“Suspended Animation” in the Popular Press

Reports in the popular press that “humans have been placed in suspended animation for the first time” have been widely circulated by advocates of cryonics. The UK tabloid Daily Star even talks of a “space travel barrier removed as docs freeze and revive human for first time.”

The actual procedure does not involve freezing (or subzero preservation) and the use of induced hypothermia for medical treatment is much older than these stories indicate. A noted scientist in the field of low temperature medicine comments:

“The news story is announcing human clinical trials of an idea called Emergency Preservation and Resuscitation (EPR) that’s been in preclinical development for more than 20 years.
https://en.wikipedia.org/wiki/Emergency_Preservation_and_Resuscitation

The purpose is to buy time to surgically fix people who’ve “bled to death” (bled out to cardiac arrest), reperfuse them with warm blood, and then restart their heart.  Without cooling and repair of the cause of the fatal bleed before attempting the restart the heart, it’s usually impossible to resuscitate people who show up in emergency rooms in cardiac arrest from blood loss.  

Cooling and reviving people from long periods of stopped blood circulation (“suspended animation”) is not new in medicine.  Some surgical patients are intentionally placed in circulatory arrest for periods as long as one hour at temperatures as cold as +18 degC for certain surgeries in a procedure called Deep Hypothermic Circulatory Arrest (DHCA).
https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_arrest

The coldest body temperature ever used in medicine dates back to 1955 when Suad Niazi at the University of Minnesota cooled a woman to only +9 degC in cadiac arrest for 45 minutes in an attempt to treat her cancer.  She successfully recovered (but was not cured of cancer).  Niazi even did it without cardiopulmonary bypass or blood substitutes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1450560/pdf/annsurg01232-0140.pdf

In the early days of DHCA, surgeons such as Christian Baarnard also used temperatures as low as +10 degC.  The claim that accidental hypothermia victim Anna Bagenholm set a low temperature survival record by recovering from a temperature of +14 degC is inaccurate, although perhaps perpetuated because her case was so dramatic and uncontrolled compared to planned medical procedures.  At the time of writing, the lowest body temperature survived by a human in the medical literature appears to be Niazi’s 1955 cancer patient at +9 degC.

If the EPR human clinical trials are as successful as preclinical work suggests they could be, it’s possible that patients might be revived after longer periods of stopped blood circulation than previously demonstrated, perhaps as long as two hours.”

For more information on Alcor’s pioneering low temperature blood substitution experiments, follow this link:
https://alcor.org/Library/html/tbw.html

Additional reading on the sloppy use of the phrase “suspended animation” here:
https://www.biostasis.com/the-purple-prose-of-suspended-animation/

1st Alcor New York Science Symposium

Cryonics returns to its New York roots on November 23 when Alcor New York organizes its first Alcor New York Symposium. Attend the most ambitious cryonics event in NYC in decades and learn about brain cryopreservation, molecular repair, and rejuvenation biotechnologies.

This symposium will feature 3 presentations by staff of Advanced Neural Biosciences about its neural cryobiology, revival, and deep learning research.

There are only a few tickets left. Register using the link below:

https://1stalcornewyorksymposium.splashthat.com/

Speakers announced so far:

Dr. Pedro Magalhaes – Will We Cure Aging in My Lifetime?

People have always sought eternal life and everlasting youth. Recent technological breakthroughs, and our growing understanding of ageing, have given strength to the idea that a cure for human ageing can eventually be developed. Hundreds of genes are now known to regulate ageing in model organisms and can increase longevity by up to 10 fold and retard the process of ageing as a whole in animals. In addition, a large number of potential longevity-extending drugs already exist. Studies of species with exceptional longevity or disease resistance, like naked mole rats that are resistant to cancer or bowhead whales that live over 200 years, may also help treat and prevent human diseases. Here, I will discuss recent advances in longevity science and human applications on the horizon. The scientific prospects of eradicating human ageing within the foreseeable future will also be discussed.

Dr. Regina R. Monaco – Low-Dose Pharmacological Interventions to Facilitate Healthy Aging – Reduction of Cancer Risk

As we grow in our understanding of aging as a series of biochemical pathways and systems undergoing programmed entropic degradations, which may be reversed, re-entrained, stabilized, minimized, maximized, turned off or on, or otherwise healthfully intervened in, we gain more and more tools to assist this process to maintain a healthful equilibrium. One important intervention to extend healthy life span is to use pharmaceuticals or neutraceuticals to reduce your probability of having cancer.

