Cryonics Without Cerebral Dehydration?

One of the interesting things about technological progress in cryonics is that awareness of technological problems, and the desire to solve them, is often dependent on other problems being solved first. For example, cryoprotectant toxicity became a more serious concern after it was possible to eliminate ice formation. After all, it is more important to eliminate severe (mechanical) damage caused by ice crystals than to prevent (minor) alterations of biomolecules.
One problem that is increasingly rising to the top of technological issues to be solved is the extreme dehydration caused by the perfusion of cryoprotectants.

The fact that perfusion of the brain with cryoprotectants causes substantial dehydration has been known in cryonics for a long time. While no rigorous academic studies are available about this topic, it is usually assumed that the cause of this dehydration is that most (but not all) cryoprotectants have poor blood brain barrier (BBB) permeability.

Another line of evidence is that prolonged warm and cold ischemia eliminate this dehydration, presumably because ischemia compromises the BBB in a time-dependent manner.  One ironic consequence of this is that in cryonics severe dehydration is often an indicator of good patient care (i.e. minimization or mitigation of ischemia). Maybe because of this there has been relatively little interest in eliminating CPA-induced cerebral dehydration.

Another reason is that dehydration actually assists in removing water from the brain to facilitate vitrification, perhaps even requiring lower concentrations of cryoprotectant than are necessary for the vitrification of other organs (preliminary evidence for this exists).

Cerebral dehydration was identified as a potential form of injury in a case report for patient A-1097 (2006) but until recently the “advantages” of dehydration seemed to outweigh its potential disadvantages. More serious concerns started to emerge in the last couple of years. Electron micrographs of brains cryopreserved with M22 and other cryoprotectants show ultrastructural alterations that are primarily presumed to be due to CPA-induced dehydration. The significance of this issue was further reinforced in 2015 when a researcher from 21st Century Medicine showed electron micrographs of aldehyde-stabilized vitrified brains (vitrification after chemical fixation) that look considerably better than traditionally vitrified brains. In addition, while employed for the Cryonics Institute, Yuri Pichugin demonstrated that the extreme dehydration associated with modern vitrification solutions is not compatible with good brain slice viability.

Since most researchers in cryonics would like to see a biopreservation protocol that does an excellent job of preserving both viability and ultrastructure, eliminating this kind of injury is likely to be a rather important research goal in the next couple of years.

It is not desirable to deliberately induce ischemia to improve BBB permeability of cryoprotectants. This leaves a number of strategies to improve delivery vitrification agents to the brain:

1. Osmotic opening of the BBB. Molecules such as mannitol have a transient effect on BBB permeability but are probably not potent enough  to permit brain cryoprotection without dehydration.

2. Yuri Pichugin has discovered that detergents such as sodium dodecyl sulfate (SDS) permit cryopreservation of the brain without dehydration.

3. Not all cryoprotectants are impermeable to the brain. Can these cryoprotectants be used in
low toxicity vitrification solutions?

Fortunately, the tools to screen the efficacy of BBB modifying technologies for brain cryopreservation are already known in the literature. Brains can be inspected for post-perfusion morphology and weight loss/gain. BBB modifiers can be tested for viability in brain slices or even whole animals. We can compare whether the use of BBB modifying strategies raises or lowers the concentration of cryoprotectant necessary to vitrify the brain. How do BBB modifiers affect overall ultrastructure in electron micrographs? What do BBB modifiers do to other cells and the vasculature? Do BBB modifiers produce more edema in the rest of the body? Will the use of BBB modifiers allow “extracellular” cryoprotectants and ice blockers to cross the BBB or even cells?

One challenge is how to validate and authorize the use of BBB modifying strategies in human cryonics cases. We know from burr hole and CT scans of neuro patients at Alcor that severe cerebral dehydration is frequently seen in good cases with little ischemia (shrinking the brain down to almost 50% of its natural size).

CT scan of Alcor patient with cryoprotectant-induced brain dehydration

Switching to a cryoprotectant that has similar or even lower toxicity as M22 would be relatively straightforward but if potent agents are used to open the BBB it will be important to choose a dosage that does not produce serious side-effects such as fulminating edema or poor cell viability.

