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This text was dumped from the document file which was used to create the hardcopy version of CryoCare Report. The text was reformatted for transmission online. We doubt that any errors were introduced by format conversion, but this possibility does exist. If in doubt, please refer to the hardcopy version of CryoCare Report as the definitive one.
Obviously, we want to tell you about CryoCare. More than that, however, we want to present news, opinions, and speculation about all aspects of cryonics. (For proof of our intentions, look no further than our first news item, which describes a case involving someone who was not a CryoCare patient.)
CryoCare Report will not be merely a "house organ" that always plays up the positive side of our organization and discreetly ignores the negatives. We are very willing to include critical and controversial material from any source. Our only requirements are that it should be factually accurate, reasonably concise, and clearly written. We believe that open discussion of issues helps cryonics far more than any attempt to be discreet or evasive; and if cryonics flourishes, CryoCare should flourish also.
We want to publish letters from our readers, and we invite our readers to contribute articles. Let's hear from you!
Send letters or contributions to the newsletter editor, Charles Platt, at 9 Patchin Place, New York, NY 10011.
Alternatively, send material by fax to (212) 929 4467.
If you prefer to use email, send it to. Now there's no excuse for not making contact.
For the time being, we will be following a bimonthly schedule. Eventually, we plan to go monthly.
Dick Marsh, a long-time member of the American Cryonics Society (ACS), experienced legal death on Friday, May 6th in Northern California. Dick had been up and around, visiting relatives, but he lost consciousness unexpectedly and suffered cardiac arrest within less than an hour.
Family members and a nurse started CPR and packed him in ice while waiting for help. Unfortunately, heavy rush-hour traffic delayed the local team from ACS, and by the time they arrived, it was no longer practical to administer the usual stabilization medications.
Meanwhile, Mike Darwin, at BioPreservation, had been notified of Dick's condition. He elected to stay at the facility in Rancho Cucamonga while the patient was flown there via an air ambulance service. Bad weather and other factors complicated the journey, and Dick didn't reach the facility till around 1 A.M. By this time the entire perfusion team was ready and waiting, including Steve Harris, BioPreservation's physician. Perfusion was completed by 6 A.M. on Saturday morning.
Fortunately, Dick had been on anticoagulant drugs. As a result, even though he had received no cryonics emergency medication, he experienced relatively little blood clotting, and the cryoprotectant was able to penetrate even small blood vessels in his brain. This was verified by means of an endoscope inserted through a burr hole in the patient's skull -- the first time this technique has ever been used on a cryonics patient.
An endoscope is a thin, rigid or flexible bundle of optic fibers small enough to slide into body cavities which are normally inaccessible without major surgery. A light shines through the fibers, illuminating the interior of the patient and transmitting the view back through other fibers to the observer.
BioPreservation is currently the only cryonics provider to own this equipment, and has a variety of different models. Two are intended for blood vessels, while a third is a larger rigid scope and was originally designed for gynecological work. This was the one that Mike Darwin was able to use to inspect Dick Marsh's brain at intervals during perfusion.
"I was able to see blood vessels down to about a quarter of a millimeter," Darwin reported afterward, "and I could see the perfusate actually flowing through the vessels. By the time we were half-way through the procedure, there was no longer any sign of blood." According to Darwin, the final concentration of perfusate reached a level of 6.2 Molar.
The endoscope was manipulated in the gap between the brain and the surrounding skull. The instrument is noninvasive and did not penetrate the brain at any time. Nevertheless, Darwin and Harris were able to see 3-5 millimeters beneath the brain's surface because the brain becomes semi-transparent when it is perfused with glycerol, much as a sheet of paper will become translucent when it is soaked in oil.
Endoscopy equipment is relatively expensive (the setup used by BioPreservation would retail new for about $48,000, and may be found used for about $10,000) but represents a genuine breakthrough in cryonics, providing welcome reassurance not only for the medical team but for relatives of the patient. It also allows for intervention; if the brain is not perfusing well, perfusion can be discontinued and freezing begun, thus saving the patient exposure time at high temperatures to a procedure that is not beneficial.
Dick Marsh reached dry-ice temperature early on Monday, May 9th, and will be taken down to liquid-nitrogen temperature at the Cryonics Institute in Michigan.
It can take literally months to get someone signed up as a member of a cryonics organization. Even highly motivated people often procrastinate over the paperwork, and additional delays are common when finalizing funding arrangements.
We've now had enough time to guide a number of people through the maze. Here's a list of members who are fully signed up with CryoCare and have told us that we can publish their names. The list is alphabetical, not chronological.