In this talk I present and discuss several low dose pharmacological interventions which have been shown to have strong ant-cancer properties, we well as some other benefits such as reduction of chronic inflammation. I will review the mechanisims and anti-cancer benefits of low-dose therapy of the pharmaceuticals metformin, naltrexone, aspirin, and for women, tamoxifen (breast cancer). I will also discuss benefits of targeting and inducing apoptosis (killing) to remove a percentage of senescent cells using rapamycin, and neutraceuticals fisetin, and quercitin, with or without dasatinab.

Ben Best – NAD+ Restoration and Senolytic Therapy

Ben Best has subjected himself to two age reversal therapies: (1) senolytic therapy (therapy to eliminate senescent cells using dasatinib and quercetin) and (2) NAD+ infusions (to restore NAD+ to youthful levels). He has also attended several conferences dealing with these subjects as well as studied and written about them, the results of which he will provide in his presentation.

Chana Phaedra – An Introduction to Brain Preservation Optimization

Vitrification has the advantage that it does not need different cryoprotectant protocols for different cell- and tissue types. Vitrification of the brain does presents two distinct challenges: low tolerance to ischemia and poor blood-brain barrier permeability of cryoprotectants. In this presentation I will review the history of brain cryopreservation, the status of brain cryopreservation research, and future directions.

Aschwin de Wolf – Revival of “Straight Frozen” Patients

Freezing of the brain without cryoprotectant (a “straight freeze”) is considered the worst cryopreservation scenario but there is a paucity of ultrastructural evidence how the straight frozen brain actually looks like. Aschwin de Wolf will review electron micrographs of the straight frozen brain (under a variety of conditions) and will discuss how “medical cryobots” will prepare the brain for molecular repair and infer the original non-frozen state from the damaged state.

Michael Benjamin – Alcor Meta-Analysis

Several attempts have been made to create quantitative case outcome methodologies in cryonics. Advanced Neural Biosciences has embarked on a comprehensive meta-analysis of all Alcor patient cases, an endeavor whose goal is to develop, experimentally validate, and refine a quantitative cryopreservation evaluation methodology. Michael will be presenting some preliminary statistics gathered during Phase 1 of the study so far.

Dr. Ralf Spindler – Functional evaluation of brain preservation protocols

Currently, reversible vitrification of whole brains is limited by neurotoxicity of the very concentrated vitrification solutions involved. Here, an automated assay is described which has proven to quantify synaptic connections in live-cell neuronal networks by a high-content confocal imaging method. Since it is known that synaptodentritic damage, especially the decrease in number of synaptic connections, correlates with cognitive decline the assay could be used to evaluate brain preservation protocols.

Dr. Roman Bauer – Computational Biology Methods for Tissue Cryopreservation

In contrast to most other biomedical fields, tissue cryopreservation has remained relatively untouched by computational techniques. State-of-the-art cryopreservation still predominantly relies on trial-and-error and large numbers of experiments for the determination of protocol parameters. Roman Bauer will review milestones in computational and mathematical work towards better cryopreservation protocols, and will discuss how he sees future automated cryopreservation technologies maximize post-thaw tissue quality.

Dr. Emil Kendziorra – Professionalization and Scaling of Medical Biostasis

With only a few thousand members world-wide, medical biostasis has stayed a very small field, albeit being around for decades. In Europe the topic has been even more niche. The EBF (European Biostasis Foundation) based in Switzerland, has recently set out to fundamentally change this situation with four main areas of activity – sign up / stand-by, storage, research and long-term asset management. Emil Kendziorra will present the core activities to professionalize medical biostasis and scale the field.

Dr. Robin Hanson – Hidden Motives Help Explain Why Cryonics Isn’t Popular

The usual pro-cryonics argument frames it as medicine, to be evaluated in terms of its technical ability to prolong life. However, though they are unaware of it, for most people medicine is more about showing that they care than about prolonging life. Robin Hanson reviews the evidence that many big areas of life are driven by hidden motives quite different from what people usually say, and then tries to apply this insight to help us understand why so few people actually choose cryonics.

