Belding Scribner

BMJ 2003; 327 doi: (Published 17 July 2003) Cite this as: BMJ 2003;327:167

The inventor of shunt dialysis

Belding H Scribner invented a device credited with saving the lives of over one million patients with kidney failure worldwide. Although his work was laughed at initially, it was his invention's extraordinary success that sparked an ethical dilemma of epic proportion.

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Scribner came upon his idea in 1960 after he saw a young man recover briefly following dialysis, only to die a few weeks later. At the time, haemodialysis could only be performed for a few cycles. In a painful procedure, glass tubes were inserted into a patient's blood vessels, permanently destroying them for further access.

The patient weighed on Scribner's mind until one night when he suddenly awoke with an idea of how to save patients with end stage kidney disease. He would fashion a loop between an artery and vein, allowing the device—rather than the patient's own vessels—to be opened and closed with each cycle of dialysis.

He enlisted instrument designer Wayne Quinton to work on his idea. They fashioned the U shaped device made of Teflon that would become known as the “Scribner shunt.” Teflon proved to have a special advantage over glass: its non-stick surface did not trigger blood clotting.

The idea worked so well that Scribner's first patient, Clyde Shields, said in a 1971 interview that his first dialysis cycle “took so much of that waste I'd stored up out of me that it was just like turning on the light from the darkness.”

In 2002, Scribner won the Lasker award—widely considered to be the most prestigious award for medical achievement after the Nobel prize—along with Dr Willem Kolff at the University of Utah. Kolff developed the coil-type dialyser, while Scribner developed the shunt and parallel plate dialyser. Lasker jury chairman Joseph L Goldstein compared the way in which Scribner and Kolff built on each other's work to the symbiosis between Matisse and Picasso.

But an ethical firestorm ensued when it became clear that the Scribner shunt could save lives. Since more patients needed dialysis than could be helped, who would be saved?

Robert A Crittenden, associate professor of family medicine at the University of Washington, says that although life and death decisions were not new to medicine, doctors had a “paternalistic approach” at the time, often making decisions themselves, with “little input from patients or their families.”

Scribner would change that. He wanted to ensure that decisions were made by the community. He turned to the King County Medical Society, which appointed a committee dubbed “The Life and Death Committee.” The NBC documentary Who Shall Live? examined the troubling questions underlying decisions by the committee. Should patients with children get priority? Those who went to church? Those who had the most productive jobs?

Bioethicist Albert Jonsen says it was Scribner's invention and the formation of the committee that gave birth to the modern field of bioethics. But, says Professor Jonsen, “Dr Scribner accepted the selection committee approach reluctantly. It was the best of a bad solution.”

Scribner was not about to let the best of a bad solution stand for long. He threw his efforts into ensuring that all patients needing dialysis could receive it. He was the driving force behind legislation enacted in 1973 providing Medicare reimbursement for dialysis.

A less known aspect of Scribner's world-view was his abhorrence for the contaminating effects of the profit motive on medical care. He felt strongly that a physician's commitment to a patient should not be tainted by profits. “He was disturbed that what had been a ‘noble experiment’ was degenerating into a rush for profits,” says Dr Christopher Blagg, professor emeritus of medicine at the University of Washington. “In 1960 it wasn't usual for academic physicians to patent inventions. They sort of gave them away. He joked that if he'd patented the shunt he could have bought an island,” said Dr Blagg. “He was upset that academia was becoming more and more involved with commercial entities.”

Concern about such broad health disparities occupied much of Scribner's later years when he increasingly talked and wrote of the need for a single payer health system in the United States.

Sharon Pahlka, who met Scribner when she was first diagnosed with kidney failure 30 years ago, says, “He was very unassuming. He wore the same grey suit every day it seemed. He lived in a simple houseboat. Everyone thinks of him in his red hat and canoe. But what stood out was his humility.”

He leaves a wife, Ethel; four children; and three stepsons.

Belding Hibbard Scribner, professor emeritus of medicine University of Washington School of Medicine (b Chicago 1921; q Stanford University School of Medicine, Stanford, California, 1948), was found dead, his body floating in Portage Bay. Bent by osteoporosis and using canes, it is presumed that he lost his balance and fell off his houseboat and drowned on 19 June 2003.

[Jeanne Lenzer]

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