1. Kevin Brown
2. Herman Earl
3. Debra Faloon
4. William Faloon
5. Maureen Genteman
6. Stanley Gerber
7. Jean Seidel Hanson
8. Curtis Henderson
9. Marcelon Johnson
10. Walter Johnson
11. Saul Kent
12. Robert Krueger
13. Stuart Levine
14. Allen Lopp
15. JoAnn Martin
16. Robert Martz
17. Michael B. O'Neal
18. Arlene Pappan
19. Brenda Peters
20. Jonathan Rosen
21. Billy Seidel
22. Maggie Seidel
23. Courtney Smith
In addition, we have another fifteen fully signed-up members who prefer not to have their names listed here or were not immediately available when we tried to reach them to ask their permission.
Total number of fully signed up CryoCare members as of May 14, 1994: 38.
The following people have virtually completed their sign-up procedure and have told us that we can list their names publicly (in most cases we are waiting only for a form to be co-signed, or for final confirmation of funding arrangements):
1. Gerry Arthus
2. Huiwing Arthus
3. Peter Crowley
4. Tina Lee Eythison
5. Steven B. Harris
6. Eric Klien
7. Deborah Michulak
8. Elizabeth Murphy
9. Elizabeth Peters
10. Charles Platt
11. Judy Norman Sharp
12. Lawrence Sharp
13. Stephen Valentine
14. Paul Wakfer
15. Brian Wowk
There are another forty-five people who are at least half-way through the sign-up process.
Total number of people currently in the sign-up process, who should be full members within the next two months: 60.
Grand total of fully signed-up members expected by the end of July, 1994: 98.
There are at least another thirty-five people who have requested sign-up documents and have been supplied with them. We expect almost all of these people to join us when they get around to tackling the paperwork.
Grand total of fully signed-up members expected by the end of 1994: at least 150.
At the risk of sounding pleased with ourselves, we'd like to list the "selling points" which we feel have enabled our rapid growth:
1. Our radically different system of independent care providers, which promises freedom of choice for the consumer and may offer better long-term stability through "separation of powers" and free-market competition.
2. Our ability to offer the services of BioPreservation, led by Michael Darwin, who is without any doubt the most experienced and knowledgable cryonics care specialist in the world.
3. Our unique document package, which makes signing up simpler and less intimidating.
4. Our sign-up specialist, Brenda Peters (who also serves as our President, when she gets the chance). Brenda has been working full-time to get people enrolled in CryoCare for most of 1994. Thank you, Brenda.
So far, much (but not all) of our growth has been achieved by signing up people who were formerly enrolled in other cryonics organizations. This is inevitable when a new group establishes itself, because there are always people who want to try something new.
Still, we are not particularly happy about the current situation. We have had philosophical differences with some of our competitors in the past, but we have no desire to deprive them of membership revenue to the extent that it would affect their financial stability. Our competitors have frozen patients to take care of, and their security is everyone's number-one priority.
Since this is a potentially contentious issue, we want to address it clearly.
We have done no mailings addressed to the membership lists of other cryonics organizations. We have presented ourselves at some local meetings, we've contacted friends, and we've made a couple of announcements via CryoNet (the computer network where cryonics information is circulated). Obviously, other cryonics organizations have the same, equal access to CryoNet and to local groups.
According to a newsletter published by the Alcor Foundation, In the first months of 1994 Alcor was adding new members as fast as it was losing old ones, partly through publicity in Omni magazine which resulted from a promotional campaign created by Charles Platt. Platt currently serves as vice-president of CryoCare and comments, "Any time a former Alcor member joins CryoCare, I remind myself that Alcor is still benefiting from my past efforts on their behalf."
Thus, the competitive situation is not quite as simple as it might seem, and we still hope for a "steady state" in which cryonics groups coexist amicably. A "membership war" would be bad for cryonics in general; hence, bad for all of us.
In the future, we expect almost all our growth to come from people who have never belonged to any cryonics group. We have many public relations schemes in mind, and as soon as the flood of current membership applications eases off, we fully intend to promote ourselves in the national media.
In the meantime, we offer our heartfelt thanks to everyone who decided to place their trust in CryoCare. We'll do all we can to live up to your expectations. And if we fail, we're well aware that anyone who joined us can just as easily choose to leave.
That's what competition is all about.
Competing proposals for health-care "reform" are still progressing through the committee process. Bills currently pending include Clinton (HR 3600/S 1575), Chafee (S 1770), Nickles (S 1743) and Gramm (S 1807). No one knows, yet, what the final plan will be; but to get some idea of the real-life consequences, we checked aspects of these plans relevant to cryonics.
Since cryonics procedures are performed after legal death has been pronounced, they cannot be considered health care. Therefoe, they should be exempt from health-care regulation. But a good cryopreservation requires prompt access to a patient and (ideally) the freedom to apply cryopreservation protocols in the hospital. This kind of cooperation is not widely available. Consequently, the freedom to choose a cooperative hospital can literally be a matter of life and (permanent) death.
Under at least one proposal, this freedom will no longer exist. You would have to purchase health insurance from the choices approved by the government, and it would be illegal to relocate geographically for the purpose of getting access to different healthcare providers (HSA pp. 243-244, Title I, Section 1423).