The Circle of Willes in Cryonics Perfusion

Blood flows into the brain primarily via the carotid arteries and the vertebral arteries. The Circle of Willis is a circular arterial structure in the brain that connects blood flowing in from the carotid arteries with blood flowing in from the basilar artery (which is fed by the vertebral arteries).
Blood flows from the Circle of Willis into brain tissue via the anterior, middle, and posterior cerebral arteries. Many studies have shown that the Circle of Willis is incomplete in most people. A 1998 study of 150 healthy adult volunteers showed a complete Circle of Willis in only 42% of cases — more often complete in younger persons and females [RADIOLOGY; Krabbe-Hartkamp,MJ; 207(1):103-111 (1998)]. A slightly more encouraging 2002 study of 118 healthy volunteers in the 65-68 age group, showed 47% had a complete Circle of Willis [THE JOURNAL OF CARDIOVASCULAR SURGERY; Macchi,C; 43(6):887-890 (2002)]

For cryonics purposes, it has been believed that perfusion into the carotid arteries, but not into the vertebral arteries will result in incomplete perfusion of the brain if the Circle of Willis is not complete. In particular, if both posterior communicating arteries are missing, then perfusing only through the carotid arteries will result in no blood getting to parts of the brain supplied by the posterior cerebral arteries. Both posterior communicating arteries were missing in 11% of those in the 1998 study and in 14% of those in the 2002 study cited above.

Nonetheless, a 2008 study showing Circle of Willis complete in only 40% of 99 patients found no case of insufficient perfusion in functional tests of patients given unilateral cerebral perfusion. The authors concluded that “extracranial collateral circulation” provides an alternative pathway to the Circle of Willis for cerebral crossperfusion [EUROPEAN JOURNAL OF CARDIOTHORACIC SURGERY; Urbanski,PP; 33(3):402-408 (2008)]. Although persons with missing posterior communicating arteries could easily have pathways to opposite sides of the brain, other variants of Circle of Willis incompleteness would be expected to prevent perfusion across hemispheres.

When the cryonics organization Alcor does a cephalic isolation (“neuro”) perfusion, the carotid arteries are initially cannulated and the vertebrals are not cannulated. Only if when the patient is being perfused into the carotid arteries no flow is seen coming from the vertebral arteries are the
vertebral arteries to be cannulated and the patient is to be perfused through both the carotids and the vertebrals. If, on the other hand, flow is seen coming from one of the vertebral arteries after perfusion of the carotids has begun, it is assumed that the Circle of Willis is complete and the vertebral arteries are clamped for the rest of the perfusion. Flow only needs to be seen in one of the vertebrals to confirm that the Circle of Willis is complete, because the vertebrals unite in the basilar artery before connecting to the Circle of Willis.

One Alcor employee has informed me that of 15-20 neuro patients perfused by this cephalic isolation method, not once has there been an absence of flow from the vertebrals and not once has Alcor perfused a cephalic isolation patient through the vertebral arteries. This would be slightly improbable, based on a 10-15% expected rate of incomplete communicating posterior arteries on both sides. But another Alcor employee remembers one or two cases where vertebral artery perfusion was done (which would match expectations).

When both posterior communicating arteries are not missing, there is another potential problem with perfusing only into the carotids and not the vertebrals — namely, loss of perfusion pressure. Perfusate entering the Circle of Willis could exit through the basilar artery (the vertebrals) instead
of through the cerebral arteries. Vascular resistance in the body is reportedly only one quarter what it is in the brain. Clamping the vertebral arteries (as is done during Alcor neuro perfusions) could prevent this problem. Blood flowing into the basilar artery need not be pushing all of the blood in the body, however, because arteries — and especially veins — have a large reserve capacity (a balloon-like ability to expand).

Possibly the reserve capacity of the brain would allow blood to flow into the brain as readily as into the body. Blood has about three times the viscosity of water, and vitrification solution has about twice the viscosity of blood. Viscosity will increase vascular resistance in all blood vessels, but the effect would be greater in the brain. The “no reflow” phenomenon would also create resistance in the blood vessels, which again might be greater in the brain than in the body.

