the bodies of persons who signed donor cards before their death, members of the same family are likely to be the best match, so the practice of donating a kidney to a relative has become increasingly common. A live donor with healthy organs can live a normal life with just one kidney. The process has gotten extensive publicity in recent years through two National Basketball Association players who suffered from kidney failure: Sean Elliott received a kidney from his brother; Alonzo Mourning's donor was his cousin.

Waiting for available cadaver kidneys can be like playing the lottery: potential transplant patients undergo testing, then wait for a properly-matched donor kidney to become available.

Donor kidneys will eventually fail. The average life of a donor kidney is about six years, but some recipients have maintained kidney function for up to 20 years. The transplant process has improved over the years: the matching process is more exact and new medications have been created that are easier on the body, says Heron. "Most of the people with transplants we do not see back: I'd say 90 percent. It used to be 30 percent when I started this."

Irwin Etter is one of those who came back. A longtime Scribner Center patient, now gets his dialysis treatments at the Northwest Kidney Centers' Lake City facility (he and his wife moved from their former home in Broadview to a Sand Point condominium). "I went on dialysis in June 1988, but I had eight years out with a kidney transplant," he says.

He originally lost kidney function due to inherited glomerulo nephritis, a genetic disorder which causes the body's own defense mechanisms against disease to attack the kidneys, leading to gradual loss of function. "I'm the first male in my family to have it and survive," he says.

Etter, who received a cadaver kidney in 1990, says a successful transplant changes your life. It allowed him to travel and participate on national committees through his job. He likens the psychological effect of losing function in his transplanted kidney to "losing a loved one. You go through all the stages: denial, anger, gradual readjustment."

He's still able to travel, but the availability of dialysis for travelers varies widely. Etter cites a New York City facility which keeps spare capacity to accommodate tourists and cruise ships which are equipped with dialysis facilities, but notes that he hasn't been able to find dialysis services when visiting his wife's family in Connecticut.

Patients sit in close proximity to one another during dialysis sessions and often talk to pass the time, he says. "For somebody like myself that's retired now, this social aspect is very nice." But it can provide some sad moments. Etter, a former Boeing employee, recalls spending many hours talking with a younger man with a similar work background. One day, "he just disappeared." Etter learned the man had died suddenly.

While Seattle has one of the lowest mortality rates in the country for dialysis patients (about 15 percent ), Etter says that aid cars still have to be called in a couple times a month to treat patients suffering from cardiac episodes. "So it's a reality," he says. "It's not just a number."

For Maple Leaf resident Sharon Pahlka, kidney failure came shockingly young. At age 23, she found her inherited condition of polycystic kidney disease hard to accept. She delayed going into dialysis, she says, and limited her number of sessions at first. "There was a lot of denial," she says. "You just can't believe such a horrible diagnosis could be given to you."

After a year of dialysis in Oregon and a period on home dialysis, she came to the Coach House, where she was under the care of Dr. Scribner for 16 years before her successful transplant. She credits Scribner for convincing her to put herself on the transplant list. Pahlka says she had seen too many transplant patients suffer health complications, and didn't want to take the risk. "Dr. Scribner kept bugging me," she says, reminding her of the advances that had taken place during her first two decades in dialysis.

Her brother, Vince, considered donating a kidney and underwent testing at the UW, but the two had never sat down to discuss the issue, she says. "He never said anything to me, and I wasn't going to say 'Let me have your kidney.'"

However, events would force her to do just that. Late one night, Pahlka received a phone call: a cadaver kidney was available, but the donor was a 55-year-old man in poor physical condition. "It was a 11 o'clock at night, and I had a half hour to decide," Pahlka recalls. She called her brother immediately, and he agreed to be a donor. This March will mark the 11th year her donor kidney has maintained proper function.

As with many successful kidney transplant recipients, Pahlka is a physical fitness buff. She has faithfully lifted weights to avoid osteoporosis (brittle bones), a common side effect of kidney failure, and was able to take up more strenuous sports such as running and aerobics after her successful transplant. "I wanted to do the best on the things I can control because there are a lot of things you can't control," she says.

While she hasn't had to return to dialysis, Pahlka has volunteered at Northwest Kidney Centers for the past 20 years. She's served on the patient advisory board, written articles for the newsletter, and been a key member of the organization's speakers' bureau.

A UW graduate with a degree in social work, Pahlka works as a life coach, often working with people "with chronic life challenges. From what I've gone through, it's given me the credibility to help other people," she says.

The name of her business: Life Is A Gift.