Problems Associated with Cryonics

(and some possible solutions)

When you buy a house, the seller is legally obliged to disclose any known defects. When you review a company's annual report, it tells you every problem that could affect the corporate share value. Since arrangements for cryopreservation may have a much greater impact on your life than home ownership or stock investments, we feel an ethical obligation to disclose problems that affect cryonics in general and Alcor specifically. We also believe that an organization which admits its problems is more likely to address them than an organization which pretends it has none. Thus full disclosure should encourage, rather than discourage, consumer confidence.

Alcor was founded more than thirty years ago. Our Patient Care Trust Fund is currently endowed with more than 2.5 million dollars and is responsible for the long-term care of at least 67 cryopatients. In almost every year since its inception Alcor has enjoyed positive membership growth. We are the largest cryonics organization in the world — yet in many respects we are still a startup company. We have fewer than a dozen employees in Scottsdale, Arizona and approximately 20 part-time independent contractors in various locations around the USA, mostly dedicated to emergency standby and rescue efforts. We serve fewer than 1,000 members and the protocols that aid our pursuit of the goal of reversible suspended animation continue to be developed. At the present time the technology required for the realization of our goal far exceeds current technical capabilities. Cryonics will not be comparable with mainstream medicine until our patients can be revived using contemporary technology, and we expect to wait for decades to see this vision fulfilled. Nevertheless, we have made important progress by introducing brain vitrification to improve patient tissue structure preservation.

Alcor shares some of the characteristics of startup companies. The organization is understaffed in some important areas and lacks as much capitalization as would be desired to support maximum growth. Limited resources prevent the organization from hiring as many highly qualified and experienced personnel as desired, and sometimes we have to postpone enhancements to equipment and procedures.

Because Alcor must react quickly to circumstances, it cannot always handle multiple tasks simultaneously. We feel a significant impact if, for example, several members experience legal death in quick succession. A heavy caseload generally means that administrative and even technical development work is postponed while member emergencies take precedence.

On the other hand, Alcor staff believe very strongly in the mission of the organization and are extremely dedicated. Alcor transport team members feel that they are saving lives, and behave accordingly. Most of all, everyone at Alcor is concerned with insuring the security of the patients who have been cryopreserved for the indefinite future. The organization's powerful sense of purpose is reinforced by the fact that all Alcor directors and most staff members have made arrangements to be cryopreserved themselves in the future.

Unlike most startups, Alcor is unlikely to fail for financial reasons. Due to the legally independent status of the Patient Care Trust from Alcor, patients can be maintained indefinitely through its portfolio of cash, investments, real estate, and capital equipment. Some wealthy Alcor members have contributed gifts and endowments to help the organization to advance, and in the event of a financial crisis, many of the people who hope ultimately to be cryopreserved would probably provide assistance. In this sense Alcor benefits from its small size, since it maintains an intimate relationship with many members which would be more problematic if our membership was ten times as large.

Inability to Verify Results

When a conventional surgical procedure is successful, usually the patient recovers and is cured. If the same surgical procedure is unsuccessful or a surgeon makes a serious error, the patient may die. These clear outcomes provide prompt feedback for the people involved. A physician may feel deeply satisfied if a life is saved, or may be deeply troubled (and may be sued for malpractice) if errors cause a death that should have been avoidable.

Clear feedback of this type does not exist in cryonics, because the outcome of our procedures will not be known definitively until decades or even a century from now. We have good reason to expect future technologies capable of repairing cellular damage in cryonics patients, but we feel equally certain that if a patient experiences very severe brain damage prior to cryopreservation, repairs may be delayed, may be incomplete, or may be impossible. The dividing line between these positive and negative outcomes cannot be established clearly at this time.

Suppose a patient experiences 30 minutes of warm ischemia (lack of blood flow at near-normal body temperature) after legal death occurs. Will this downtime create damage that is irreversible by any imaginable technology? Probably not. But what if the ischemic interval lasts for an hour — or two hours, or a day? We simply don't know where to draw the line between one patient who is potentially viable, and another who is not.

Of course we can refer to experimental work that has evaluated the injury which occurs when cells are deprived of essential nutrients. These studies provide some guidance regarding the likely damage that a patient may experience, but they still cannot tell us with certainty if future science will be able to reverse that damage.

Another problem afflicting cryonics cases is that many uncontrolled variables prevent us from developing objective criteria to compare one case with another. Consider these two examples:

• Patient A has received blood thinners prescribed by a primary care physician, independent of Alcor, to treat a pre-existing condition. These drugs have the fortunate effect of helping to keep the circulatory system open after legal death is pronounced. Since the patient is in a hospital which allows prompt access by a transport team, postmortem cardiopulmonary support and cooling can begin immediately, and all medications are administered. Blood washout is performed successfully at a local mortuary, reducing body temperature to 3 degrees Celsius. So far, so good: This is a textbook case. However, because the patient is in a remote location and is insufficiently funded to pay for a chartered jet, transport to Alcor must be via scheduled airlines. The patient must wait overnight for the first flight out in the morning. A missed connection causes additional delay, and then all flights are grounded by exceptionally bad weather. When the patient reaches Alcor he is still packed in ice but has experienced a total transport time of 36 hours.
  
