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CryoCare Report #9


Online Edition, January 1997


From


Converted to HTML, January 1997

Note: there may be some small differences between this text and the text that appears in our actual newsletter, because of edits that were subsequently made. The text is substantially the same. If in doubt, please refer to the hardcopy version of CryoCare Report as the definitive one.

Contents

Cryopreservation of James Gallagher
Part Two

by Mike Darwin


Discussion of Transport Data

As was noted in Part One of this case report, the use of premedication, intracorporeal cooling, active compression-decompression-high impulse CPR, and advanced reperfusion medication resulted in this patient experiencing less injury than any previous cryopatient as documented by serum tissues specific enzymes, blood gases, and clinical criteria (i.e., absence of pulmonary edema and good overall capillary integrity).

The impact of intracorporeal cooling in the form of colonic and peritoneal lavages with 0 degrees C buffered Normosol can be seen graphically in figure 1. As was previously noted, a cooling rate of slightly over 1.0 degrees C per minute was achieved for the first 10 minutes post arrest.

Close examination of this patient's cooling curve discloses what we believe to be additional valuable information. For the first 50 minutes of CPR, rectal and tympanic temperatures smoothly track each other. However, at approximately the 50-minute post arrest mark there is a sudden reduction in the rate of tympanic temperature descent. This flattening of the tympanic temperature cooling curve continues until the start of extracorporeal support at which time there is a sharp decrease in tympanic temperature and resumption of "tracking" of the rectal temperature.

We believe this sudden slowing in the rate of tympanic temperature descent, which persisted until the start of femoral-femoral bypass, indicates a failure of cerebral perfusion. The author has repeatedly observed the same phenomenon in the dog lab with confirmation of failed cerebral perfusion obtained by intravenous dye administration followed by necropsy. In conventional closed-chest CPR. Using a canine model and the standard ACLS drug protocol we typically see failure of cerebral perfusion following 10 to 15 minutes of mechanical CPR. If the delay before starting of CPR is greater than 5 minutes after the onset of cardiac arrest it is uncommon to achieve any significant degree of cerebral cortical reperfusion during CPR.

In view of the canine data from our laboratory, the persistence of cerebral perfusion as indicated by continued decrease in tympanic temperature for the first 50 minutes of CPR in this patient is encouraging. However, it should also be noted that the presumed loss of cerebral perfusion occurred at approximately 24 degrees C (without further significant reduction in tympanic temperature) approximately 110 minutes prior to the beginning of bypass, and associated resumption of both cerebral perfusion and cerebral cooling.

Clearly, it is critical to be able to take advantage of the relatively brief period of CPR-generated brain perfusion to achieve the maximum amount of cooling possible. In this case, another 2 to 3 degrees C of cooling could have been achieved with the addition of partial liquid ventilation by filling the patient's lungs to vital capacity with an appropriate heat exchange medium which is also capable of gas exchange (1).

It is also apparent that further colonic and peritoneal lavages with 0 degree C fluid would have been useful during the first 50 minutes of CPR.

Finally, faster application of extracorporeal support is critically important and every effort should be made to initiate bypass within a maximum of 45 to 50 minutes of cardiac arrest and sooner wherever possible.

As figures 2 and 3 show, venous pO2 and pCO2 improved steadily during CPR. Lactate levels rose steadily (figure 4) but remained impressively low during 142 minutes of CPR, peaking at 13 mmol/L immediately prior to the start of bypass.

Serum glucose levels rose steadily during CPR (figure 5) indicating adequate hepatic perfusion (there was no exogenously administered glucose) but failure of glucose regulation, with serum glucose being above 350 mg/dl at the start of bypass.

Venous pH was not aggressively raised to 7.4 in this patient, but rather was to be held in the range of 7.0 to 7.2 during CPR. Control of pH was not as tight as was desired and the patient remained acidotic with a pH ranging from 6.95 to 6.84, which is undesirably low (figure 6). The decision to keep pH in the range of 7.0 to 7.2 is based upon experimental evidence from our laboratory and elsewhere (2) that rapid correction of pH to normal levels can be deleterious to the brain and that low pH is somewhat protective during cerebral ischemia.

In the future, it would be desirable to be able to measure pH dynamically in the patient during CPR and we are actively investigating means for doing this.

Other indicators of the efficacy of CPR in meeting this patient's metabolic demands are the patient's serum sodium, potassium, and chloride levels which are presented in figure 7. Note that the patient's serum potassium remains stable at under 5 mmol/L throughout 120 minutes of CPR. Similarly, serum sodium is constant at between 130 and 135 mmol/L.

Graphic data for arterial pressure during bypass and total body washout (TBW) are presented in figure 8 and again reflect the good physiologic state of the patient.


Cryoprotective Perfusion

Patient Assessment

Following transport of the patient to BPI's facilities in Southern California for cryoprotective perfusion and freezing (arrival time 0545 on 13 December, 1995) the patient was moved from the portable ice bath and onto the operating table. Assessment of the patient at that time disclosed evidence of good cutaneous blood washout and no evidence of rigor mortis, and the patient was repacked in ice.

The patient was assessed for the presence of pulmonary edema radiologically and by measuring peak and mean inspiratory airway pressure. The chest film disclosed lungs clear to the bases bilaterally and peak airway pressure was 36 cm H2O when inflated with 10 cc/kg of air. This was consistent with absence of pulmonary injury which has previously invariably occurred as a result of antemortem shock, CPR and TBW during Transport.

Determination of lung water status (i.e., the absence of pulmonary edema) was critical in this case because of our desire to carry out cryoprotective perfusion using femoral-femoral vascular access, as opposed to performing a median sternotomy and achieving vascular access via the aortic root and right atrium. Work done at BPI over the past two years has established the safety and efficacy of this approach to cryoprotective perfusion utilizing newly developed flat-wire, high-flow, low-resistance, femorally placed venous cannulae which allow for caval drainage at the level of the right atrium. However, for this approach to be used safely it is essential that the patient not develop high intra-thoracic pressure from lung edema which could impede venous return.

In the past, all patients undergoing cryopreservation in the authors' experience have developed marked edema of the lungs during transport which has invariably progressed to massive edema of the lung parenchyma with alveolar transudation and filling during cryoprotective perfusion. Often this edema is so severe that closure of the chest wound over the distended lungs is problematic. Such massive fluid accumulation and accompanying increase in intrathoracic pressure would be unacceptable and lead to compartment syndrome and consequently failed caudal perfusion in a patient with a closed chest.

Assessment of lung compliance during cryoprotective perfusion was carried out by measuring peak inspiratory pressure using the same tidal volume at several intervals during cryoprotective perfusion. (Peak inspiratory pressure increases during cryoprotective perfusion as a result of reduced lung compliance due to cryoprotective-associated stiffening of the pulmonary parenchyma and this must be taken into account during evaluation). Radiologic evaluation can also be used to determine lung edema status dynamically.

Final Preparations For Cryoprotective Perfusion

Final preparation of the patient for cryoprotective perfusion consisted of the application of occluding tourniquets to all four limbs (metal hose clamps were used) and re-establishment of the extracorporeal circuit by connection of the femoral arterial and venous cannulae to the cryoprotective perfusion circuit (see figure 20). Care was taken to avoid introduction of any air into the tubing/cannulae during re-establishment of the extracorporeal circuit.

In parallel with reestablishing the bypass circuit, the patient underwent aseptic preparation and draping for craniotomy. Scalp incisions were then made 2 cm from the midline over each parietal lobe, and a DePuy pneumatic perforator was used to make two burr-holes ca. 10 mm in diameter in the cranial bone. The dura was opened in each burr hole using a dura hook and iris scissors and was dissected away to the edge of the burr hole using the iris scissors. The brain was noted to be slightly dehydrated and retracted from the margin of the burr holes bilaterally by 2 mm. A silastic and teflon clad, copper-constantan thermocouple probe (22 gauge) was placed on the cortical surface at the level of the temporal lobes by advancing the thermocouples through the burr holes over the cortical surface. Initial temperature readings were 1.8 C for the right temporal and 2.0 C for the left temporal lobes.

Initiation of Cryoprotective Perfusion at BPI

Cryoprotective perfusion was begun at BPI at 0834 at a flow rate of 1.1 LPM, a MAP of 45 mmHg, an FiO2 of 9.2, sweep gas flow rate of 4 LPM an esophageal temperature of 3.2 C, a right brain surface temperature 1.8 C and left brain surface temperature of 2.0C. Patient temperatures during cryoprotective perfusion are presented graphically in figure 9.