Prior to the use of vitrification solution, the Cryonics Institute only perfused cryonics patients through the carotid arteries — there was no attempt to perfuse into the vertebral arteries. Nonetheless, dehydration was seen in the patients, and adequate effluent flow was seen from the jugular veins. Perfusion pressures were reportedly not excessive.

Currently, CI’s funeral director has been opening the chest (median sternotomy), and attempting to clamp the subclavian arteries, as well as the descending aorta, to perfuse into the ascending aorta. In several cases the ascending aorta has been perforated, forcing higher cannulations or the subclavians have been difficult to cannulate after having opened the chest. Our funeral director refused to open the chest at all for a known case of Methacillin- Resistant Staphylococcus Aureas (MRSA).

It would be preferable if a case could be made for perfusing all CI patients only through the carotids. Carotid-only has been recommended for vitrification perfusions overseas, as well as for glycerol perfusions in post-mortem sign-ups. Whether vitrification solution perfusion into the carotids can achieve adequate perfusion pressure in the brain — and whether adequate perfusion pressure can be verified by the observation of effluent from the jugular veins remains unresolved.

It should not be too difficult to clamp the vertebral arteries by cutting near the clavicle, as CI’s funeral director did when CI began the attempt to perfuse the vertebrals as well as the carotid arteries. Nonetheless, this would result in failure to perfuse portions of the brain supplied by the posterior cerebral arteries in the 10-15% of patients who are missing both posterior communicating arteries.

First published in The Immortalist, February, 2011

Biostasis.com

Biostasis.com is the world’s largest independent website about cryonics and medical human biostasis.

In 2007 Aschwin de Wolf launched the cryonics blog Depressed Metabolism, the first professional blog to exclusively cover the science and practice of cryonics. Out of this platform emerged The Institute for Evidence-Based Cryonics (2008-2018), a non-profit aimed at educating the general public about cryonics. The Institute organized a number of groundbreaking symposiums on cryonics and dementia and cryonics revival scenarios. The Evidence-Based Cryonics Institute website also became the official host of the Scientist’s Open Letter on Cryonics and engaged in several campaigns to draw attention to recent breakthroughs in brain cryopreservation.

Biostasis continues the journey that started with Depressed Metabolism and the Institute for Evidence-Based Cryonics. Its goal remains to educate the general public about cryonics and human biostasis in all its aspects. We will keep publishing new content and historical documents relating to cryonics and remain the official host of the Scientist’s Open Letter on Cryonics. This year we will also announce the publication of the first detailed medical human biostasis protocol that will allow hospitals to educate themselves about offering cryonics as an elective medical procedure. In 2019 we will also announce a series of initiatives to study the theoretical aspects of conducting cell repairs at low-temperatures, or medical cryobotics.

All entries from the depressed metabolism and evidence-based cryonics website remain available on the biostasis website. Please update your links and spread the word about biostasis.com.

Good Cryonics is Local

The enemies of a good cryonics case are time and temperature. Deployment of a standby team that can start rapid cooling upon circulatory arrest should take care of the temperature challenge. The time element is more challenging. Even if a patient is stabilized rapidly after pronouncement of legal death, logistical and legal challenges can interfere with timely transport to Alcor for subsequent procedures. For example, if a patient is rapidly cooled down in North Dakota but logistical challenges and flight schedules prevent arrival of the patient at Alcor until several days later, the patient will still be subjected to progressive deterioration of the fine structure of the brain, breakdown of the blood brain barrier, swelling, and a number of processes that prevent smooth cryoprotection of the brain, or even necessitate a “straight freeze” (cryopreservation without a cryoprotectant). How should Alcor deal with the challenge of having only one physical location in Arizona but being responsible for members all over the world?

The most obvious solution is for a terminal member to move to Alcor. In almost all cases this is the preferred solution because this prevents several potential logistical, legal, and technical challenges. The advantages of moving to Alcor are so great for both the cryonics organization and the patient that Alcor offers up to $10,000 in relocation assistance. To further incentivize such a choice, Alcor could consider further increasing the amount of relocation assistance and/or actively assist older and sick members to consider relocating.