The Clinton plan allows literally no escape from socialized medicine. It would make it a felony (i.e., punishable by two or more years in prison) for patients to spend their own money on special treatment. Doctors accepting such a "bribe" would be subject to fifteen years imprisonment (HSA p. 973, Title V, Subtitle E, Section 5434). In this way, private medicine would be completely eliminated. If you think it can't happen, look at Manitoba, Canada, where it already has.
The regulations would have a severe impact on life- extension therapies (remember, the FDA does not regard aging as a disease, and therefore, from their point of view, there is no such thing as a legitimate anti-aging drug). Doctors would only be able to administer treatments on the "reimbursement screen," i.e., those which are approved and for which there is a billing code in place. You would not be able to get prescriptions for drugs that happen to be effective in areas for which their use has not been approved. Deprenyl, for instance, could no longer be used as an anti- aging therapy. The drug Tacrine, which is used to treat Alzheimer's disease, could no longer be used as a potent AIDS antiviral. And so on.
To see the long-term impact of socialized medicine, we only have to look at countries where it already exists.
Mike Darwin recalls walking into a Canadian intensive care unit at a major university teaching hospital to do a standby for a cryonics patient a few years ago. "It was like a medical antiques show," he says. "I saw equipment which hadn't been in use in the US for ten years, some of it for nearly fifteen or twenty. The most advanced ventilator they had was MA-1, which was late 1960s technology. There was no computer monitoring of EKGs. No computer diagnostics at all. I wouldn't have run those monitors in my dog lab, they were so old."
Mike had a similar experience in Britain when he and Jerry Leaf tried to purchase used medical equipment for the British cryonics facility. They couldn't find any, because it was all still being used in hospitals under the Nation Health Service. In the end, most of the sophisticated medical hardware for the British facility had to be shipped from America.
If a similar situation develops here, cryonics organizations would have to choose between spending more money on brand-new equipment or doing without. This would also have a significant impact on cryonics research.
CryoSpan and BioPreservation, our sole providers of long-term care and cryopreservation services, respectively, are both located dangerously close to the San Andreas Fault. Naturally, this is a source of great concern -- not just for our members, but for ourselves. (Remember, we too are depending on CryoSpan for our long-term survival.)
Why are our care providers in a danger zone? And what are we going to do about it?
Michael Darwin, the founder of BioPreservation, was formerly Director of Research for the Alcor Foundation, located in Riverside, California, about fifty miles east of Los Angeles. When Mike left Alcor, he decided to set up his own research facility. For many reasons, it was convenient to locate this in the same general area as Alcor. Mike had learned where to buy surplus medical equipment at bargain prices, he had his own home in the area, he knew of qualified medical personnel in the area, and commercial real estate was relatively inexpensive.
Subsequently, it was necessary to move into a larger facility -- again, for purposes of doing research. When Mike learned that the nearby community of Rancho Cucamonga was one of the few places in the state that would actually welcome a company engaged in animal research, and, in addition, he found a building whose internal layout was idealy suited his purposes, he decided that this was too good an opportunity to miss.
Meanwhile, a group of cryonicists had decided that the only way they could get the kind of cryonics organization they wanted was if they created it themselves. One of their highest priorities was to use the services of Mike Darwin -- not for research, but for cryopreservation of human patients.
Mike suggested that the research facility at Rancho Cucamonga could be adapted for perfusion of patients. He would have to purchase some additional items (most obviously, an ambulance), but the basic infrastructure was already in place, and it seemed absurd not to use it. Also, there simply wasn't enough money and manpower to uproot yet again and relocate the lab in a different part of the country, or to set up two separate facilities.
Maintaining BioPreservation's facility in Southern California was not just a matter of convenience and expediency. There were several good reasons for staying there.
First, Alcor was about to relocate in Arizona, and many people in the Los Angeles area wanted a local team with an immediate response capability.
Second, California is still the only state where the legality of cryonics has been challenged and verified in a court of law.
Third, the earthquake risk is at least a known quantity in Southern California, and the area is probably better prepared to deal with a major seismic event than any other place in the world. Moreover, other forms of natural disaster are virtually nonexistent in Rancho Cucamonga.
Bearing all this in mind, the decision was made to keep BioPreservation in its current location -- at least for now.
The next question was where to locate CryoSpan, the long-term storage company. In this case, more than anything else, it was a problem of money and manpower. The only person with enough time, money, experience, and dedication to run CryoSpan was Paul Wakfer, who had helped to purchase and equip the building in Rancho Cucamonga. Since he was located there, and since there was some unused space at the rear of the building which could be made immediately available for cryonic dewars, CryoSpan was established alongside BioPreservation.
Bear in mind that at this time, late in 1993, there were at least twenty people clamoring for cryopreservation services. Many of them had donated $1,000 apiece to help establish services as soon as possible. They were impatient, and they felt insecure. CryoSpan was created mainly in response to this urgent demand.