A Sarns 16310 oxygenator-heat exchanger was used for oxygenation and temperature control. Sweep gas FiO2 was decreased to 2.4 at 0842. Cryoprotective perfusion was initiated with 10% (v/v) glycerol in MHP-2 base perfusate. This perfusate was recirculated for 10 minutes before beginning the glycerolization ramp.

Increase of glycerol concentration over 10% (v/v) was begun at 0840 by the addition of 200 cc/min of 60% (v/v) glycerol to the recirculating system (patient loop) and the removal of 170 cc /min of perfusate from the venous return line to discard. Initial arterial and venous glycerol concentrations were 0.2 M and 0.7 M respectively at 0846. Arterial and venous glycerol concentration during the course of cryoprotective perfusion are presented graphically in figure 10.

Arterial and venous perfusate samples were drawn at 15 minute intervals during cryoprotective perfusion. The initial two venous chemistry samples were of questionable value due to technician error during collection (the arterial side of the 3 gang stopcock was not completely shut off during venous sample collection). The first venous sample (chemistry) results are thus not reported. The first arterial and venous (gases) perfusate samples were collected at 0839 and disclosed the following:

Arterial Sample
  Measured Values Normal Range
glycerol (M) 2.8
pH 7.748 7.35 (mean)
pCO2 9.1 mmHg 45-55
pO2 324.2 mmHg 40-50
BUN 5.0 mg/dl 7-25
Creatinine 0.6 mg/dl 0.7-1.4
Sodium 54 mEq/l 135-146
Potassium 29.7 mEq/l 3.5-5.3
Chloride 53 mEq/l 95-108
Calcium 3.0 mg/dl 8.5-10.3
Phosphorus 6.7 mg/dl 2.4-4.5
Protein, Total 0.3 g/dl 6.0-8.5
Glucose 182 mg/dl 70-125
Bilirubin, Total 0.0 mg/dl 0.0-1.3
Alkaline Phosphatase 0.0 U/L 20-125
LDH, Total 113 U/L 0-250
GGT 0.0 U/L 0-65
AST 25 U/L 0-42
ALT 10 U/L 0-48
CPK 187 U/L

Venous Sample
Measured Values Normal Range
glycerol (M) 2.8  
pH 7.223 7.35 (mean)
pCO2 32.7 mmHg 45-55
pO2 99.1 mmHg 40-50
(Chemistries were not available on the first venous sample.)

The next labs were drawn as follows:

Arterial (gases) 0855:
  Measured Values Normal Range
pH 7.462 7.35 (mean)
pCO2 18.7 mmHg 45-55
pO2 113.6 mmHg 40-50

Arterial (chemistries) 0904:
  Measured Values Normal Range
Sodium 52 mEq/l 135-146
Potassium 28.8 mEq/l 3.5-5.3
Chloride 53 mEq/l 95-108
Calcium 2.6 mg/dl 8.5-10.3
Phosphorus 2.6 mg/dl 2.4-4.5
Glucose 177 mg/dl 70-125
Alkaline Phosphatase 0.0 U/L 20-125
LDH, Total 63 U/L 0-250
GGT 0.0 U/L 0-65
AST 17 U/L 0-42
AL 8.0 U/L 0-48
CPK 216 U/L    

Venous (gases) 0905:
  Measured Values Normal Range
pH 7.426 7.35 (mean)
pCO2 21.4 mmHg 45-55
pO2 375.5 mmHg 40-50

Venous (chemistries) 0904:
  Measured Values Normal Range
Sodium 58 mEq/l 135-146
Potassium 30.0 mEq/l 3.5-5.3
Chloride <50 mEq/l 95-108
Calcium <2.5 mg/dl 8.5-10.3
Phosphorus 2.9 mg/dl 2.4-4.5
Glucose 190 mg/dl 70-125
Alkaline Phosphatase 5.0 U/L 20-125
LDH, Total 64 U/L 0-250
GGT 0.0 U/L 0-65
AST 17 U/L 0-42
ALT 5.0 U/L 0-48
CPK 196 U/L

Data for arterial and venous perfusate gases and relevant chemistries are presented graphically as figures 11 through 17. Graphic data for mean arterial perfusion pressure is presented in figure 18.

Cryoprotective perfusion proceeded uneventfully. CVP remained below 10 mmHg until 1000 at which time it was 11 mmHg at a MAP of 68, flow rate of 1.1 LPM and a glycerol concentration of 5.0M arterial, and 4.2M venous.

The cerebral cortical surface was repeatedly examined during cryoprotective perfusion using both flexible and rigid fiberoptic endoscopes. A Storz Hopkins 26156B, 30 degree angle rigid endoscope was used for maximum resolution of the cortical surface and could be extended through the burr holes to view the cortical surface over a 5-6 cm area underlying the burr hole once cerebral dehydration had become pronounced (greater than 20%). The flexible scope is a 4 mm diameter 20 cm long custom "cerebroscope" manufactured by Trimedyne Corp. of Santa Ana, CA. A Storz endoscope camera and Xenon light were used as the cold light source and imager.

Resolution with the Storz rigid endoscope is at the level of small arterioles and venules, and particles in the range of 20 to 30 microns can be easily seen inside vessels. As a consequence of altered tissue refractive index due to glycerolization the cortical surface becomes translucent and it is possible to look into the cerebral cortical surface to a depth of approximately 3-5 millimeters by adjusting the focal plane.

In this patient blood washout was judged to be excellent. The cortical microvasculature was examined at multiple locations in both brain hemispheres and only occasionally were any aggregates of RBCs observed; the frequency of RBC aggregates was comparable to that observed in nonischemic dogs undergoing cryoprotective perfusion following induction of hypothermia and TBW under controlled (and optimum) conditions.

Optical resolution limitations do not allow for such detailed evaluation of the intravascular space using the flexible fiberoptic cerebroscope, however the device does allow gross evaluation of the cortical surface for nonperfused areas as large pial vessels which are blood filled are easily resolved with this instrument. Flexible fiberoptic endoscopy of the surface of both cerebral hemispheres disclosed no visible areas of failed perfusion as evidenced by the absence of blood filled pial vessels. Because the results of the endoscopic exam indicated uniform cerebral perfusion, and because clinical observations did not indicate any problems with cryoprotective perfusion (i.e., no edema, acceptable MAP and flow rate) intravascular dye was not administered to evaluate brain perfusion status in this patient.

Near the end of cryoprotective perfusion an external temperature probe was anchored with surgical staples to the left temple. The esophageal probe was repositioned (guided by fluroscopy) in the left frontal sinus with the tip resting on the bone abutting the forebrain. The brain was noted to be moderately dehydrated at the conclusion of cryoprotective perfusion with an estimated 30% reduction in volume.

Terminal glycerol concentrations were 6.7M arterial and 5.45M venous at 1045. Perfusion was discontinued at 1050.

Cephalic Isolation

Surgery for cephalic isolation was begun at 1055. The skin, cervical musculature, and spinal cord all exhibited complete blood washout and typical signs of thorough and uniform glycerolization (dehydration, waxy texture, ambering of the skin and deepening of skeletal muscle color).

Closure of the burr holes was delayed until the completion of cephalic isolation. The cranial vault was then bilaterally suctioned of perfusate (burr hole drainage) and the isolated head was turned calvarium down to facilitate additional drainage of perfusate from the burr holes while the stump was covered in gauze 4"x4" squares and stockinette put in place. The head was then positioned calvarium up at which time the burr holes were filled with bone wax (with the thermocouple probes still in place) and the skin incisions over the burr-holes were closed with staples. All probes were further secured with surgical staples to the skin of the patient's head.

Cooling to -79 Degrees Celsius

The stockinette was then unrolled to cover the entire head with the temperature probes exiting from the crown of the head through the stockinette. The stockinette was secured to the thermocouple probe bundle and excess stockinette trimmed. The patient (cephalon) was then placed in two 1 mil polyethylene bags. The patient was then submerged in a 15 liter Silcool bath which had been precooled to -39.8 degrees C.

The first temperature readings after submersion in the Silcool were right brain 5.3 C, left brain 6.4C, frontal sinus, 3.7 C and skin surface -12 C.

The patient's cooling curve to dry ice temperature is shown in figure 19.

Postmortem Examination

A thorough postmortem examination was performed on the noncryopreserved remains of this patient. Examination of the abdominal and thoracic viscera disclosed no infarcted areas and apparently uniform distribution of cryoprotectant with the exception of the left ventricular endocardium. On cross section of the left ventricle it was noted that the endocardium had not perfused and that epicardial glycerolization extended only 5-7 mm into the ventricular wall. The transition from perfused to unperfused tissue was strikingly sharp. We believe this selective failure of left ventricular endocardial perfusion is a result of distention of the left ventricle under the static pressure load of the retrograde aortic perfusion.