Another solution is to bring all major Alcor procedures to the location of the patient. This is easier said than done. Whereas a patient relocation does not require major expenditures and logistical decisions on the part of Alcor, bringing cryoprotection to the patient is a non-trivial task because it entails performing Alcor’s operating room procedures at a remote location. In practice, this can be done, and Alcor has cautiously authorized “field cryoprotection” for overseas and selected US cases. In principle field cryoprotection is possible for both neuro-patients and whole body patients but true whole body field cryoprotection would require the creation of an adequately equipped vehicle or satellite facility, not to speak of medical expertise. Recognition of the fact that many Alcor members do not relocate when terminally ill, and potential cost savings, have prompted some Alcor officials to advocate expanding field cryoprotection to more members.

Since it is obviously easier to bring a patient to a hospital than a hospital to a patient, more effort will need to be spent in educating members of the advantages of timely relocation to the Scottsdale area.

There might be one route to bringing the hospital to the patient and that is to encourage the creation of several of “cryonics hubs” in areas with large numbers of Alcor members. Support and recognition from Alcor for such initiatives is necessary but a decentralized approach could be effective here. Local members can start with creating a cryonics infrastructure to assist professional standby teams. Such efforts can include maintaining a list of pertinent local regulations, cooperating funeral homes, local volunteers and medical professionals, and flight schedules. A more ambitious step would be to equip certain areas with a local rescue vehicle, as was done in the past in Southern California. A more ambitious step would be to equip such a vehicle for field cryoprotection or even set up such facilities in a cooperating funeral home or building. This is a formidable task that would require many hours of work and considerable expenses but it would produce a more robust response infrastructure for Alcor to utilize. It could also make some areas less vulnerable to episodes of deteriorating response capabilities at Alcor. Last but not least, bringing people together to engage in such a project will also tighten the social fabric and local visibility of cryonics.

Originally published as a column in Cryonics magazine, November – December, 2018

Hybrid Standby Infrastructure

Cryonics has limited appeal but cryonics organizations have assumed global responsibility to cryopreserve their members timely and competently. A hybrid model in which local members and volunteers work together with medical staff members and contractors to deliver the best possible cryonics care is the best answer to this situation. Taking Alcor as an example, what does this model entail in terms of infrastructure and staffing?

The most important response mandate of a cryonics organization is to ensure competent local response capabilities through full-time employment of medical professionals and cryonics experts at the facility. Unlike remote response capabilities, Alcor’s response to local cases should not be dependent on erratic, case-by-case, contracting with local medical professionals. While such professionals can supplement Alcor’s own capabilities, Alcor should never find itself in a situation where it cannot deploy an effective standby due to a shortage of available staff members. This mandate requires that Alcor’s staffing policy cannot be allowed to outcrowd its local response capabilities. In practice, this means having at least three staff members available for local case work with at least two of them being proficient (and preferably certified) in conducting medical procedures that are elemental to cryonics stabilization (placing IV lines, placing an endotracheal tube etc.).

A strong mandate to primarily deliver state-of-the-art care in the Scottsdale area may look rather meager in light of its global responsibilities, but considering the fact most Alcor members do not die suddenly, and are eligible for an attractive Alcor relocation-reimbursement, out-of-state cases may increasingly be seen as reflecting choices made by Alcor members, as opposed to inevitable events happening to them. The significantly higher costs, and potential logistical and legal complications, of out-of-state cases are a strong argument to further increase Alcor’s relocation reimbursement amount.

The next layer is to coordinate a network of professional cryonics response providers (such as Suspended Animation and ICE) and local groups to respond effectively to out-of-state cases. Such companies can provide a valuable element to deliver rapid response provided that access to such services does not lead to allowing the atrophy of local groups and response capabilities. Professional standby companies usually deploy out of a single state (or two at most), which means that relying on local capabilities created by members remains an essential component for responding timely to time-sensitive cases. To ensure consistent and competent non-local response coverage, the coordination and monitoring of non-local response capabilities should be an important job responsibility of a full-time Alcor staff member.