Ideally, CryoSpan and BioPreservation would be in different locations -- not just because of earthquakes, but in case of any legal problems or local backlash. Maintenance of people who are considered legally dead is an inherently safer, duller business than going into a hospital where someone is dying, negotiating with potentially hostile local doctors and other officials, and applying complicated medical procedures. Ideally, this "higher risk" occupation should be totally separate from the "lower risk" business of long-term patient care.
Right now, however, CryoSpan still lacks the personnel and the capital to create a new facility elsewhere. In addition, there is considerable patient advantage in having CryoSpan in the same building as BioPreservation. Since it is likely that most BioPreservation patients will receive long- term care from CryoSpan, the costs and risks of transferring them to liquid nitrogen are minimized.
CryoSpan, like BioPreservation, enjoys some real benefits from its location in Southern California.
Liquid Nitrogen. There are three huge liquid nitrogen production plants in the Los Angeles area. Competition has forced prices to their lowest level in America, and bulk delivery is easily available. Even a major earthquake would be unlikely to eliminate all three sources. A temporary interruption in supply would not be a cause for concern, since CryoSpan requires deliveries on an infrequent basis. If necessary, it would be possible to drive to the Union Carbide plant, located only five miles away, and pick up liquid nitrogen in person.
Low risk of flooding. Rancho Cucamonga is located on the foothills of the San Gabriel mountains. It is relatively high above the Los Angeles Basin (elevation 1500 feet), but at least two miles from any slope which could conceivably cause a mud slide. It is seventy miles from an ocean coast which might be struck by a tidal wave. The local water table is more than 400 feet below the surface.
Low risk of destructive weather. Hurricanes, tornadoes, cyclones, and typhoons are unknown in Southern California. There are seasonal Santa Ana winds which sometimes gust up to 70 miles an hour, but buildings in the area are designed with this in mind.
Low risk of urban unrest. CryoSpan is at least an hour's drive from any Los Angeles crime or riot area. Rancho Cucamonga is a modern suburb, almost completely free of crime. The local police station is just one block away. The facility has a telephone-reporting, burglar alarm system with motion detectors and magnetic sensors.
Looking at the entire United States, there are very few areas which can be considered ideal in every respect for a cryonics storage facility. Over a period of 100 years, earthquakes, floods, and other natural catastrophes may strike in many regions which are normally considered "safe." Also, it is not necessarily safer to locate a facility in a remote area rather than an urban area. There may be less chance of outside interference, but liquid nitrogen will be less easily available, and it will be harder to get help in an emergency.
Taking all these factors into account, CryoSpan believes it is at least as well situated as other cryonics storage organizations -- provided it can take steps to reduce earthquake risk.
CryoSpan has already obtained a detailed proposal from a company that specializes in the business of earthquake protection. Their proposal suggests constructing a below- ground concrete vault, large enough for up to six "bigfoot" dewars (each of which can hold four whole-body patients).
All major components in the vault would be non-flamable. Six inches of fireproof insulaton (providing additional thermal insulation and seismic cushioning for the dewars) would be placed around the dewars and under a steel-plate ceiling half an inch thick. If the building above collapsed, burning timber would be physically unable to penetrate the vault, and there would be insufficient heat to harm the dewars or their patients.
Estimated cost for the vault is $60,000. This includes $25,000 for design and engineering, $30,000 for complete construction of the underground vault (including dewar anchors and steel plate ceiling), and $5,000 for a small, separate, above-ground modular vault to protect the monitoring and filling equipment, the emergency generator to run this equipment, the vault's sump pump, and a diesel fuel supply.
The capacity of the vault should be sufficient for CryoSpan's first six years of operation.
The whole structure would be designed to withstand the "Maximum Credible Earthquake," defined as creating effects which have only a ten percent probability of being exceeded in the next 250 years.
CryoSpan has consulted another consultant to verify the plan described above. This new consultant has disagreed with some of the assumptions, and until this dispute can be resolved, it won't be possible to raise money and begin the work.
In the meantime, however, CryoCare has made a preliminary approach to the Cryonics Institute in Michigan to see whether we can negotiate a contract that will enable us to offer CI as an alternative storage provider, for members who are concerned about the California earthquake risk. We should have a full report in our next newsletter.
We still believe that the way CryoSpan has been set up makes it a sound choice for long-term care, and we believe that it will be an excellent choice when earthquake protection has been achieved. At the same time, however, we have always maintained that our system of independent service providers would benefit our members by eventually giving them the freedom to pick and choose. In the area of long-term storage, this freedom may soon become a reality.
Note: as most of our members are fully aware, BioPreservation is an entirely independent company which CryoCare employs to provide cryopreservation services for our members. BioPreservation also provides services for the American Cryonics Society. The following report was provided for us by Michael Darwin, the founder of BioPreservation.