Distention of the left ventricle and presumed compromise of endocardial blood flow are normally avoided in sustained circulatory arrest cardiopulmonary bypass by the expedient of venting the left ventricle through the cardiotomy reservoir. Use of the closed chest approach to cryoprotective perfusion prohibits this technique from being applied. While this is likely of no significance in patients who have elected for neuro-cryopreservation it may be a relative contraindication to the use of this technique in whole-body cryopatients. Certainly this finding (confirmed in canine cryoprotective perfusion using a variety of CPAs) indicates that in whole body patients undergoing open chest cardiopulmonary bypass the left ventricle should be routinely vented to assure adequate perfusion of the endocardium.

Samples of spinal cord, liver, kidney (renal cortex) and cardiac muscle (left ventricle) were collected for subsequent evaluation. One set of samples was cooled with the patient, and is currently undergoing freeze-substitution at -80 degrees C so that transmission electron microscopy can be performed to determine the ultrastructural integrity of the tissue and the quantity and location of ice in the cryopreserved state.

Samples of spinal cord, left ventricle, and renal cortex were weighed to 0.01 g and then homogenized in known weights of distilled water for determination of glycerol concentration by osmometery. Glycerol concentration was highest in the kidney and lowest in the left ventricle. Results are given in the Table below.

Glycerol Concentration in Selected Tissues
Tissue Glycerol
Concentration in Moles
Left Ventricle 4.25*
Spinal Cord 5.01
Renal Cortex 5.10
*Note that this sample included some visibly nonglycerolized endocardium.

Postmortem examination disclosed widespread metastatic adenocarcinoma of the bowel. Metastases were noted in the liver, both kidneys, lungs, pancreas, mesentery, abdominal and thoracic lymph nodes, and the mediastinum. The liver was heavily invaded with tumor both macroscopically and microscopically. Remarkably a number of the patient's arteries were invaded with linear rod or wire-like metastases (confirmed histologically) including the right femoral and iliac arteries.

Also atypical was the presence of multiple cystlike, spherical metastases in the kidney, and widespread invasion of the skin with multiple metastases ranging in size from 1 cm to 6 cm and also typically presenting as spherical, cyst-like masses.

The patient had suffered unrelenting nausea with occasional vomiting and was unable to take normal quantities of food during the final months of his illness. Despite aggressive treatment with a wide range of potent antiemetics (including marijuana) this remained an intractable problem throughout the patient's illness. CT of the abdomen was unremarkable save for the presence of hepatic and renal masses, and the cause of the patient's nausea remained undiagnosed during life.

Autopsy disclosed extensive carcinomatous invasion of the stomach presenting the classic "leather bottle" appearance with extension of the tumor from the cardiac portion of the stomach into the mediastinum. The vagus nerve was encased in tumor to a level above the bronchial hilus. This is noteworthy in that the patient developed a moderate bradycardia (HR of 50-60) during the last months of his illness which was in sharp contrast to his previous high resting heart rate of 80-90 when he had enjoyed good health. We presume that vagal involvement with malignant disease was responsible for this bradycardia as the few cardiac metastases that were observed were epicardial and right ventricular and did not appear to impact the cardiac conduction system.

Another remarkable finding at autopsy in this patient was the presence of bead-like coal-black nodules in the mediastinum with many of the hilar lymph nodes exhibiting a similar appearance. These lesions were strikingly pigmented and yielded an oily black smear when cut on gauze. Subsequent histopathological evaluation of these masses and of the lung disclosed these lesions to be anthracosis. This finding is remarkable in that the patient had no history of exposure to coal dust or hydrocarbon pyrolysis products and the patient had not smoked cigarettes (or cohabited with smokers) in over a decade. The finding of anthracosis is consistent with the histological finding of bilateral moderately advanced emphysema in all lung samples submitted for pathological evaluation. The etiology of the anthracosis and chronic obstructive pulmonary disease remains unknown.

Discussion

We believe the care this patient received during the premortem, agonal, and transport phases of his cryopreservation represents the best achieved anywhere to date. Mitigation of antemortem and postmortem shock-mediated ischemia-reperfusion injury by premedication seems to have played a critical role in protecting this patient's lungs and brain from ischemic injury. The use of advanced methods of CPR allowed for restoration and prolonged maintenance of acceptable mean arterial pressure and optimum levels of blood gases and CO2.

However, we believe further improvements to transport can be made, particularly improved rates of cooling using intracorporeal (intraperitoneal and intrapulmonary) methods until extracorporeal circulation and cooling can be achieved.

It is now arguably possible to recover and stabilize selected cryopatients who have been pronounced legally and medically dead without the complication of cerebral ischemic injury (i.e., to stabilize such patients at near 0 degrees C with brains which are viable by contemporary medical criteria). However, we note with continuing frustration that inflicting massive gross, histological, and ultrastructural disruption as a result of cryoinjury is still unavoidable. We suggest, in the strongest possible terms, that future research efforts (and the expenditure of nearly all discretionary money available to cryonics organizations) be focused on improving the subzero aspects of human cryopreservation (cryoprotection and cooling to long-term storage temperature).

Notes
1. Darwin M, "A Bypass on the Way to Bypass," CryoCare Report Number 7, April 1996, pp 11-16.
2. Lemasters J J et. al., "Reperfusion injury to heart and liver cells: Protection by acidosis during ischemia and a 'pH paradox' after reperfusion." In Surviving Hypoxia, ed. P W Hochachka et. al., Boca Raton: CRC Press, 1993.





New Emergency Phone Number

CryoCare's main 800 number is always the one to call in an emergency (see below), but in every issue of CryoCare Report we remind you that you can also make direct calls to CryoCare's president Brian Wowk or Charles Platt.

Charles Platt's number has changed since the last issue of CryoCare Report. He can no longer be reached at 1-212-929-3983. Please substitute the new number (listed below) on the emergency calling card that we sent to you earlier in 1996.

In Emergency:
Call 1-800-TOP-CARE (1-800-867-2273)

or make direct contact by dialling

Charles Platt
Phone: 1-212-243-4444
Pager: 1-800-908-0470
Brian Wowk
Phone: 1-204-254-6192
0r
1-204-984-6618
Pager: 1-204-933-0324



BioPreservation Training Course

by Ben Best

During the week following Labor Day this year, a Transport Technician course was given at BioPreservation Incorporated (BPI). This course provides training for those who would like to assist in the cryopreservation protocols initiated immediately before and after legal death. A detailed manual, written and continually revised by Mike Darwin, is provided with the course.

Ten students were registered, several of whom received monetary sponsorship. The Life Extension Foundation paid for two paramedics and one staff member, the Life Extension Society paid for one student, and a pair of German businessmen subsidized two German students as part of their program to establish cryonics facilities in Germany. One of the German students is a physician. I paid my own way, as did two other Canadians, one of whom is a professional intensive care unit nurse. A Cryonics Institute director also attended.

Mike Darwin did most of the teaching, but we also received instruction concerning infections diseases and the dying process from Dr. Steve Harris. Carlotta Pengelley (CryoCare Signup Administrator and a professional nurse) was able to give us hands-on training on the use of syringes and IV administration sets.

Both the current Alcor Transport course and the BPI Transport course are refined versions of the course that Mike Darwin designed and taught at Alcor. The theoretical and practical focus was on mechanisms of ischemia and protocols to minimize ischemia. Every cryonicist needs to understand the importance of rapid cool-down. Packing a patient in ice simply isn't good enough. An ice bath will dramatically hasten the rate of cool-down and reduce the amount of ischemic damage.

A healthy experimental animal can be cryopreserved with up to 60 minutes of global ischemia and show good ultrastructure. Most signed-up cryonicists are not so lucky. 5-6% die without being frozen at all. Another 20% are autopsied. 5-6% die so suddenly that they experience long periods of ischemia, even though they are not autopsied. 20-30% experience organic brain damage due to Alzheimer's Disease, AIDS, brain cancer, etc. And another 20% experience long periods of pre-mortem shock during a slow dying process. That leaves a minority of signed-up cryonicists who get a cryopreservation that has not been preceded by a great deal of brain tissue damage.

Mike gave us the theoretical background we needed for the two dog experiments we performed under his supervision. The first dog experiment demonstrated liquid ventilation using a new BPI proprietary formulation called CryoVent. The air in the dog's lungs was replaced with ice-cold CryoVent liquid, which was poured through an endotrachial tube. Cryovent substitutes liquid-based oxygenation for air-exchange oxygenation, while accelerating the cool-down process. The experiment was successful, and the dog made a full recovery.