To augment the services of cryonics standby organizations and the resources available to local members, regions with substantial numbers of Alcor members should be encouraged and supported in creating robust physical cryonics responsibilities. In such areas, maintenance of a full set of standby kits, a response vehicle, and even on-site field cryoprotection capabilities should be pursued. These non-Scottsdale cryonics “hubs” should be allowed some degree of autonomy, provided their efforts conform with Alcor’s protocols and standards. Further enhancement of these cryonics hubs can be reaped if such efforts are supported by other cryonics-supporting activities such as research and public outreach. Examples of areas where such hubs would be feasible and desirable include New York City, Los Angeles, and San Francisco. The mandate for these areas should be to close the gap between Scottsdale-based cases and local cases.

International cases are a formidable challenge for Alcor and the cryonics hub idea will need to be extended to countries (or even a set of neighboring countries). Collaboration between members of different cryonics organizations is often a necessity in international cases. Transport times to the US necessitate the use of procedures such as field cryoprotection and shipping on dry ice

Originally published as a column in Cryonics magazine, September – October, 2018

Why Don’t You Start With Standby First?

In the 15 years I have been involved in cryonics I have observed a predictable pattern. An enthusiastic group of people want to create a new cryonics organization. Reasons can range from wanting to have a cryonics organization in their own continent or country (Europe, Australia) to having a distinctly different vision how cryonics should be practiced. Some of these attempts have succeeded and others have failed. The common denominator I have seen in the failed attempts is to do “something else” first before offering long-term maintenance. If this “something else” would simply comprise exercising due diligence in having a sensible financial and legal framework in place before accepting patients that is understandable. But here “something else” concerns achieving something even harder as a precondition for building a storage facility: creating state-of-the-art response capabilities.

One argument for this approach is that without adequate standby and stabilization having a cryonics storage facility is pointless. I do not think this is true and if this argument is followed to its logical conclusion there will never be a good moment to start offering storage as long as cryonics is as unpopular as it is right now. Sure, it is indisputable that a cryonics patient who receives a prompt response and good stabilization procedures will sustain less damage and better cryoprotection. This does not mean, however, that anything that falls short of this is doomed. The ultrastructure of the post-mortem brain is more robust than even most cryonicists assume and ice formation does not necessarily render the original structure of the brain un-inferable.

The other argument is often a variant on the idea that the most challenging element of a cryonics endeavour (i.e. storage) should be done last. But the hardest part of cryonics is not storage but standby. Creating cost-effective, dependable, responsible capabilities for a region larger than a city or small country is a non-trivial challenge. Let’s consider Europe for example. Providing standby coverage for all countries would require a massive initial investment with numerous medical professionals on retainers being available for a case at the right time at the right place…a case which may not happen for many years. Will such an organization be able to keep its supporters motivated and financially committed? In reality this mandate often creates a situation where the organization cannot live up to its standby claims, storage is (indefinitely) postponed, and interest wanes until the next attempt is made to do the same thing. It is no surprise, in my opinion, that some of the newer cryonics organizations (KrioRus, Oregon Cryonics) accepted patients for long term care from the get-go.

Standby is important and I do not pretend that it will take care of itself when there is storage. But whereas storage needs to be centralized (having a storage facility in each of the European countries at this point would be ludicrous) having sound and dependable standby capabilities is a decentralized process which can be pursued by different groups in different states or countries based on their different needs and (financial resources). As we speak, the UK and the Netherlands have made impressive efforts to create such capabilities and these efforts will further grow and spread when there is a facility with patients to care for. One needs to start somewhere and the most realistic path is to first create a sensible storage solution followed by de-centralized efforts to transport patients to the facility in the best possible condition.

Originally published as a column in Cryonics magazine, July – August, 2018

Cryonics Revival Scenarios

Ralph Merkle’s new article “Revival of Alcor Patients” constitutes an important contribution to the growing cryonics survival literature. What sets Merkle’s latest piece apart from (his) prior efforts is its extensive treatment of the validation of revival attempts (“did we do it right?”) and the ethical principles of revival.

The most important distinction between revival methodologies concerns those that involve in-situ repair and revival and those that aim for repair and revival on a different substrate (i.e. “mind uploading”) after conducting a (molecular) scan. Merkle also presents a revival scenario that involves a destructive scan of the cryopreserved individual, followed by in-silico repair, and biological revival. Some cryonicists (including the “godfather” of cryonics, Robert Ettinger) have expressed concerns that some of these proposals will not produce meaningful individual survival. In particular, it is argued that “running” a complete simulation of the brain on a computer won’t give rise to consciousness, let alone produce individual survival.