In a 2007 Alcor article (“Securing Viability of the Brain in Cryonics”) I speculated that we should assume that viability of the brain (or slices made from such a brain) is currently lost about halfway through cryoprotectant perfusion as consequence of cryoprotectant toxicity. As we understand it now, the need to use high concentrations of cryoprotectants also produces brain shrinking. If we want to move Alcor closer to its mandate of developing reversible human cryopreservation both problems will need to be revolved. This will most likely involve a minor re-formulation of M22 or a novel cryoprotectant that is more “friendly” to the brain.

For 2016, my lab Advanced Neural Biosciences has made identifying such a brain-friendly cryoprotection protocol a high priority. The good news is that we already know of strategies that work. Now we need to identify protocols that maximize high viability and excellent ultrastructure
to make the next step in further closing the gap between cryonics and suspended  animation.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, January-February, 2016

Suspended Animation as a Research Goal and Case Benchmark

Cryonics is a complicated idea to explain and one of the most common misunderstandings is to confuse it with suspended animation. This leads critics to conclude that cryonics cannot work because we are not yet capable of placing a patient in cryostasis and reversing this procedure without causing damage. Advocates of cryonics have written careful expositions to make the point that human suspended animation is a desirable goal but not necessary for cryonics to succeed. I will not go into these arguments here but want to discuss what role the idea of suspended animation can play at Alcor.

First of all, the development of human suspended animation can be a formal research goal of a cryonics organization. As obvious as this may be, I am not aware of any cryonics organization that has communicated that this is their ultimate research objective. This is unfortunate because it is important for our credibility to develop a form of reversible biostasis. After all, if our procedures are fully reversible we do not always need to evoke alternative definitions of death and will often be able to claim that a critically ill patient who is cryopreserved is still alive (without the need for quotation marks around the word death). Offering human suspended animation as a form of biostasis leaves critics to argue that a disease will never be cured as the only remaining objection, which would be a rather preposterous claim.

The goal of offering suspended animation can also guide a cryonics organization to decide which new technologies to introduce and upgrade. For example, suspended animation is incompatible with the presence of fractures (which would need repair) and a transition to cooldown or long term care technologies that prevent fracturing would be a necessary step to move further into the direction of suspended animation. It is important to understand the piecemeal nature of this. A cryonics organization does not go from offering straight freezing to suspended animation overnight but seeks to introduce improved procedures towards that goal on an incremental basis. The more obstacles to suspended animation we can eliminate (ice formation, fracturing), the more identifiable and recognizable the remaining challenges, like cryoprotectant toxicity, will be.

One major misunderstanding about the role of suspended animation is that until we have perfected our technologies, the concept of suspended animation cannot be used as a benchmark to evaluate cases. In fact, we can use the concept of suspended animation in a meaningful way when we write our case reports and discuss case outcomes right now. The reason why we can do this is because loss of viability is not a characteristic of all our procedures but, in a good case, is something that happens further downstream. In an ideal case, we suspect that viability is lost somewhere mid-way during cryoprotective perfusion where the concentration of the cryoprotectant and exposure time render organs non-viable by contemporary viability criteria. Another way of phrasing this is that our procedures should be reversible up to that point. This benchmark is extremely important in evaluating the quality of care at a cryonics organization and guiding procedures in an actual case. It is even possible to identify the point at which viability is lost by monitoring the patient during stabilization procedures and taking a small (microliter) brain or spinal cord biopsy after cryoprotective perfusion.

If Alcor takes itself seriously as a scientific organization, each case report should contain a discussion about how successful the organization was in sustaining viability as long as possible, and if not, whether these problems were beyond Alcor’s control or reflect errors made during the case. This allows us to observe patterns and trends and introduce measures and upgrades that push reversibility further downstream in our procedures.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, December 2015

Cryonics is not Mind Uploading

On September 15, 2015, the MIT Technology Review published an article named “The False Science of Cryonics” that revealed how much ignorance about cryonics still exists among those that should know better (scientists, medical professionals, etc.). First of all, cryonics is not a “science” but an experimental medical procedure that is informed by scientific developments in disciplines such as cryobiology and neuroscience.