The second experiment simulated a cryonics patient, while demonstrating the use of extracorporeal circulation (substituting an external pump for the heart). The night before the experiment we set-up the perfusion circuit. The next day we worked from 8 am to midnight attempting to deliver the best in cryonics patient care to our dog. Although Mike provided guidance, he attempted to have the students do as much of the actual work as possible. The German physician and I were able to do some of the surgery--using strictly choreographed sterile technique. The dog might have recovered had there not been an equipment failure and a misunderstanding which resulted in excessive infusion of pressor agent.

Nonetheless, the most important outcome of the experiment was the knowledge and experience we all gained. If Mike had dictated every action there would have been fewer mistakes, but less would have been learned. During our debriefing session, we all had the opportunity to describe our shortcomings, and to discuss what we could have done to improve our performance.

Few people choose to spend their vacations taking an arduous course such as this one. However, those who someday find themselves assisting with the cryopreservation of a friend or relative will be thankful for what they have learned. And the more knowledge a CryoCare member can provide to friends, family and other local CryoCare members, the better the care that the member is likely to receive for his/her own cryo-preservation.



DNA Samples and Photographs Required

In cases of sudden or traumatic death, CryoCare and our service providers must be able to verify a member's identity as quickly and accurately as possible. Therefore, we're asking every member to send us a current photograph for our files.

Also, the next time you have a dental x-ray, please ask for an extra copy and send it to us--or ask your dentist for your previous x-ray set and send us that instead.

Surprisingly, there are situations where even dental x-rays are inadequate. Consider this scenario: you suffer cardiac arrest at a distant location (perhaps overseas), there's no way to prevent an autopsy, and the best we can do is receive your brain via express shipment on ice. This may sound implausible, but it has happened (although not to any CryoCare members). In such cases DNA analysis is the only real means of authenticating identity. DNA analysis is also the most reliable method of forensic identification under any circumstances. Therefore we also want a sample of your DNA for our files.

Please follow these instructions:

1. Obtain a picture that shows your face clearly. Color prints, black-and-white prints, Polaroid photographs, and 35mm slides are all acceptable. Write your name, bracelet number, and the date of the photo on the back of the print or on the slide mount. Send the picture to Charles Platt, 9 Patchin Place, New York, NY 10011 where it will be scanned and digitized. We will return the picture to you if you enclose an envelope with your address on it.

If you have a picture that has already been digitized, you can email it to us in any format including JPEG, GIF, TIFF, and Photoshop. You may uuencode the data or use binhex, compress it with Stuffit or PKZip, or simply send the unmodified file as an attachment to an email message. Address it to Charles Platt at.

2. Obtain your dental x-rays and put them in an envelope, and write your name, bracelet number, and the date of the x-rays on the envelope. Next, into a new, clean envelope place a few pulled hairs (including the follicle) and/or some flakes of dried skin from a callus. Seal the envelope and write on it your name and bracelet number. Send the x-rays and the DNA sample to CryoCare secretary Ben Best, Box 788 Station A, Toronto, Ontario M5W 1G3, Canada.

Please don't postpone this very important chore. If you won't be visiting the dentist for a while, send us the other forms of identification now and leave the dental x-rays till later.

Do not send blood or any other fluids as we are not prepared to collect such samples at this time.



Report on the World Science Fiction Convention

by Ben Best

Only because the convention was being held in Anaheim, relatively close to BioPreservation/ CryoSpan, did I decide to pull out all stops and promote CryoCare to the fullest extent possible. Despite all my attempts (even working with Alcor people) I was unable to schedule a panel dealing with cryonics. But we did have a CryoCare/Prometheus Project dealer's table, four room parties, and a bus tour of the facility shared by BioPreservation and CryoSpan.

The room party on the first night was reasonably well attended. I would estimate that approximately 100 people visited that night. I had some excellent conversations and we handed out a fair bit of literature. Attendance on subsequent nights was sparser, but many good conversations could be held when there were only a few people in the room at one time. (For example, Paul Wakfer and I both had a good chat with Max More and his friends on Saturday evening.) So the subsequent evenings could have been quite productive as well.

Only four people showed up for the first bus tour: A fellow named Bob Ford who saw my CryoNet announcement (and was not attending WorldCon) plus Micheal O'Neal and two graduate students. Paul Wakfer rode with them on the bus and had a chance to get to know Micheal, Bob and the students. Micheal said that one of the graduate students is now very serious about signing up after he finishes his studies.

Only Keith Lynch and I were on hand for the second bus, so I cancelled it. I would have scheduled it for 7:15 (and got better attendance) rather than 6:15 if I had realized that the panels were longer (and ran later) than at previous world science-fiction conventions.

Alcor had a $300 booth in the dealers' room rather than the $125 table that we had. They were disappointed with the results and they didn't even show up on the last day. They will not have a booth (and may not even have room parties) at next year's convention.

I collected 22 names and addresses of people who wanted to be contacted further, 14 of whom live in Southern California. About half of these names were of people who visited the dealers' table. I expect that we will get more leads from the literature we handed out. I am hoping that Marce Johnson and Maureen Genteman can use some of these people to "recharge" the Southern California group. Even a few "gems" can reap large rewards. (Ken Wolfe was one of the "gems" whom we first contacted at the Winnipeg world science fiction convention.)

Personally, I think that the $855 budgeted for the convention at Anaheim was worthwhile, even if the benefits are harder to quantify than the costs. There were many productive contacts besides the "recruitments"--even among the CryoCare members who participated. Special thanks to Carlotta Pengelley, Marce and Walt Johnson, Maureen Genteman, and Paul Wakfer.



Cryonics Institute vs. CryoSpan: a Debate


Editor's Note:

In past issues of CryoCare Report we've published a lot of features on CryoSpan, the independent organization that offers long-term care in liquid nitrogen for members of CryoCare and the American Cryonics Society.

But CryoSpan isn't our only provider of long-term care. Early in 1995 we negotiated an agreement enabling any of our members to choose the Cryonics Institute (CI) instead of CryoSpan if they wish. (This was reported in CryoCare Report number 3.)

Since we're serious about offering our members this option, you may have wondered why CryoCare Report has published features only about CryoSpan, never about CI.

There are two simple answers. First, CI publishes its own magazine (The Immortalist) which is widely read in the cryonics community. Second, while CryoSpan's CEO Paul Wakfer has written regularly for us and has supplied us with photographs, we've never received any contributions from CI.

I haven't been happy about this situation, because if we don't keep our members properly informed about CI, they can't make an informed choice. Therefore, a couple of months ago I urged Robert Ettinger to write for CryoCare Report, and I suggested that he might like to debate the advantages of his organization with Paul Wakfer.

We quickly established the ground rules: Mr. Ettinger would have his say, Mr. Wakfer would have a chance to answer, and then Mr. Ettinger would have the last word in favor of CI (which seemed only fair, since we've previously published so many articles about CryoSpan).

The resulting debate was strong, frank, and informative. I'm very pleased to publish it here, complete and unedited (except where I chose to spell out some acronyms).

The Cryonics Institute is located at 24355 Sorrentino Court, Clinton Township, MI 48035, phone 1-810-791-5961, email. Robert Ettinger is now living at 3326 North 81st Street, Scottsdale, AZ 85251, phone 1-602-941-5591, email. Contact CI directly if you have specific questions about their facility; contact us at 1-800-TOP-CARE (1-800-867-2273) if you need to know financial or legal details.

Remember, regardless of where you end up, we at CryoCare retain full legal responsibility for your welfare.

CryoSpan's corporate address is 1313 North Market Street, Suite 3410 NE Hercules Plaza, Wilmington, DE 19801-1151, email [ changed to ], phone 1-909-481-4433, pager 1-800-805-2870.

CryoSpan and CI have very different philosophies on funding. One consequence of this is that CryoCare members will pay less for neuropreservation if they opt for CryoSpan, but they'll pay less for whole-body cryopreservation if they opt for CI. The reasons are explained in the sidebar on Page 16 titled Financial Arrangements. You might want to look at this sidebar before you read the debate between Robert Ettinger and Paul Wakfer, because they refer to each others' price schedules.

We hope to publish more news and commentary from CI in the future. Remember, CryoCare Report is not just a house organ for CryoCare; we're open to contributions from anyone in cryonics. If your viewpoint hasn't been represented here, the solution is in your own hands. Write!