Since it may be quite some time before technology is at a state to favor one position over the other, we need sound principles to make prudent decisions now. In his article “Brain Preservation and Personal Survival: The Importance of Promoting Cryonics-Specific Research” (Cryonics magazine, November-December, 2017), Alexandre Erler introduces a new kind of “wager” to make such decisions when faced with philosophical uncertainty concerning the nature of identity and consciousness.

The use of Pascal-style “wagers” is nothing new in cryonics. The most famous wager was proposed by Ralph Merkle himself to compare the potential outcomes for an individual who faces a choice between signing up for cryonics or not. “Merkle’s Wager” consists of a matrix of four choices: Sign up and it works; sign up and it doesn’t work; don’t sign up and it works; don’t sign up and it doesn’t work. Merkle concludes that signing up for cryonics is the favored rational option. Michael O’Neil and Aschwin de Wolf extended this wager to making a choice between neuropreservation and whole body cryopreservation in their “The Case for Whole Body Cryopreservation” article (Cryonics magazine, expanded version, June 2014). Most readers may not be too concerned about the loss of identity-critical information in either cryopreservation option but being wrong on the nature of consciousness could be fatal. If consciousness is substrate-dependent and/or destroying the original brain (during a scan) excludes personal survival, choosing a wrong revival method can produce certain death, despite having received an excellent cryopreservation.

Erler simply asks the question what would be the prudent choice to make given that we cannot know with certainty (right now) which philosophical position is right. The short answer is that in-situ repair and revival of the preserved brain (or whole organism) will give rise to individual survival regardless of which philosophical view is correct.

One thing that is important to emphasize here, which is also discussed in Ralph’s repair article, is that non-destructive (molecular) scans of some kind and in-silico repair may still be a necessary step for in-situ biological repair and revival. The conservative position on revival is limited to the claim that it would not be prudent to instruct the cryonics organization to discard the original brain and seek revival by “running” that model on a computer.

Alcor allows for members to express their revival preferences. One complex question is whether it is currently possible to give informed consent for a revival scenario other than in-situ biological repair. A related question is to what degree cryonics organizations should honor requests for enhancements during the revival process, especially if these requests are (then) known to produce substantial identity-altering effects. There has been little in-depth discussion of these topics to date.


Originally published as a column in Cryonics magazine, May – June, 2018

What is Cryonics First Aid?

First aid in medicine is defined as “the assistance given to any person suffering a sudden illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery.” Its aims can be summed up as the three P’s: preserve life, prevent further harm, and promote recovery. With the exception of the aim of “promoting recovery” this framework is applicable to cryonics, too.

The rationale for allowing laypersons to provide basic medical procedures rests on the recognition that the health condition of a person can rapidly change and/or professional responders may be unable get to the patient in a timely fashion. A major difference between mainstream medicine and cryonics, however, is that in cryonics there often is no local professional response team that can deploy quickly to stabilize the patient. As a consequence, one would expect to see more situations in which the initial, or even all, aspects of a cryonics case will need to be done by local volunteers—and that is exactly what has been observed. This does not necessarily indicate a deficiency on the part of professional cryonics standby organizations. Cryonics is simply not big enough to have professional response teams in every state and major city.

The objective of professional cryonics standby teams and cryonics first aid are the same: stabilize the condition of the patient. What sets cryonics first aid apart from the comprehensive protocols of professional standby organizations is the degree to which this objective can be accomplished and the equipment used.

Cryonics first response entails three procedures: cooling, circulation, and medications administration. One clear advantage that cryonics first aid responders have is that our most effective procedure, cooling, is also the easiest to implement. What usually sets good cryonics first aid apart from suboptimal cryonics first aid is the efficiency of cooling achieved and whether induction of hypothermia is augmented by chest compressions and medications administration. When cryonics first aid is done competently response time is fast, cooling rates are fast, circulation is restored, and a basic medications protocol to prevent clotting, brain injury, and swelling is administered.