  
• Patient B experiences cardiac arrest while alone at home, and remains undiscovered for several hours. Since she happens to be located very close to Alcor, our team members arrive quickly to administer anticoagulants and clot-busting drugs, supplemented with hand-held cardiopulmonary support. The patient is transported to our operating room and receives cooling and cryoprotective perfusion just two hours after legal death was pronounced.

In the first case, will the long transport time negate the advantage of a rapid initial response and replacement of blood with a chilled preservation solution? In the second case, will the initial hours of warm ischemia outweigh the advantage of the rapid transport to Alcor? We can make educated guesses, but we cannot answer these questions definitively. We have no certain way of knowing which case will work out better, because we have no evidence — no outcome.

We do have some simple ways to determine if a patient's circulatory system allows good perfusion with cryoprotectant. Personnel in the operating room will notice if blood clots emerge when perfusion begins. The surface of the brain, visible through burr holes which are created to enable observation, should be pearly white in color. The brain should shrink slightly as water is replaced with cryoprotectant. When perfusion is complete the patient's features should have acquired a sallow color indicating that cryoprotectant has diffused through the tissues.

These simple observations are helpful, but still the people who work hard to minimize transport time and maximize the rate of cooling can never enjoy the satisfying payoff that a physician receives when one of his patients recovers and returns to a normal, active life. This lack of positive outcome can cause feelings of frustration and futility, sometimes leading to disillusionment and burnout.

Conversely, if a case goes badly, team members will be protected from negative feedback. A team leader can never say to one of the personnel, "Because of your error, the patient has no chance of recovery."

The lack of a clear outcome also prevents us from refuting people who claim that future science will be able to undo almost any degree of damage. The danger of this extreme positive thinking is that it can lead to laziness. Why bother to make heroic efforts to minimize injury, if nanotechnology will fix everything?

Alcor's stated policy firmly rejects this attitude. Team members are very highly motivated to minimize injury because we believe that our members should not bet their lives on unknown capabilities of future science. Alcor generally hosts a debriefing after each case, encouraging all participants to share complaints, frustrations, and suggestions for improvement. Ideally, each case should be a learning experience, and participants should welcome criticism as an opportunity to identify weaknesses and overcome them in the future.

Still the lack of a clear outcome remains one of the biggest weaknesses in cryonics, since it encourages complacency and prevents accountability. The antidote to this problem is a better set of objective criteria to evaluate cases, and Alcor is working in consultation with brain ischemia experts to develop such criteria.

Volunteer Help

During the 1960s the first cryonics organizations were run entirely by volunteers. The field was not sufficiently reputable to attract qualified medical staff, and no one could have paid for professional help anyway.

Today cryonics is making a transition to professionalism, but financial limitations are prolonging the process. Some paramedics are associated with Alcor, and we hope for more in the future. We have an MD medical director, access to three contract surgeons, access to a hospice nurse, and assistance from an ischemia research laboratory in California where staff has extensive experience in relevant procedures such as vascular cannulation and perfusion. Alcor also communicates with a cryobiology laboratory that has made the most important advances in organ preservation during the past decade. Still, most transport team members who work remotely from the facility are volunteers who receive a week or two of training and modest payment for their work.

In the future, as Alcor becomes more financially secure and is able to offer higher salaries, the organization will attract more medical professionals. At this time, the transition is incomplete.

Limited Support from Mainstream Science

In the 1960s scientists in mainstream laboratories investigated techniques to cryopreserve whole organs. By the end of the 1970s most of this work had ended, and the field of cryobiology separated itself very emphatically from cryonics. The Society for Cryobiology has discouraged scientists from doing work that could advance cryonics, and has adopted a bylaw that threatens to expel any member who practices or promotes cryonics. Consequently the few scientists who are willing to do cryonics-related research live in fear of being excluded from the scientific specialty that is most relevant to their work.

The rift between cryonics and cryobiology may have been caused initially by fears among mainstream scientists that cryonics had a "tabloid journalism" flavor incompatible with science. In addition many scientists have been dissatisfied with the idea of applying procedures without a complete and full understanding of their outcome. Generally, in medicine, first a technique is studied, validated, and perfected, and then it is applied clinically. Cryonics has, of necessity, done an end-run around this formal approach by rushing to apply a technique based on theoretical arguments rather than validated clinical effectiveness.

During the past decade our knowledge and procedures have advanced far beyond the crude freezing methods imagined by most cryobiologists, and experts in molecular nanotechnology have voiced strong support. As more papers are published describing technical advances, we expect that cryobiologists and other scientists will revise their negative assessment of cryonics. In the future we believe that the arbitrary barrier between cryonics and cryobiology will gradually dissolve, and cryonics research will be recognized as a legitimate specialty of the field. However, for the time being the dim view taken of cryonics by most cryobiologists remains problematic, impairing Alcor's ability to achieve respectable status among other relevant groups such as prospective members, regulatory officials, and legislators.