-Charles Platt


Storage at Cryonics Institute for CryoCare Members

by Robert Ettinger

Most CryoCare members signed up for storage at CryoSpan before the option existed of storage at Cryonics Institute (CI). They may want to reconsider after contemplating the following.

1. Track Record.

CI (non-profit) was founded in 1976 and has never raised its prices, even in the high-inflation years of the late '70s and early '80s.

Minimum suspension fee is $28,000, full body--no further payments. (Initial membership fee $1,250, additional family members at $625, one-time payments.) CryoCare patients, like those signed up with CI only, will also be entitled to use of general CI resources for revival, rejuvenation, and rehabilitation when that becomes possible. This means that extra funds accruing to CI through investment, bequests, donations, etc. are likely to result in personal benefit to all our patients, including those received through CryoCare. (This will be true whether or not CryoCare members have separate personal trust funds.)

On an inflation-adjusted basis, our prices have steadily decreased. As of September, 1996 we have 20 patients in storage, all full body. By almost all criteria, we are the second largest cryonics organization, after Alcor--and first in number of full body patients.

2. Financial Strength.

CI (fiscal year ending March 31, 1996) had total assets of $1,771,248.90. There were no liabilities except then-current withholding and payroll taxes, $2,838.35. Excess of operating revenues over expenses was $52,601.93. Excess of total revenues over expenses was $36,936.93. Cash flow was net positive $429,581.05 (largely from a bequest by a patient).

CI owns its properties free and clear, and has a policy of never having any debt (other than minor current accounts payable). In a crunch we could hunker down and operate with volunteer personnel only. We have no creditors, no landlords, and no stockholders. CI officers and directors have never been paid.

Sources of revenue for CI presently include membership fees, suspension fees, dues (for those who want voting rights), donations, bequests, and investment income. There may be additional future sources of revenue including royalties for use of Visser-related technology. (CI, along with Alcor, has exclusive rights to the present and future Visser technology for cryonics purposes, including the right to sublicense.)

I have not seen a CryoSpan financial statement, but I suggest that CryoCare members obtain one and compare it to CI's. (CryoCare will always have our complete statements available.)

3. Cryostats.

CI designs and fabricates cryostats on our own premises. These are made of fiberglass with typically at least a foot of evacuated perlite for insulation, with a moderate vacuum of 10 to 100 microns of mercury. They are very rugged and durable. None has ever failed, and those in operation show no signs of deterioration. Cost of operation is a maximum of about $1,000 per year per patient for liquid nitrogen; the newest and largest rectangular units, as well as the cylindrical designs, have considerably less boiloff, and future economies of scale should further reduce the cost.

If someone took a sledge hammer to one of our cryostats, and managed to crack that thick hide all the way through, there would be no crisis; the perlite without vacuum is still pretty good insulation, and we could effect immediate repairs. The MVE type units used by other organizations (including CryoSpan) by contrast are relatively fragile, and there have been failures. Even a small leak in these will result in very quick and almost total loss of insulation, because they rely on very high vacuum. Even a dent can produce a hot spot (as we have seen in the similar dewars used for nitrogen delivery). In addition, I am told, they require periodic hardening of the vacuum, usually involving baking and injection of new getters, and transfer of patients while this is going on. This may happen every 10 to 20 years.

4. Earthquakes.

The risk of earthquake in Michigan is close to zero, but very high in CryoSpan's location in California. CryoSpan has taken commendable steps to reduce the direct vulnerability of its cryostats, but extremely serious long-term risk remains. In event of the major quake that many experts say is inevitable in coming decades, it might become, and for a long time remain, nearly impossible to service the facility, for reasons including collapse of roads and bridges, interruption of liquid nitrogen delivery and of utilities, and other concomitants of damage from the quake and from the resulting fires and from the potential breakdown in the economy.

We are told that there are three nitrogen suppliers near CryoSpan. But where is the explicit, detailed evidence that at least one of these could continue to function after a major quake? Where is the detailed evidence that their employees will come to work within the (two week? two month?) CryoSpan requirement? That their major customers will remain open for business? Nearby or not, what happens if the roads are not passable? What happens if their large storage tanks fall into a chasm? What happens if the Cryospan building itself falls into a chasm?

Again I stress that we are not talking about remote possibilities, but (in the opinion of at least some seismologists) events that are more likely than not in coming decades. (Of course, an actual chasm opening up under the CryoSpan building does not have high probability--less than the probability that CryoSpan will just go out of business.)

A CryoSpan brochure says, "CryoSpan is continuing detailed search and evaluative procedures aimed at eventually opening another branch of the company, to include a long-term patient care facility, in a location which is freer from environmental risks." No comment needed.

5. Shareholders vs. Patients.

CI, as noted, is nonprofit (although not tax exempt), has no shareholders, and no officer or director derives any financial benefit. The only interest we have is in the welfare of our present and future patients, including ourselves.

CryoSpan, on the other hand, is organized for profit, which instantly raises the specter of conflict of interest. All for-profit corporations have this problem--they must try to meet legal or moral obligations to the shareholders, the customers, the employees, management, and the community.

Ordinarily the shareholders come first (in theory; often management puts itself first). Management is often considered to have a moral as well as legal obligation to put shareholder interests ahead of the interests of customers--patients in this case. The closest parallel might be that of a for-profit hospital. The hospital will claim to put patient interests first, and government regulations may force them to do so to some extent, but the hospital is not compelled to remain in business if it is not profitable. And many of the newer HMOs, physician group practices, and similar health organizations have been repeatedly accused of putting profits ahead of patients. Certainly the temptation to do so will always be there.

6. CryoSpan Can Pass the Buck.

As I understand it, CryoCare hires CryoSpan to store patients, paying on a yearly basis. The buck stops with CryoCare, not CryoSpan. If CryoSpan wants to bow out for any reason (such as a shareholder desire to liquidate) it can do so, leaving CryoCare with the job of finding another storage provider and moving the patients.

CI, on the other hand, is paid in a lump sum soon after time of death, and then has permanent responsibility, just as for those patients signed up with CI only. CryoCare still retains the right to move the patient, at its own expense and with no refund, if it wants to do so for any reason; but CI does not have the option of telling CryoCare to take back its patients.

I don't doubt that the present shareholders of CryoSpan are committed cryonicists who would make sacrifices, if necessary--at least for a while--to keep CryoSpan in business, even if it is formally for profit. But no one knows who the future shareholders will be--and even committed cryonicists, if they are losing money year after year, might choose to pass the buck to CryoCare. Prospective patients don't want to be nomads.

7. Funding and Reserves.

CryoCare requires $75,000 for full body storage with CryoSpan; CryoCare then pays CryoSpan $1,500 annually until the patient is revived, or until CryoSpan prices go up. Under the CI option, after death of the member, CryoCare would only have to pay CI $28,000 with nothing further; the balance of $47,000 could continue to grow by investment under CryoCare's management. In less than 10 years, at 5% earning rate, CryoCare would again have its (your) $75,000 in hand, with no more payments to CI required! (That $75,000 would then continue to fatten indefinitely.) Belt and suspenders!

[Editor's note: actually, the situation is slightly more complex for CryoCare. See the sidebar titled Financial Arrangements.]

In sum:

CI is established, sound, stable, growing, and by far the least expensive (or with by far the highest safety margin) when you consider all the factors above. CryoSpan is new and has uncertain prospects and substantial risk, both physical and financial.

Of course you are welcome to visit (by appointment) or call or correspond.


Storage at the Cryonics Institute or CryoSpan

by Paul Wakfer

Since there have already been many reports in CryoCare Report detailing the progress and merits of CryoSpan, this article will mainly reply to Bob Ettinger's criticism of CryoSpan and point out some major weaknesses in his own organization.

First of all, it should be noted that the Cryonics Institute (CI) and CryoSpan operate under very different principles with respect to their patients and to the organizations for which they provide long-term cryonics care services. The most essential difference is that CI is also a full service organization caring for its own patients. All Bob's statements concerning the investment of the long-term care capital and the use of the funds from bequests, donations, etc. have no relevance whatever to any services which CryoSpan provides. Instead these things relate to CryoCare's investment of patient funding and its use of bequests, donations, etc. CryoSpan is strictly a service provider to CryoCare, the American Cryonics Society (ACS), and any other cryonics organizations with whom we may choose to enter into contractual agreements, and as such receives only a yearly fee. The same remark of non-relevancy applies to any comparison of the financial statements of CI and CryoSpan. If one is not to be comparing "apples with oranges", one would have to combine the financial statements of CryoSpan, with those of CryoCare and ACS and all their patient funds and investments to have anything meaningful.