Semantics aside, a major flaw in the article is that it conflates mind uploading and cryonics. While some of our members may favor the possibility of “substrate-independent minds,” in its most “conservative” incarnation resuscitation will occur through repair of the same biological brain (or whole body) that was preserved. Complicated philosophical issues about whether a copy is “you” do not come into play in this repair scenario at all. So when Alcor was asked by a reporter to comment on the article, we submitted the following response:

The article in the MIT Technology Review rests on several mistaken assumptions. First of all, cryonics does not require or imply mind uploading. While some of our individual members are interested in this topic, the default resuscitation scenario for cryonics patients involves molecular repair of the patient’s biological brain (and body). While we are encouraged by the rise of connectomics, the aim at Alcor is to cryopreserve all the fine details of the brain and even secure viability of the brain as well as we can. In fact, in our stabilization procedures we aim to keep the brain viable by contemporary medical criteria and collect data to evaluate the efficacy of our procedures.

Alcor is a charitable, non-profit, organization and we do not make a profit when we place our patients in biostasis. Also helpful to understanding the ethics and financial feasibility of cryonics for persons of ordinary means is that most people fund cryonics through an affordable, dedicated, life insurance policy, making cryonics an accessible personal choice.

We strongly disagree that without proof of human suspended animation or flawless ultrastructural preservation it is not ethical to practice cryonics. Our organization challenges the mainstream definitions of death, and we believe that perfected cryopreservation is a sufficient but not necessary condition for cryonics to succeed. As long as we have good reasons to believe that the original state of the brain can be inferred from the damaged state, making cryonics arrangements can be a rational choice to make. To our knowledge, there are no rigorous, scientific, studies that demonstrate that today’s cryonics procedures produce irreversible destruction of identity-critical information.

Information about the ultrastructural effects of the vitrification solutions we use to inhibit ice formation can be found here: http://www.alcor.org/Library/html/newtechnology.html

It is disappointing that scientists and professional writers put so little effort into understanding what cryonics entails and what the real technological challenges are. Unfortunately, there is essentially no cost to being factually wrong about cryonics. In fact, when professional cryobiologists comment on cryonics they often make claims about their own field that are factually incorrect, such as that cryonics produces intracellular freezing, or that ice-free cryopreservation of complex organs is not yet possible.

We may not be able to persuade everyone that cryonics is the prudent, conservative choice to make, but we might benefit from giving more thought to how to prevent and counter factually erroneous articles such as the one in the MIT Technology Review.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, November 2015

False Modesty Hurts Cryonics

No credible cryonics organization would ever claim that if you get cryopreserved you will be resuscitated in the future. We tend to make more qualified claims and even include language in our cryopreservation contracts about the (potential) challenges that are associated with today’s procedures. One counterproductive attitude that I have encountered since becoming involved in the field, however, is to think that we look more respectable and credible if we put the odds of success really low or claim that patients who were cryopreserved with older, cruder, technologies probably will not be revived. A typical statement goes like, “I think there is about a 2% chance that cryonics will work but I think it is a rational decision to make considering the potential benefits.” When I hear statements like this I always wonder, “how do you arrive at such a probability estimate?” and “what kinds of damage do you exactly think irreversibly erase identity-critical information?” If you make strong statements about the (technical) feasibility of cryonics you’d better back them up.