So far, 1994 has seen rapid growth in our basic cryopreservation capability and important innovations in our transport procedures. Some of these changes are simple and straightforward, such as reorganizing our remote standby kit. Others involve profound changes in fundamentals of the transport procedure.
The most important innovations are patentable, and we can't discuss them in detail until applications have been filed (a process that will take months). Still, there are more than enough other advances to fill this column.
The first major improvement in remote standby capability came when the American Cryonics Society (ACS) decided to purchase a remote standby kit from us. This kit enables field surgery, total body washout, and transport of patients at near 0 degrees Centigrade for cryoprotective perfusion. The existence of the ACS kit improves security not only for ACS patients but for other cryonicists served by BioPreservation, since it would be available in addition to our own kit if two emergencies should occur at the same time (as has actually happened in the past).
The BioPreservation kit has been radically upgraded and restructured as a collection of separate components, each of which weighs less than the airline maximum of 65 pounds for passenger baggage. This means that the kit can now be taken on the same flight as BioPreservation personnel instead of being shipped separately as freight. This is an important capability because even if freight space is available on the same flight as our team (which is not always the case), freight items must be processed through separate airline offices and picked up at a location remote from the passenger terminal, causing a delay that can be highly significant if patient is profoundly unstable or already down.
A major element in achieving weight reduction was the procurement of "state-of-the-art" industrial instrumentation transport containers made of rugged new plastics that can take baggage handling stresses and still hold up.
In addition to reconfiguring and modularizing the kit we have also made it easier to use. The medications box is no longer a gray Flambeau tool chest; instead, it is designed like a suitcase with a large, lift-out panel on which all the medications are mounted, in the order to be given, in clear acrylic boxes secured to the panel with Velcro.
Medications needing refrigeration are in color-coded overpacks, reminding personnel to insert them onto the panel just prior to use. Incompatible medications are also color- coded.
We now have a Dinamap automatic, oscillographic, noninvasive blood pressure monitor which can be deployed on- site with the patient. The Dinamap is far more accurate and reliable than other cuff-monitoring methods such as a microphone or stethescope, and it can continue monitoring blood pressure noninvasively (i.e., without needles or catheters) at any arbitrary interval desired.
It also displays pulse and calculates/displays mean arterial pressure. This is critical in evaluating how long a patient will remain in the last stages of the dying process before heartbeat ceases.
It has adjustable "High" and "Low" alarms that are triggered by both systolic and diastolic pressures, so that family or personnel can be alerted to any significant changes in the patient's status. This is vital, since exhausted standby personnel or family members can easily become distracted or fall asleep during long bedside vigils.
We can now transmit EKGs and breath and heart sounds to consulting clinicians who may be thousands of miles away. We are now investigating the use of videophones such as the AT&T Picturephone, which can transmit modest-quality images that could be of critical importance to help consulting physician(s) evaluate the patient's condition. Hard experience has already taught us that even a crummy picture is worth a lot of words.
Inclusion of this equipment in the standby kit (if we decide it is cost effective) would also allow less skilled personnel to be guided through equipment set-up in an emergency situation where the kit is on-site but our team has not yet arrived. (Increasingly, we are sending out the kit well in advance of anticipated need).
The MCL allows us to do the following evaluations: hematocrit (% of blood as red cells), hemoglobin, serum total protein, osmolality (blood/urine/perfusate), chemical urinalysis (ketones, glucose, bilirubin, blood, etc.), urine specific gravity (along with urine osmolality -- a critical indicator of the patient's fluid balance status or degree of dehydration, which can be very important if the patient is dying secondary to dehydration as a direct result of the disease process or by consciously choosing to refuse all food and fluid). Blood/perfusate pH is also on line in the kit.
The MCL also enables us to prepare, on-site, the new 21st Century Medicine/BioPreservation perfusate which has been shown effective in inhibiting cold-rigor mortis after blood washout (this solution will probably soon replace Viaspan for most of our remote uses).
Several questions probably come to mind about the addition of this clinical laboratory capability:
First, why? The answer is simple; we often find ourselves in field situations where we are unable to tell what is happening to the patient and/or what the patient's likely time-course to cardiac arrest may be. This was a problem in the first cryopreservation performed by BioPreservation earlier this year.
Second, why not just send a blood sample to a local clinical lab for analysis? There are two reasons: it can be costly (up to $200 for each "stat" run) and is often logistically difficult. The sample has to be drawn, containerized, run down to the lab -- and then we wait for results.
Monitoring rapid deterioration of a patient's condition is simply not cost-effective or practical when using an outside lab. Also, since the information is not for "therapeutic" purposes, physicians usually refuse to order tests because insurance won't reimburse the cost. Setting up our own pay-per-use arrangement with a local lab (one located near the patient, as opposed to one across town which the doctor uses) is very problematic. By comparison, having our own on-site lab lets the treating or consulting physician order tests effortlessly and allows everyone to get almost instant feedback (usually in less than five minutes!).