CryoStats vs. Dewars

The cryogenics industry has been manufacturing containers to hold liquid nitrogen and other cryogenic fluids for over half a century. Many types of containers have been tried. Over the years, improvements in dewar making relating to both boil-off rate and endurance have been made. Since I do not think that the properties of a cryogenic container needed for the purpose of storage of cryonics patients are very different than those for other types of biological storage, CryoSpan employs the stainless-steel dewars which have now become the industry standard, for the storage of its patients. Even the largest currently manufactured cryogenic vessels (tens of thousands of gallons) are made of stainless steel inner container, carbon steel outer jacket, and either perlite and medium vacuum, or superinsulation wrapping and high vacuum between the two. I accept the conclusions of the cryogenics industry, that this construction will be more durable and longer lasting, and will be cheaper to operate in the long run than any other type of cryogenic container. CryoSpan's cost for liquid nitrogen per year for each whole-body patient in its 4-patient dewars is under $500 per year (vs CI's per year patient cost for liquid nitrogen of $1,000). Our costs will be even lower when CryoSpan's dewar enclosures are complete and will also be less for the larger dewars we will acquire as our patient population increases.

CryoSpan's dewars are not at all "fragile." Engineering analysis by CryoSpan's vice-president, Mark Connaughton, an MIT mechanical engineering graduate, has proven that when inside their silo-vaults, they are easily capable of withstanding the largest earthquake forces which are predicted ever to strike the facility housing the dewars. When housed in their reinforced high-density concrete silos, they are cushioned from the walls and further insulated by 5" of special low thermal conductivity laminated foam (this additional external insulation together with the surrounding concrete will allow a six-day hold time even after the loss of total vacuum).

Buried reinforced concrete vaults were completely undamaged during the last major earthquake in the Los Angeles area. The dewars in the silos are topped by another 6 inches of foam, 4 inches of heat retardant material, and a 600# steel plate silo cover. In addition, a large bore steel drain pipe leads from each silo at a level 3 feet below surface (and well below the dewar openings) onto our downhill neighbor's parking lot. Thus are CryoSpan's dewars not only safe from "sledge hammers" but also from fire, flood, wind, chemical spills, theft and gunfire. Can CI make the same claim? I think not.

With respect to the possible reduction of the vacuum over time (caused by outgassing from the heat shield wrapping materials inside the evacuated double hull), the major effect of this is a very gradual rise in the boil-off rate. With newer manufacturing methods, it is not clear how soon the boil-off rate on recently built dewars might increase to unacceptable levels. There are dewars which have been in service for over 30 years without requiring re-evacuation. In any case, this is something which is very gradual, can be scheduled well ahead of time if ever needed, and could even be avoided completely by hardening the vacuum "in-place" (although this is not the most efficient way to do it).

Environmental Risks

Earthquakes

While it is true that Southern California is an active earthquake zone and CryoSpan has consequently been compelled to safeguard its patients completely from this threat even in the short run, we believe that in the long run of the time-scale over which today's cryonics patients will need to be stored (100-200 years) almost anywhere in North America has the potential of suffering a major earthquake. I believe that for this reason and the many other dangers mentioned below, every cryonics long-term care provider needs to put its patient containers in hardened enclosures. The result of the imminent earthquake threat to CryoSpan's facility has been that CryoSpan's patients are now better protected than those of any other long-term care provider (and CryoSpan's owners have had to put more up-front capital into the company).

In addition, CryoSpan has more than adequate protection from delays in liquid nitrogen delivery which might result from a major earthquake. We buy our liquid nitrogen in bulk and maintain a "reservoir" dewar (also a backup for any of the patient dewars) which is never allowed to be less than one-third full. In the long run, CryoSpan intends to maintain a patient-to-reservoir-dewar capacity ratio of no more than 3 to 1 and will keep its reservoir dewars always more than one-half full.

What this means in practice is that because of this reservoir and the low boil-off rate of all our dewars, CryoSpan will have a worst-case patient hold-time of 120 days. (We define the "hold-time" as the time before any portion of a human patient is above -140 degrees Celsius--the commonly agreed temperature below which no biological activity occurs and no further ice formation can take place.) In the Los Angeles area, there are over 10 plants which produce liquid nitrogen, run by four companies. They are widely scattered and it is almost inconceivable that all would be out of commission at the same time (certainly not for more than 120 days). In addition, liquid nitrogen can be trucked in from many places outside the LA area. One benefit that has come from being "pushed" by Bob to "check my premises" is that our supplier has now given CryoSpan a disaster delivery priority second only to medical facilities. All things considered, I believe that CryoSpan's patients are safer with respect to availability of liquid nitrogen than those at any other facility.

Since CryoSpan is not near any known fault (the only places where "chasms" could possibly occur), asking questions such as "What happens if their large storage tanks fall into a chasm? What happens if the Cryospan building itself falls into a chasm?" is little different from asking "What happens if an airplane crashes into the CI facility?" (In fact, from what I understand, it is not even possible for Southern California earthquakes to generate "chasms"--except in the movies, of course.)

Bob Ettinger refers to a statement in an early CryoSpan brochure which says, "CryoSpan is continuing detailed search and evaluative procedures aimed at eventually opening another branch of the company, to include a long-term patient care facility, in a location which is freer from environmental risks." and follows it with "No comment needed". What he doesn't realize is that the statement he quotes was included in the brochure, for several purposes, none of which relate to his implication. First, it is known that there are many people (non-Californians such as Bob it would appear) who do not understand that earthquakes can be well protected against. Second, I am from Toronto and would much rather, in the long run, have a facility somewhere in the north-east. Third, although there are many advantages to CryoSpan's location in Southern California, it would be nice to have a location which didn't require such high capital costs for protection as both CryoSpan and CI do (such as in an abandoned Colorado mountain railroad tunnel). Fourth, when the brochure was written, the silo-vaults had not yet been built and if we had found another location we would have had the luxury of foregoing that capital cost of protection (and living a bit more dangerously) as do all the other long-term care providers. Fifth, when the brochure was written, I was (foolishly) expecting the cryonics care business to grow much faster than it has done and appears to be going to do in the near future.

Snow-Fall

At CryoSpan's facility it never snows. At CI in Michigan, I would expect that once every 50 years or so there is a large enough snowfall to possibly cave in the roof of the CI facility. The effect of this might well be that a roof beam would puncture even through to the inner wall of one of the fiberglass cryostats with consequent danger to the patients inside. I believe that the least that CI should do to guard against this possibility would be to build a steel cage around each cryostat. In addition, I would expect that even more often the amount of the snowfall is such that roads are closed (and liquid nitrogen delivery is not available) for many days. With its substantially higher boiloff rate per patient, CI might be wise to consider keeping a reservoir container full of liquid nitrogen at least during the winter months.

CryoSpan stores its whole-body patients with their heads down (and human neuro cans only 3 deep). Therefore, the most important part of the patient is the last to warm up even to -140 degrees Celsius (and possibly suffer slight additional damage) during a prolonged delay in liquid nitrogen delivery. Since CI stores its patients flat, the head of the topmost patient might even warm up slightly during the delivery delay caused be a severe snow storm. This is an additional reason why I am suggesting the emergency reservoir arrangement to CI.

Winds

The only winds which ever bother the CryoSpan facility (with a bit of dirt and dust) are the yearly Santa Ana's--steady warm winds sometimes gusting to 70 miles per hour which blow in off the desert. The whole Michigan area is potentially open to the threat of tornadoes. All weather experts agree that without doubt tornadoes pack a denser destructive punch than any other form of weather phenomena. If a large "twister" were to directly hit the CI facility, I believe that every patient there would be in danger. The only protection against this possibility that I can envision is either to put the cryostats underground or to build a heavy, fairly densely packed steel-bar cage around each cryostat which would also need to by solidly anchored to the concrete floor.

Fire

CryoSpan's dewars are made of highly heat resistant stainless steel, are below ground and separated from anything flammable by concrete, steel and fire/heat retardant material. If the whole facility (which is fully sprinklered by the way) in which they are housed caught fire and burned to the ground with the walls falling down and the roof caving in, all that would happen to the dewars would be that the boil-off rate might increase temporarily a tad, and the monitoring equipment would cease to work and might be destroyed (it too will eventually be vault protected). Half a day's work with a bulldozer would give us access to the dewars. With the mild climate, it is hardly necessary for the silos to be housed within a building, so servicing them without a building overhead would be little problem. How would CI's patients fare under such a situation? With their low-melting-point, unprotected, fiberglass cryostats, not very well I think. If this occurred in the middle of freezing-cold weather, servicing even the cryostats that were still intact would be a nightmare.