The topic of cryonics first aid has not received as much attention as other topics in cryonics. In the early days of cryonics it did not make sense to draw a distinction between cryonics first aid and advanced procedures because all procedures were done by (trained) volunteers. And later, when professional cryonics standby organizations were formed, the topic also received little attention because it was not sufficiently recognized that there would still be a large role to play for local cryonics groups in the provision of cryonics procedures. It is only now when we have come to appreciate the advantages of a “hybrid” standby model in which local team members provide first aid, or interact with professional standby organizations, that there is a need to clearly define the objectives, scope, and physical infrastructure associated with cryonics first aid.

Some of the current questions about cryonics first aid that Alcor seeks to address include: What is the exact cryonics first aid protocol? Which items should be in a cryonics first aid kit? Should cryonics first aid kits be available to groups or also to individual members? What makes a local group eligible for a full set of standby kits instead of a first aid kit? What will cryonics first aid training comprise? What is the difference between Alcor’s first aid protocol and Alcor’s abbreviated protocol designed for professional standby teams in case of a delayed response? How do professional standby teams such as ICE and SA interact with local cryonics first aid responders? Should first aid capabilities be enhanced in areas with many members and an active local community?

Originally published as a column in Cryonics magazine, March – April, 2018

A hybrid model for standby?

In 2003 Charles Platt organized a week-long standby training in Arizona to teach a gathering of long-time and new Alcor members basic and advanced standby procedures. This well-attended meeting was one of the most ambitious gatherings to educate U.S. and international Alcor members in the knowledge and skills to participate in a case, from communicating with hospital staff to remote blood washout. Retrospectively, the timing of this event was problematic. For right then there were two ongoing developments that would largely render this model of doing cryonics procedures obsolete: the creation of Suspended Animation in Florida and the hiring of medical professionals at Alcor.

The rationale behind this transition is eminently understandable. If resources permit, why not run cryonics cases with medical professionals instead of motivated members and volunteers? If cryonics is a medical procedure, should it not also be conducted by medical professionals? As we look back on the rise of medical contracting in cryonics, however, I think some caveats and sobering observations should be made.

As Charles Platt astutely observes in his article “The Most Challenging Procedure” in this issue of the magazine, consistently deploying successful standbys in cryonics is a monumental challenge. Unless an organization has the resources to employ multiple medical professionals (paramedic, perfusionist, etc.) full-time, a typical case becomes a complex juggling act to ensure
enough medical professionals (who often are meaningfully employed elsewhere) can be at the bedside at the right time. In addition, medical professionals may have the skillsets to perform a subset of cryonics procedures but not all elements of a cryonics case are routinely taught in medicine. Case reports sometimes reveal a lack of understanding about the rationale of cryonics procedures and how to prioritize them in specific circumstances. Engaging medical contractors in extensive education about cryonics procedures and its subtleties is necessary but time-consuming and costly.

One unfortunate consequence of the medical professional contractor model of cryonics is that it can lead to the decline of member engagement in casework, neglected readiness resources and people at the main cryonics organization, and the atrophy of local cryonics groups. Cryonics organizations are especially vulnerable to this outcome when they agree to exclusively contract with an organization for their standbys. This is quite troubling from a community perspective but it also threatens the basic local standby infrastructure that that even professional standby organizations often need to draw upon to be effective.

In mainstream medicine there is a need for non-professionals to perform “first aid” before professionals arrive. In cryonics there is an even stronger need for such “first aid” because the professionals often are deployed out-of-state and may arrive too late. In such cases, local cryonics first aid responders will be forced to conduct the most important stabilization procedures such as rapid cooling and circulation. If professional standby organizations are not willing to take “post-mortem” cases, a compromised local cryonics infrastructure can be (literally) deadly.

What I want to propose here is to move toward a “hybrid” model of cryonics standby. The first layer of such a standby is the employment of several medical professionals at the cryonics organization who remain available for local and remote casework. The next layer is the establishment (or rejuvenation) of vibrant local member groups that can do basic cryonics first aid procedures and aid the cryonics organization or contract standby organizations. The third layer is to have in place a number of non-exclusive contracts with professional standby organizations to conduct casework or assist in Alcor-run cases. When this hybrid model is pursued with accountability and sound quality control, the benefits of both models of cryonics can be reaped.

Originally published as a column in Cryonics magazine, January -February, 2018