Why is it so critical to know what is going on medically with the patient when the end-point (legal death) is always the same? Here the answer is simple: preparedness and cost containment. Every day of remote standby costs a minimum of $1,000. If stabilization medications are prepared too early and have to be discarded, another $1,000 to $2,000 goes down the drain. We believe that better in-field diagnostic capability will be effective in containing standby costs as well as providing better care to the patient.
The MCL can't be carried as personal baggage and has to be air-shipped. Still, it is likely to be needed only in longer cases of standby, so we don't see this as a problem.
By the time you read this, BioPreservation should have taken delivery on a new system for delivering CPR which should double our cardiac outputs (blood flow) compared with the old high-impulse system used by other cryonics organizatons. In others words, this unit should allow us to deliver nearly normal baseline cardiac output in many patients. (As most of our readers know, it can be vital to maintain blood flow in a patient immediately after legal death, to minimize brain damage by "feeding" cells with glucose and oxygen, and to circulate medications through the system.)
Our new CPR system has taken months to design and engineer and has required a great deal of innovation and a lot of effort, both here and from our British colleagues who have worked with us to make this system possible. We cannot give you the details yet, but we can tell you that this is only the "first half" of a revolution in patient care centering on transport.
The new CPR unit is computer-driven, and preliminary tests of a prototype indicate that we may be on the threshold of solving many of the problems such as pulmonary edema, grossly inadequate cardiac output, and rapid loss of brain perfusion which have been traditionally associated with conventional closed-chest CPR.
A major problem has been getting a workable (portable) power supply, since this unit, unlike Michigan Instruments Thumpers and Brunswick HLRs, uses computer-controlled solenoids to move the chest. Incidentally, the price tag on this unit was a "mere" $10,074.63!
An innovative upgrade to cryoprotective perfusion has resulted from the acquisition of fiber-optic endoscopy equipment. Endoscopy means looking inside the body, and this area of medicine has developed explosively since the late 1960s. The pace has quickened in recent years, and it is now possible to perform major abdominal surgery such as gall- bladder removal via endoscopic means.
BioPreservation has acquired a Sony high-resolution CRT (video monitor) with accompany video recorder, a Storz endoscopic television camera, ACMI halogen and Storz Xenon light sources, as well as related suction and irrigation equipment.
We also have a variety of endoscopes including a gastroscope, a colonoscope (both made by Olympus), a rigid hysteroscope (which allows visualization of blood vessels well under .5 mm in diameter on the brain surface and even slightly (1-2 mm) BELOW the brain surface using our Xenon light source), and two ultrathin (1.5 and 2.5 mm diameter x 1 meter length) flexible "vascular" scopes (the latter has an irrigating/working channel down which an instrument can be passed) which allows us to visualize almost the entire brain surface through burr holes opened over each cerebral hemisphere.
We can snake these scopes between the tough dura matter which covers the brain, and the brain surface itself, and look at the pial blood vessels to assess the degree of blood washout or continued perfusion (via injection of dyes). These two scopes can also be passed through blood vessels so that we can check for retained clots after washout has taken place, in patients who did not receive good transport/blood washout in the field.
Added capabilities are the ability to inflate the abdomen with carbon dioxide (using a Wolff insufflator) so that we can then use our rigid scopes to examine the abdominal viscera. This is important if we see abdominal distension indicating possible perfusate leakage during perfusion. These instruments also enable us to pass biopsy equipment down their working channels, allowing us to biopsy abdominal organs on whole-body patients for evaluation of their response to cryoprotective perfusion/freezing -- something that could be done in the past only by making a large abdominal incision (clearly unacceptable for data gathering purposes in whole body patients).
We can also examine the inside of the stomach for lesions that may cause loss of perfusate, and "treat" these lesions to a limited extent by cauterizing them or distending the stomach and compressing the leaking area with a gastric balloon filled with carbon dioxide.
Finally, yet another added capability is pulsatile perfusion of the patient's circulatory system, which is especially useful in facilitating perfusion of patients with extended post-arrest ischemic injury.
We feel confident that these upgrades will go a long way towards improving patient care. We look forward to reporting on even more exciting ones in the near future. If you have any questions about BPI's services, feel free to give us a call (909) 987-3883.
One of the basic principles of modern cryonics is that we all have to make financial arrangements in advance to pay for our long-term care. Usually, of course, this is done via a life insurance policy which names the cryonics organization as beneficiary. The organization receives the money, invests it, and uses the interest to cover storage costs.
In the past, a very few people have gone further and set up their own individual trusts. So far as we know, however, no cryonics organization has followed this example and set up a trust, governed by independent trustees, to manage the funds of all the patients it has cryopreserved.