"Shareholders vs. Patients"

This section is without doubt the most amazing of Bob's criticisms. It reads like something right out of "Socialism 101." I do not think that I have any need to defend the validity of free market, for-profit principles and practice to the readers of CryoCare Report.

"CryoSpan Can Pass the Buck"

And this one is almost as bad. The yearly cash expenses of CryoSpan are really quite small (under $5,000) now that the major capital costs have been expended. There is only a net loss when regard is given to the worth of the labor being put into the company. As CryoSpan "owner" (until the company is profitable enough to "go public", I will keep over 50% of the stock), I have pledged to maintain it by my own funds, if necessary, until it becomes profitable. If something should happen to me, I know of others who would be willing to do the same. Therefore, there is really no possibility of CryoSpan going out of business unless all of its patients were removed by ACS and by CryoCare Foundation.

However, even if CryoSpan did decide to go out of business, under its contract with CryoCare it is obligated to continue caring for the patients for an minimum of 15 months after giving notice to CryoCare, which should provide ample time for CryoCare (which holds all the patient funds) to find other options. In addition, no patient funds would be lost in the process. This sort of occurrence is one of the major reasons why CryoCare adopted an unbundled (not all eggs in one basket) approach to cryonics patient matters. As a point of philosophy and psychology, it is usually much easier to keep on doing an unpleasant but necessary job when one doesn't "have" to. On the other hand, if CI were to suddenly get a flood of minimum cost patients (e.g. doubling its present patient population of 20), without any bequests or donations, it could very quickly be in a financial position where its income was not sufficient to pay its expenses. Since it requires lump-sum, up-front payments for perpetual storage, it can't raise its fees for patients which it already has. Each year capital would need to be taken from the CI patient care fund to make up the shortfall. Without donations coming in from somewhere all the patients would be in danger, even the ones who had put in much larger than minimum amounts. If, under the circumstances, CryoCare decided to remove its patients, each whole-body patient would have incurred a $28,000 capital loss of funding.

"Funding and Reserves"

This section is a flagrant example of the economic fallacy of not examining the "unseen". By the same reasoning Bob uses (and the same unrealistic, inflation disregarding interest rate), if the patient went to CryoSpan, then at 5% per annum interest only $30,000 of the $75,000 capital is needed to provide the $1,500 per year care fee. This leaves $45,000 (almost as much as the $47,000 left if the patient went to CI) to grow and "fatten" on its own. In addition, the funding capital still contains the $30,000 which is producing the $1,500 income. Yes, eventually, the amount that $47,000 would grow to would be larger than what $45,000 would grow to, by more than this additional $30,000 (in 55.5 years actually). However, long before that time, market forces and economies of scale would have caused CryoSpan to considerably lower its yearly charge for care--relative to inflation, and thus the CryoSpan patient would still be financially ahead.


Response to Paul Wakfer

by Robert Ettinger

1. Paul says one cannot compare finances of Cryonics Institute (CI) and CryoSpan (CryoSpan) because they are structured differently.

This is disingenuous at best. It most certainly is relevant to estimate probable future solvency on the basis of track records and present condition.

2. Continuing this line, Paul says one should compare CI's finances with those of CryoSpan combined with CryoCare or ACS. Not so--first, because the immediate question is simply whether CryoSpan itself will fail, forcing CryoCare to relocate the patients and reduce the available reserves. Second, CryoCare patients stored with CI will still have the CryoCare backup, so by Paul's own reasoning one should add together the strength of CI and CryoCare. In other words, the CryoCare backup exists in either case--storage with CI or CryoSpan--so the only relevant question, in choosing a storage provider, is which is most likely to be able to carry through (and which will provide extra potential services).

Third, I don't know what the reference to ACS is supposed to mean. I know that ACS sometimes contracts storage with CryoSpan, but surely ACS is not going to rescue any CryoCare patients that might need help because of a failure of CryoSpan. ACS would not have that legal right, with respect to its patient care funds, and is unlikely to have the means or desire to do so out of its general funds.

Fourth, Paul refers to CryoCare's use of funds from "bequests, donations, etc." To the best of my knowledge, CryoCare is unlikely to receive any bequests or donations on a meaningful scale, because it has deliberately chosen a policy of earmarked funds, each patient a stand-alone, sink or swim with his own funding.

Fifth, as far as I know, CryoCare does not have any substantial assets of its own. Again, each member is essentially on a stand-alone basis financially. CryoCare is strictly a provider of oversight service, plus recruitment, information, research support, and coordination functions.

Due diligence requires CryoCare members to compare CI and CryoSpan financial statements.

3. On the merits of various cryostat designs:

(a) Paul says "I accept the conclusions of the cryogenics industry" (on which types of storage to use). Interesting--perhaps he would also accept the judgment of the cryobiology establishment that cryonics is hopeless. Appeal to authority is beside the point: Our claims for our cryostats are verifiable. Pay us a visit.

(b) My references tell me a somewhat different story on established practice, viz.: For small containers, the MVE type "superinsulation" with high vacuum is usually used; for intermediate size, perlite with relatively soft vacuum; and for very large size perlite without vacuum.

(c) Paul repeats a cost of $1,000 per year per patient for liquid nitrogen at CI. I said this was our original estimate and currently the maximum. Our newer units (and also some of our older ones) do considerably better than that--down to $600 per year. We will be reporting probably next year on our newest and largest, currently under construction. In any case, what counts is total cost, track record, and overall stability.

(d) Paul asks whether CI patients are safe from fire, flood, wind, chemical spills, theft, and gunfire.

Fire: Many precautions have been taken, including subdividing with approved firewalls.

Flood: Come look at the terrain and you will see for yourself. There has never been a flood in that area, but if there were, there is an enormous drainage ditch close enough to keep the water low. At worst, water in the building would be only an inconvenience, not a disaster.

Wind: At the last Board meeting, Joe Kowalsky raised the question of security against tornadoes. A very remote contingency, as the statistics clearly show; nevertheless, we are investigating enclosure of each cryostat with a heavy steel cage.

Chemical spills: No dangerous chemicals are ever nearby in quantities capable of making a dent in one of our cryostats.

Theft: A thief with the desire and ability to steal a cryostat of many tons, or break into one and steal bodies out of liquid nitrogen, would be an unusual thief indeed. In fact, he wouldn't be a thief in the usual sense, but some kind of fanatic--and against fanatics there is no passive defense.

Gunfire: The fiberglass hides of our cryostats are much thicker and stronger than the "bullet-proof" clear plastic shields used in stores and banks, and much tougher than the steel and Kevlar body armor used against rifle fire. Of course, the real question is whether armed saboteurs could invade a building and wreck its contents. No amount of passive defense can do much more than slow down an assault. Any major gang could break into Fort Knox and loot it--except for the nearby presence of the Second Armored Division and the 82nd Airborne. And CryoSpan's underground vaults would mean little against a few armed invaders with thermite or explosives.

CI night security currently depends mainly on top-of-the-line, redundant professional electronic alarm systems, including radio backup if telephone lines are cut. Within the next few years we expect to have live personnel on site at all times, as Alcor does. If meanwhile there is any hint of actual, specific danger, we will immediately hire armed patrols--even though Clinton Township police respond very quickly. (My wife Mae's grandson is on the force, incidentally.)

4. Earthquakes.

(a) I have already acknowledged that the risk of CryoSpan falling into a chasm is low--much lower than the probability of bankruptcy.

(b) Paul says that, over a century or two, "almost anywhere in North America has the potential of suffering a major earthquake." This is much like saying: "Even careful drivers have accidents, so I'm not going to be careful." Michigan is nowhere near as dangerous as California.

(c) Paul has not addressed the many questions involving major physical and economic disaster if the big one hits. (Neither has almost anybody else, to be sure.)

5. Snow. No building of CI's type in that vicinity has ever suffered a roof cave-in because of snow, as far as I have been able to find out. Nor does snow accumulate instantly; in case of danger, we would act. And we have steel beams under the roof. Roads in that area, or the expressways, have never been closed more than a day or so.

6. "Shareholders vs. Patients." Paul is dodging the issues, and changing the subject by accusing me of socialism. These are real-world problems, which won't go away just because he salutes the flag.

7. "CryoSpan Can Pass the Buck."

(a) Paul did not dispute my simple statement of fact, that CryoSpan--whenever it wishes--can give notice and bow out, requiring relocation of patients. He just makes optimistic estimates and promises, after admitting that CryoSpan (a for-profit company) is covering its losses by not paying for work done.