I think that most of the time these low estimates have little rigorous reasoning or data behind them. True, some have attempted to produce formal probability estimates. While I consider these exercises useful for identifying the various challenges that will need to be overcome for cryonics to succeed, a major problem is that a lot of the individual probabilities that go into these calculations are not independent. For example, if we can produce stronger scientific evidence for brain cryopreservation, legal protections will improve, membership and financial stability will increase, etc. Also, is it reasonable to do probability estimates for things that are considered mainstream medical knowledge or common sense sociological prerequisites? For example, what kind of Alzheimer’s researcher would discuss a potential new drug with the caveat that the drug will only be effective if the brain gives rise to the mind (“who knows, maybe it is a disease of the soul?”), or that civilized society should still exist to introduce such drugs to patients? There are all kinds of conditions that can be considered necessary for cryonics to succeed and if we assign all of these independent probabilities we will always end up with extraordinarily low numbers. No mainstream researcher talks about his / her aims like this.

Another important thing to recognize about likelihood estimates in cryonics is that many of the things that need to go right for cryonics to succeed are outcomes of our own actions. We cannot just sit down, calculate, and wait. We have to get up and do something about them. Cryonics is a field where individuals and small groups of individuals can still make a huge impact on the credibility and sustainability of the field.

Does false modesty about cryonics command more respect from scientists? I don’t think so. If you think that cryonics causes irreversible damage, please explain this on a specific, molecular level. Claiming that today’s cryonics procedures cause “damage” is not an argument against cryonics unless you can make a case for how this kind of damage leads to a condition where the original ultrastructure of the brain cannot be inferred from the damaged state. Information is hard to destroy and in cryonics damage is often produced concurrent with decreases in temperature that lock these changes in place. One quick rule about talking about damage in cryonics: ask for specifics, do not accept sweeping statements about “the brain.” Ask how exactly this damage makes information irreversibly disappear.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, October 2015

Cryofixation and Chemopreservation

The most common modern protocol for imaging brain structure at high magnification is to chemically fix the brain with aldehydes (formaldehyde, glutaraldehyde) and heavy metals like osmium and then prepare it for electron microscopy imaging. Using this method, a tremendous amount of detailed anatomical information about the structure of the brain in its healthy and pathological state has been obtained, including the effects of (prolonged) ischemia.

Almost from its inception, however, the limitations of this method have been recognized. In particular, when fixatives are introduced to the brain through the process of perfusion a number of distinct artifacts are produced, notably shrinking of the brain and a reduction of the extracellular space. While different solutions and protocols have been developed to reduce these artifacts, the gold standard for ultrastructural analysis is a method that does not use aldehydes at all; cryofixation.

In cryofixation small tissue samples are rapidly cooled (without freezing) and then prepared for electron microscopy. This method produces the most realistic images of the ultrastructure of the brain, as evidenced by papers that compared this method with aldehyde fixation or used advanced tools to understand the properties of the brain without doing electron microscopy.

Although the word “vitrification” is rarely used in the context of cryofixation, the pristine images in this method can only be achieved when ice formation is avoided through ultra-rapid cooling. Vitrification without the use of high concentrations of (toxic) cryoprotectants would be quite attractive if it could be scaled to the size of organs (or even humans!) but unfortunately this method can only be used on very small tissue samples.

The pristine images obtained from cryofixation raise some important issues. Does conventional aldehyde fixation produce only predictable distortions or is identity-specific information irreversibly lost? What are the ultrstructural effects of the heavy metal exposure when cryofixed samples are prepared for electron microscopy? In a more general sense, to what degree can we be confident that a technology can produce a completely realistic image of the ultrastructure of the brain?

Will computer simulations of scanned fixed brains need extensive correction if they are to serve as a simulation of the brain? One clear advantage of using viability assays in addition to electron microscopy is that we can test brain slices or whole brains for resumption of function (or retention of memory) after subjecting them to experimental protocols. This is a clear advantage of the use of cryopreservation technologies over chemical fixation. In a cryonics case we can monitor the patient from the start of our procedures to the point of long term care and collect data and viability information. In the case of chemopreservation no such feedback is possible and taking brain biopsies for electron microscopy is all we can do to assess the effects of our cryopreservation procedures.