Establishing such a trust has always been one of CryoCare's objectives. First, we had to hammer out the details of our structure; once that had been accomplished, late in 1993, Courtney Smith (then the CEO of one of the largest futures brokerage houses) volunteered to do whatever was necessary to determine how and where the trust should be established.
Since then, Courtney has paid for a succession of legal opinions in this difficult area. (It's "difficult" because we are trying to do something which in many respects has not been done before; consequently, there are no direct legal precedents.) The following progress report summarizes Courtney's progress. His most recent results were obtained by consulting Ernst & Young, which is one of the "big six" accounting companies in the world and can draw on huge reserves of specialized experience in trust and tax law.
Many people told us they liked the idea of setting up a trust outside the U.S. tax system and regulatory environment. After examining many variants of this option, we are no longer very enthusiastic about it, for two reasons: 1) such an arrangement probably makes an IRS audit more likely, and 2) interest and dividends earned by the trust can be considered passive income, which may be taxable under the Foreign Passive Income Act. According to Ernst & Young, this is a "tax-inefficient" way to invest our patients' money.
The nature of the trust will be influenced to some extent by the status of CryoCare. We decided, early on, that CryoCare should be a nonprofit corporation, mainly because cryonics organizations have never made a profit anyway, and nonprofit status helps to reassure newcomers that cryonics is not a "scam" or "get-rich-quick scheme."
Nonprofit, however, is not the same as tax-exempt. To be tax-exempt means satisfying IRS guidelines.
In the past, more than one cryonics group has qualified for tax exemption under section 501 (c) 3 of the IRS code. This section requires the organization to conduct research for the general benefit of the community. An organization which charges a fee for a service and promises a specific benefit that varies for each individual member does not qualify under this code.
Every authority that we have consulted has told us that no matter how we reword our bylaws, we cannot plausibly present ourselves as a 501 (c) 3 tax-exempt organization. By offering each individual member a specific service in return for a fee, we fail the test. Also, cryonics patients in long- term storage are not being used for "research" in the sense that IRS auditors are likely to understand the term. And we would have difficulty showing that our efforts benefit the community generally. Indeed, one of the most common complaints about cryonics is that it's a "selfish" procedure!
Ten or twenty years ago, the IRS was much less strict about granting tax-exempt status. More recently, it has tightened its regulations. When Robert Ettinger's group in Michigan applied for 501 (c) 3, its application was refused.
Of course, we might be able to satisfy the IRS by presenting an incomplete or misleading picture of CryoCare; but this would create the danger of being audited and assessed substantial penalties and back taxes in years to come.
There is more than one way to be tax-exempt. Under the tax code, it seems as if CryoCare may qualify as a section 501 (c) 13 organization. This section covers cemetery associations which receive money at the time of death and apply it via a perpetual care fund to maintain members who have been buried or cremated.
Since the word "buried" is already used legally to describe people whose remains are stored in crypts above ground, we feel it could be extended to include a patient in a dewar. Of course, CryoCare is hoping that the patient will ultimately be revived; but in religions which are serious about the concept of Judgment Day, the same hope exists. To our way of thinking, a cryonics patient who has been properly treated is not necessarily "dead" at all; but the phrase "Not dead, only sleeping" also crops up on numerous tombstones. Thus, overall, we feel we have a reasonably good chance of convincing the IRS to accept us as a cemetery association. We may seek a determination on this in the very near future.
There's a separate problem, however. Each state has a regulatory board which is required to certify cemetery associations. Would such a board be willing to accept cryonics as a valid form of interment?
Already, Robert Krueger (a member of CryoCare who has immense experience of tax law and the incorporation of businesses) has found a precedent where a company provides cemetery services but is not itself a cemetery. Also, regulatory authorities seem not to have bothered to certify fraternal organizations and churches that maintain small cemetaries for their members.
We are now planning to approach a cemetery association with our case, and we'll report the results in a future newsletter.
Meanwhile, in our current status as a non-tax-exempt organization, there is a different option which we could use right now. In some businesses, it's quite acceptable to amortize a sum of money over a long time period during which a service is being provided. In other words, if we figure how long a patient may expect to be frozen, we may spread the patient's funding over that number of years and pay tax only on that annual amount.
There are many precedents for this approach. For example, when a monthly magazine receives payment for a year's subscription, the income is declared in twelve separate installments as each issue is shipped out, even though the total sum of money was received up front.
In our case, suppose that the patient's funding was paid directly to the Patient Care Trust, which in turn paid the cost of cryopreservation. In this model, the cost of cryopreservation could then be charged as an expense against the income.
An example may help to make this clear. At the time of death, a whole-body patient's funding arrangements provide a minimum of $125,000. Of this money, approximately $45,000 is spent on cryopreservation and fees for CryoSpan and CryoCare, leaving $80,000 to be invested by the Patient Care Trust. Suppose we assume a storage period of forty years. (Why forty? Because we know of cases where the IRS has already allowed goodwill to be amortized over this length of time.) If we spread the initial $125,000 over that period, we only need to declare slightly more than $3,000 per year as income.