(b) Paul asks what would happen if CI suddenly got a flood of patients paying the minimum suspension fee. Actually, that would probably be good, because it would reflect heightened acceptance of cryonics and much greater economies of scale. Even now, incremental patients don't cost us much at the margin. In any case, we could--if necessary--raise prices; but I don't see that happening. Nor do I see any reason to think that future patients will provide less on average than past patients. Motivation remains the same.

8. "Funding and Reserves."

(a) Paul says that eventually "market forces and economies of scale" would reduce the CryoSpan yearly fee. We don't know when, or to what extent, economies of scale will kick in. We don't know how long Paul or a successor will be willing and able to donate time and effort. We don't know if future shareholders in CryoSpan will want to stay in a business that isn't returning as much as other investments. "Market forces" cannot reduce prices for long if the result is loss to the shareholders.

(b) Paul mentions an "unrealistic, inflation disregarding interest rate" of 5 percent. Presumably that means he thinks that inflation-adjusted or "real" interest rates are likely to be less than 5 percent, and CryoCare policies agree with that as a conservative stance. He fails to note, first, that the CI record of no price increases includes the high inflation years of the late 1970s and early 1980s. Second, that CI is much less vulnerable to inflation than CryoSpan, since CryoSpan relies (in principle) entirely on paid help, while CI does not. (And CI owns its property, so need not face rent increases.)

(c) Paul fails to address or acknowledge the very important point that CryoCare members, if stored with CI, stand to benefit (for example, with respect to revival, rejuvenation, and rehabilitation) from all general financial gains by CI, including donations and bequests by other members of CI--whereas a CryoCare member stored with CryoSpan is strictly stand-alone.




IRS Denies Tax-Exempt Status to CryoCare

Shortly after CryoCare was formed three years ago, we started examining various options to shelter patient care funds from taxation. Long-term care funds of CryoCare members who opt for CryoSpan as their storage provider are held and managed by the Independent Patient Care Foundation (IPCF). For this reason the tax-law investigation was led by IPCF president Courtney Smith and board member Bob Krueger, working in association with the internationally famous accounting firm of Ernst and Young.

Section 501(c)3 of the federal code provides tax-exempt status for non-profit organizations engaged in scientific research and/or public education contributing to the general betterment of society. Cryonics organizations have traditionally classified themselves under this section, but the IRS has not approved any new application on this basis for more than 20 years. Also, all the attorneys and tax experts whom we consulted unanimously agreed that when an organization receives money for maintenance and possible future revival of patients (instead of merely doing research and promoting the concept of cryonics) it is now engaged in "fee for service" operations. This renders the organization ineligible for 501(c)3 status.

We investigated other tax-exempt classifications. The most promising seemed to be section 501(c)13, which exempts cemetery perpetual care funds from taxation since cemeteries perform an important function--disposal of bodies--that the government would have to perform otherwise. We felt that authorities should logically classify cryonics organizations as providing the same function as cemeteries, since cryonics patients have been declared legally dead.

Negotiations to achieve 501(c)13 status for CryoCare began in 1994 as a prelude to acquiring the same status for the IPCF. The IRS sent a letter of rejection in the fall of 1995, but the letter contained numerous inaccuracies, so we launched an appeal. Negotiations were reopened and continued through the first half of 1996. Discussions concluded on a positive note in a meeting in Washington, DC in May, and we were optimistic about a favorable outcome.

We were surprised when the IRS sent us a final letter of rejection in August of this year. Incredibly, one of the pivotal points in the decision was that cryonics does not constitute "permanent disposition." In other words, the U.S. Internal Revenue Service acknowledges the possibility that cryonics might actually work! Consequently, cryonics cannot qualify for tax relief since it is not truly disposing of bodies as a cemetery does.

In one respect this is a positive decision, since the federal government has added its voice to that of the California Attorney General's office when they issued their formal legal opinion in 1980 that "cryonics does not constitute a cemetery operation". This affirms that cryonics is beyond the jurisdiction of state cemetery regulators and is something new and different. As legal precedent and legislation continue to accumulate in the years ahead, we may be able to steer these developments toward legal recognition of cryonics patients as people.

Unfortunately we are back to square one on the tax protection problem. According to our research, the most comprehensive (but complicated and expensive) solution would be to place patient funds in offshore trusts. Doing this inexpensively and without adding to our members' paperwork burden will be a real challenge. Still, we hope to meet it within the next 12 to 24 months.

CryoCare is deeply grateful to Courtney Smith and Bob Krueger for their past and continuing work on the tax aspects of cryonics. In addition to many hours of time, Bob and Courtney have personally contributed more than $20,000 to cover the legal costs of these investigations. Thanks also to Paul Wakfer and Kevin Brown for their work on associated writing and paperwork.



Developments in Cryonics Research

Many of our readers have heard about the Visser experiments cosponsored by Alcor and the Cryonics Institute, in which a rat heart was frozen in a new cryoprotective solution and resumed rhythmic contractions after rewarming. Some CryoCare members have asked whether we believe this is a genuine breakthrough and whether it will affect our own cryopres-ervation protocol in any way.

We cannot judge the true worth of the Visser experiments until full details are released. We can say however that we will not use any new cryoprotectant on a human patient until we are satisfied that it has been appropriately tested for toxicity and effectiveness. No evaluation of the Visser method under conditions relevant to cryonics (using slow cooling of large organs, with the central nervous system as target organ) has yet been published.

Some CryoCare members are also shareholders in 21st Century Medicine, which owns the laboratory used by our service provider, BioPreservation. 21st Century has been sponsoring the most ambitious program of privately funded cryonics-related research in the world at its facility for the past three years. Mike Darwin has announced various achievements in previous issues of CryoCare Report. During 1997 we believe there will be more news of immediate interest to CryoCare members.



Contacting CryoCare

On our printed documents and web page you will soon see a new street address for CryoCare:

Suite 3410 NorthEast Hercules Plaza, 1313 North Market Street, Wilmington, Delaware 19801-1151. (Delaware is the state in which our organization was incorporated.)

We will maintain this address as a permanent location for mail inquiries from nonmembers. Please note that it is not our "head office" in any real sense. Since CryoCare is a management organization that subcontracts the hands-on work to service providers, we don't need a central physical location.

Our members should continue to contact us directly, on a personal basis, preferably by e-mail or by phone, as follows:

For membership fees, newsletter subscriptions, and other financial matters: 

Kevin Brown
Treasurer, CryoCare
19-353 Dell Place
Stanhope, NJ 07874
Phone: 201-347-1695

For change of address, general information and new signups: 

Carlotta Pengelley
Membership Administrator, CryoCare
P. O. Box 177
Newbury Park, CA 91319-0177
Phone (daytime): 805-376-0355
Voicemail: 805-523-3894
E-mail:

For newsletter content and public relations: 

Charles Platt
Vice President, CryoCare
9 Patchin Place
New York, NY 10011
Phone: 212-243-4444
E-mail:

For revisions or updates to your cryonics documents (e.g. new insurance arrangements, new health information): 

Ben Best
Secretary and Vice President, CryoCare
Box 788 Station "A"
Toronto, Ontario M5W 1G3
Canada
Phone weekdays 416-862-3193
Phone weekends 416-534-0967
E-mail:

In Emergency:

Call 1-800-TOP-CARE (1-800-867-2273)
or make direct contact by dialling: 

Charles Platt
Phone: 212-243-4444
Pager: 800-908-0470

Brian Wowk
Phone: 204-254-6192 or 204-984-6618
Pager: 204-933-0324



Subscriptions

Members of CryoCare receive the newsletter at no charge.

If you are a non-member and wish to continue receiving CryoCare Report, write a check made payable to CryoCare Foundation for just $9. The next four issues will be sent to you via first class mail.

Provided your name and address are on the check, you don't need to enclose anything with it. Just write "Subscription" on the memo line of the check and send it to Kevin Brown, Ph.D., Treasurer of CryoCare, at 19-353 Dell Place, Stanhope, NJ 07874. We'll do the rest.

Overseas subscriptions: by air mail only, $15 per year. Payment must be made in US funds: cash, a check drawn on a US bank, or an International Money Order.

Back issues: $3 each ($4 overseas).



CryoCare Report is published four times a year by CryoCare foundation, a non-profit corporation whose main office is located at Suite 3410 NorthEast Hercules Plaza, 1313 North Market Street, Wilmington, Delaware 19801-1151.
President: Brian Wowk
Directors: Brenda Peters, Bruce Waugh, Brian Wowk.
Treasurer: Kevin Brown.
Secretary and Vice President: Ben Best.



End of CryoCare Report #9, Online Edition
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