It is tempting for a cryonics organization to choose the method of preservation that produces the most crisp electron micrographs. In reality, however, there are challenges and unknown issues. Cryofixation cannot be scaled to work for cryonics. What is the effect of conventional aldehyde perfusion in ischemic brains? How do aldehyde fixed brains look on the molecular level compared to cryopreserved brains? How can we know that identity-critical information is not irreversibly altered? And, last but not least, any preservation technology that renders tissue dead by conventional criteria cannot be considered as a means for achieving true human suspended animation.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, September, 2015

Charisma: The Missing Link in Cryonics?

In the June issue of Cryonics magazine, I published an article called “Concepts of Identity and the Growth of Cryonics.” With the exception of my co-authored article on hostile partners in cryonics this article garnered the most feedback that I have ever received on an opinion piece about cryonics. Many people seemed to be sympathetic to the point that the lack of popularity of cryonics cannot be simply attributed to its lack of technological feasibility but I am not sure how widely my suggestion for cryonics organizations to embrace a broader concept of identity is shared. In fact, one person wrote to tell me that my perspective still ignores a rather fundamental point about the successful adoption of ideas and beliefs; the importance of charisma. He writes:

“Your list of rational responses to alleged shortcomings in cryopreservation procedures was good, but I think it misses the point. We can be rational about this, day after day, and get nowhere—because you are omitting the key factor, which I think is the ability to *close a deal*…The ability to sell entails persistence, force of personality, confidence, charm, and a kind of charisma. Most of these attributes are rare among cryonics activists…Why should charisma be necessary? Because of the “disconnect,” which I have seen so often. I run through the rational reasons for cryonics, and I answer all the questions. The person I am speaking to becomes reflective. The person often says, something like, “I guess it does make sense.” Then I say, “How about for you?” The person blinks, looking surprised, and pulls back a little. “Oh no, not for ME!”… This is the disconnect, between abstract agreement and personal commitment. I don’t think the perception of identity has much to do with it. That’s just another in the long list of issues such as religious faith, fear of the future, and concern about depriving heirs of a life insurance payout.”

I am quite persuaded by this response because it can both explain why ideas with no scientific credibility whatsoever can persuade so many people and why ideas with solid reasoning and evidence behind them have remained in obscurity. But I do think this is still only part of the puzzle. Having a very charismatic proponent of cryonics may be be sufficient for rapid growth, but is it necessary? Let’s look at my favorite example, astrology, again. I think that the rather widespread belief in astrology cannot be attributed to one charismatic person, or a number of charismatic persons. Astrology seems to offer something so important that many people demand little in terms of scientific evidence. In this case if offers assurance about personal identity and the future. Interestingly enough, cryonics presents an interesting contrast because people believe that it raises even more uncertainty about personal identity and the future. An unorthodox way to put this would be to say that the idea of astrology itself has “charisma” because it appeals to the hopes and aspirations of many people.

An obvious rejoinder to this would be to point out that the idea of immortality or overcoming death should have the biggest draw of all. That idea of eternal life that is often associated with cryonics is such an appealing prospect that even people with “negative charisma” would not be able to prevent its widespread endorsement. Well, that is not quite the situation we have found ourselves in (to put it mildly). I actually think that for many people the idea of overcoming death or (true) immortality sounds great but as in most fiction and SF movies, the idea of indefinite life has often been associated with “bad” events. A prevalent one in popular fiction is to associate the desire for immortality with the selling of one’s “soul.” In the case of cryonics many people think that the price for indefinite life is alienation and loss of family and friends.

So I remain convinced that offering a vision of cryonics that does justice to those concerns has a much higher chance of gaining in popularity but we also still need a charismatic person to close that deal. Let’s go for both!

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, August, 2015

Cryonics for Families

Alcor allows members to specify the conditions under which they do or do not want to be cryopreserved. One popular option reads as follows: “I wish Alcor to place into cryopreservation any biological remains that they may be able to recover, regardless of the severity of the damage from such causes as fire, decomposition, autopsy, embalming, etc.” Interestingly, the options available in the Alcor membership application all concern scenarios in which the circumstances of only the individual member determines whether to proceed with cryopreservation.