Now let's apply the expense of $45,000 in cryopreservation fees. This expense can completely cancel the $3,000 per year income for the first fifteen years. (Actually the picture is slightly more complicated, because the $80,000 that is invested will generate interest, and that interest will be taxable.)
In the case of neuropreservation, the picture looks even better. Of the $58,500 received from the patient at legal death, $41,500 goes to cryopreservation and one-time fees. If the $58,500 income is spread over forty years, we declare income of slightly less than $1,500 a year. The expense of cryopreservation can be charged against this, eliminating it completely for the first twenty-eight years. (Once again, the real picture is more complicated, since the money invested will yield interest that is taxable.)
This situation is not ideal. Since it would require the Patient Care Trust to pay some taxes a decade or more down the road, we regard it as a fall-back, worst-case scenario. But we do feel it would be something we could live with, and we have been assured by our various advisors that it is absolutely consistent with generally accepted accounting procedures.
Another factor to bear in mind is that no taxes are charged on an estate valued under $600,000. Therefore, if we receive funds in the form of a bequest, it can be tax-free. (On estates where the value exceeds $600,000, taxes must be paid before the money is divided among the beneficiaries.)
Generally speaking, CryoCare is reluctant to allow anyone to make funding arrangements through a will, because there has been at least one case in the past where relatives went to court and successfully reduced a large sum that had been bequeathed to a cryonics organization. Also, even if a case was decided in favor of CryoCare, it would still entail substantial delays and legal fees.
As a means of providing additional funding beyond our minimums, however, a bequest may be an option worth considering.
According to the advice we have received so far, insurance death benefits are not taxable. Therefore, if a member of CryoCare arranges funding entirely via life insurance, and if the death benefit goes directly to the Patient Care Trust, there should be no problem.
The situation may be more complicated than it seems, though, because some life insurance carries "cash value" as well as a death benefit, and if the cash value is transferred to a beneficiary, it is taxable.
A "term life" policy has no cash value. In other words, if the policy holder is still alive at the end of the term, (s)he doesn't get any money back. A "whole life" policy, however, is like money in the bank: the insurance premiums are paid into an account that earns compound interest, and the policy holder can cancel the insurance and retrieve the money at any time.
We will know more about the insurance situation in the very near future. In the meantime, you may be wondering what happens if one of our members suffers legal death while some of these questions are unresolved. Under these circumstances, we have been advised that it would be legitimate to place the patient's funds in an escrow account until the trust is ready to receive the money.
Remember, no other cryonics organization currently has a trust, and so far as we can tell, none of them has plans to set one up along the lines that we have in mind. Our current situation (which we consider temporary) is not very different from the long-term situation in other cryonics groups, where patient money is received and invested by the directors and no separate, independent trustees are allowed.
Maybe you feel that we should have settled all this before we started accepting members. In an ideal world, this is true: we would have raised a substantial sum of capital, hired full-time staff, and researched every conceivable legal angle.
Unfortunately, cryonics has never been done this way. The reason is simple: worldwide, fewer than 1,000 people have signed up for cryopreservation. This is a tiny customer base to sustain an endeavor which involves large capital outlays for medical equipment, personnel, and procedures, quite apart from the legal problems that are involved.
It would be easy to gloss over this whole topic and say, simply, "Don't worry, we have good people working for us, and we won't let you down." But our objective, here, is full disclosure. This can be difficult and sometimes embarrassing, especially if we fail to achieve a goal that we have previously announced. But if we really want you to have faith in us, we have to tell you the bad news along with the good. So, the bad news here is that our Patient Care Trust is not yet ready.
Overall, our judgment call has been that if the worst comes to the worst, we would rather live with a small, known risk of having to pay a modest amount of taxes than a larger but unknown risk of being audited and assessed for back taxes and penalties that could literally wipe us out. We hope you'll agree that we've made the right decision.
In 1993, when the idea of a new cryonics organization was first seriously discussed, some very wonderful people made some very generous donations. In many cases, they pledged $1,000 apiece. With their consent, some of this money was subsequently directed to CryoSpan, where it has purchased shares in the company. Some of the money has gone to CryoCare, to help with our start-up expenses. Some of it has been considered an advance payment against membership dues for the first two or three years.
Needless to say, all of the money was appreciated. It enabled CryoSpan to make a down-payment on the four-patient dewar that it now owns, and it enabled CryoCare to become a reality.
In alphabetical order, we thank:
Steve Harris
Marce Johnson
Walt Johnson
Saul Kent
JoAnn Martin
Robert Krueger
Arlene Pappan
Bill Seidel
Maggie Seidel
Paul Wakfer
Roy Yowell
...and two others who prefer to remain anonymous.