Limited Legal and Government Support

Cryonics is not explicitly recognized in the laws of any state in the United States (see The Legal Status of Cryonics Patients). This does not mean that cryonics is illegal or unregulated. In fact, Alcor must comply with state laws controlling the transport and disposition of human remains, and we make arrangements with licensed morticians to insure than these requirements are met. Alcor also complies with federal regulations established by agencies such as OSHA and EPA.

Still, the lack of specific enabling legislation for cryonics can cause problems. In the late 1980s the California Department of Health Services (DHS) asserted that because there was no statutory procedure for becoming a cryonics organization, human remains could not be conveyed to a cryonics organization via the Uniform Anatomical Gift Act (UAGA), and therefore cryonics was illegal. Fortunately, the courts were unimpressed by this argument. In 1992 the legality of cryonics, and the legality of using the UAGA for cryonics, were upheld at the appellate level.

In 1990 the Canadian province of British Columbia enacted a law that specifically banned the sale of cryonics services in that province. In 2002 the Solicitor General (Canadian equivalent of a state Attorney General) issued a written clarification stating that the law only prohibited funeral homes from selling cryonics arrangements. Cryonics could still be performed in the province, even with the paid assistance of funeral homes, provided they were not involved in the direct sale of cryonics. This position is affirmed by the Business Practices and Consumer Protection Authority of British Columbia. Despite these assurances, anxiety about the law remains.

In 2004 a bill was passed by the Arizona House of Representatives to place cryonics and cryonics procedures under the regulation of the state funeral board. In its original form this law would have prevented our use of the UAGA. The bill was ultimately withdrawn, but may be revived at a later date. Very hostile comments were made about cryonics during the floor debate of this bill. We cannot guarantee that any future legislation will be friendly to cryonics or will permit cryonics to continue in Arizona.

Despite these uncertainties, the United States enjoys a strong cultural tradition to honor the wishes of terminal patients. We believe that the freedom to choose cryonics is constitutionally protected, and so far courts have agreed. We are hopeful that we will be able to continue performing cryonics without technical compromise, under state supervision where necessary, for the indefinite future.

Limited Mainstream Medical Support

Cryonics is not an accepted or recognized "therapy" in the general medical community. To the average medical professional, cryonics is at best an unusual anatomical donation. At worst it can be viewed by some physicians as fraud upon their patient. Hospitals have sometimes deliberately delayed pronouncement of legal death, delayed release of patients to Alcor, or forbade the use of cryonics life support equipment or medications within their facilities. On one occasion in 1988 Alcor had to obtain a court order to compel a hospital to release a patient to Alcor promptly at legal death and permit our stabilization procedures on their premises.

Relations with hospitals and their staff are not always difficult. Usually when nurses and physicians learn that cryonics is a sincere practice that is overseen by other medical professionals, they will be willing to accommodate a patient's wishes, or at least will not interfere with them. Sometimes medical staff will even assist with cryonics procedures such as administering medications and performing chest compressions if Alcor personnel are not present when legal death occurs.

The lack of formal medical recognition or support for cryonics generally means that cryonics patients remote from Alcor must be moved to a mortuary for blood replacement before transport to Alcor. Ideally these preparatory procedures should be performed within hospitals, not mortuaries. Hospitals presently allow organ procurement personnel to harvest organs from deceased patients (a fairly elaborate procedure) within their walls. We are hopeful that similar privileges will be extended to cryonics more often as the process becomes better understood and accepted, but we cannot predict how quickly this change will occur.

High Incidence of Poor Cases

In more than 50 percent of cryonics cases legal death occurs before Alcor standby personnel can be deployed, and is often followed by hours of warm ischemia. This downtime may cause severe cellular damage.

The threat of autopsy, in which the brain is routinely dissected, is an even greater danger. Any person who suffers legal death under unexpected circumstances, especially involving accidents or foul play, is liable to be autopsied. Alcor strongly urges members living in California, Maryland, New Jersey, New York, and Ohio to sign Religious Objection to Autopsy forms.

Sometimes cryonicists perish under circumstances resulting in complete destruction or disappearance of their remains. Cryonicists have been lost at sea, suffered misadventures abroad, or even disappeared without a trace. Two members of cryonics organizations were lost in the 2001 collapse of the World Trade Center towers. One was a policeman performing rescue operations.

Cryonics is not a panacea or a "cure" for death. The cryonics ideal of immediate cooling and cardiopulmonary support following cardiac arrest cannot be achieved in the majority of cases. We have good reasons to believe that molecular records of memory persist in the brain even after hours of clinical death, but only future physicians using medical technology which we do not yet possess will be able to determine, finally, whether such a person is really still "there."

What can be done?

If you are:

• An attorney interested in protecting cryonics rights in your state...
• A scientist interested in advising Alcor, or publicly supporting cryonics...
• A medical professional interested in advising or assisting Alcor...
• A paramedic or EMT interested in becoming involved in cryonics field work...
• A layperson interested in training to do cryonics field work...
• Someone with ideas or resources to help address any of the many problems above...

...then please contact us at .

...or check out our volunteer opportunities.

You can also discuss cryonics issues in the Alcor United online discussion forum.