But what about scenarios in which, for example, a whole family makes cryonics arrangements and a catastrophic accident permits only one family member to be placed in cryopreservation? When most people consider cryonics, one of their most immediate concerns is that the procedure could be disruptive of their social and family life. Is making cryonics arrangements without considering the preferences of those around me considered to be going it alone? If we all make cryonics arrangements and one person is the victim of a terrorist attack or plane crash, would I still want to proceed? How can I be sure that my whole family will be cryopreserved under acceptable conditions?

Default cryonics wisdom has it that it is better for a person to live than to die but the outlook of someone who is anxious about the idea of cryonics seems to conform more to something like this:

I would like everyone I care about to be cryopreserved and revived but if I lose someone I care for, I’d rather not come back either.

Now this is a rather bold version of the position I am trying to characterize but it does raise an important point. Would cryonics perhaps appeal to more people if cryonics organizations offered a number of options that reflect concerns about joint cryopreservation and revival?

In this document I use conditions for cryopreservation and survival together but we are really talking about two distinct issues here. For example, it is possible that a whole family is cryopreserved but meaningful revival is only possible for one of them. Successful cryopreservation is not necessarily equivalent to successful revival. Would it be feasible and desirable to allow more flexibility regarding such scenarios? For example, should members be permitted to insist on joint revival even if a family member has been cryopreserved under conditions that permits faster resuscitation? Should a cryonics organization allow members to be thawed out and buried in case circumstances prevent their other family members to be cryopreserved?

These are difficult questions and need to be considered in more detail. We do know that most people who make cryonics arrangements care about these issues and that many people care about these issues to such an extent that they conclude that cryonics presents more of a risk than a potential benefit. In general, what would it mean for a cryonics organization to incorporate the joint preferences of families in the services it offers?

Comment by Mike Perry

About 25 years ago a case came up in which an Alcor member stated they didn’t want to be revived unless all of their children could be, and were, revived. Alcor in effect was being asked to kill this member if it was unable to save one or more others. Alcor could not agree to such an option. (This individual remained a member and is still a member today.) Short of that, however, it might be reasonable to time revivals so that all in a group are brought back together.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, July, 2015

Moving The Goalposts

Being a cryonicist can sometimes be exasperating. We like to think that making (technological) progress in our field will persuade more people to make cryonics arrangements. Are you concerned about the long-term stability of cryonics organizations? We set up a patient care trust fund designed to maintain patients in perpetuity. Are you concerned about ice formation? We introduce a new technology that eliminates freezing and turns tissue into a “glass.” Are you concerned about fracturing? We can store a patient at intermediate temperatures. Are you concerned about the use of volunteers? We contract with a company that uses professional surgeons and perfusionists. Are you concerned about long transport times? We develop protocols that allow us to do cryoprotective perfusion in the field. Are you concerned about a cryonics organization’s operations being dependent on bequests and donations from wealthy donors? We insist that the operating expenses of the organization should be covered by membership dues.

One would think that each time Alcor introduces new technologies and policies skeptics will re-calibrate and a larger number of them start making cryonics arrangements. For example, ice formation is generally perceived to produce a lot of damage to tissues. As a consequence, the transition from conventional cryopreservation with glycerol to vitrification should have produced a sharp increase in membership. It did not. Strangely enough, the publication of Eric Drexler’s Engines of Creation produced a larger increase in membership than the introduction of ice free cryopreservation. How can this be reconciled with the emphasis many of our critics place on empirical evidence? After all, Drexler’s book was a popular but theoretical argument about the feasibility and desirability of molecular nanotechnology and the introduction of vitrification was an actual, real-world, upgrade of cryonics procedures.

This failure of technological progress to translate into an increased acceptance of cryonics is often observed within the same person. First it is ice formation that is posited to be the obstacle to making cryonics arrangements. Then, when vitrification is introduced, the objection changes from ice formation to fracturing. When it is shown that storing at intermediate temperatures can mitigate fracturing the person suddenly is concerned about cryoprotective toxicity. And the list goes on and on. A clearer example of someone moving the goalposts cannot be found. The question is “why.” I think a close examination of these scientific and technological issues will not answer the question.

If something has become increasingly clear in informal conversations about cryonics it is that these kinds of objections are often superficial and follow-up conversations usually reveal more personal, psychological reservations. If we look for the common denominator of these objections we find that to many people cryonics does not offer the prospect of the continuation of life but a disruption and threat to personal identity. Cryonics may present the prospect of survival but the fear is that outside of our brain and bodies not much else will survive (family members, friends, careers, assets, money etc.).

Is the weak correlation between technological progress and the growth of cryonics a reason for pessimism? Not necessarily. If we really want cryonics to take off and grow we should re-frame our presentation of cryonics and present it as an attractive means to continue one’s life, expand one’s social connections and relationships, grow one’s assets, and improve one’s body and well-being. If we succeed in delivering a friendlier presentation of cryonics, more people will make cryonics arrangements, which will lower the threshold for other people to make cryonics arrangements, which will further arouse interest in cryonics, et cetera. And then, ironically, more money and resources will be available for research to bring us closer to real human suspended animation.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, June, 2015

 

 

Competition and Cooperation in Cryonics

When I told Jordan Sparks that his new cryonics organization, Oregon Cryonics, would be featured in Cryonics magazine he was quite surprised. To me it is obvious. I think that cryonics is still in such a fragile state that new organizations can have a positive effect on other existing organizations. I also believe that the existence of multiple cryonics organizations with different services and pricing will bring cryonics within the reach of more people and can create a safer environment for already existing organizations.

Of course, not every new cryonics organization should be enthusiastically welcomed by existing cryonics organizations. A cryonics organization which does not disclose any information about its protocols or cases should be treated with great caution. An organization that accepts patients on a “pay as you go” basis is at much greater risk of having to thaw their patients and cause a bad reputation to the field as a whole. A cryonics organization that seeks to gain members through the dissemination of unrealistic promises or denigrating statements about other organizations would not be helpful either.

One reason why I think existing cryonics organizations should not feel threatened by the existence of other organizations is because I do not think that a membership gain by one organization is necessarily at the expense of the other organizations. At this point the two major existing cryonics organizations (Alcor and the Cryonics Institute) approach cryonics from a different philosophy and have different price structures. It is also conceivable that in the future there will be a new cryonics organization that pursues an explicit for-profit model.

The existence of multiple cryonics organizations also spurs innovation and quicker adoption of new technologies. After all, most cryonics organizations would like to be perceived as “state of the art” and the introduction of a new technology at one organization often causes the other organization to adopt it (sooner) as well. The most prominent example of this is the transition from conventional cryoprotection to vitrification. No sane cryonics organization today would decide to offer freezing with a poor cryoprotectant as the preferred protocol. In the future we may see a wider embrace of brain-only cryopreservation, or even the addition of chemical preservation as a low-cost option. The existence of multiple cryonics organizations also leads to greater national and international press coverage.

In an ideal world, a cryonics organization should be close enough to do prompt stabilization and cryoprotection without the need for air transport or prolonged ground transport. If cooperation among organizations is excellent we may even see that organizations make available (for a fee) their space to stabilize and cryoprotect a patient of another organization to minimize long periods of cold ischemia. Such an arrangement could be advantageous for all organizations involved.

I admit being also rather relieved. Other than KrioRus, there has not been a new all-service cryonics provider since the mid-1990s, and none at all in the Western Hemisphere. Running a cryonics organization is not trivial so it is extremely encouraging to see there are still people who want to to do it. Let us wish Oregon Cryonics good luck and hope that cryonics in general grows faster as a result.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, May, 2015

Medical Myopia and Brain Death

Recently someone sent me a number of papers that discussed the biophilosophical underpinnings of brain death. Medical doctors increasingly find themselves in the midst of heated debates about what constitutes death by neurological criteria. It is not hard to understand how controversies can occur in this area. Whenever a patient who satisfies the criteria for brain death shows signs of improvement or recovery, these criteria are called into question. Or, perhaps more troublesome, some people will simply not concede that a patient is dead because recovery can be envisioned. In such cases, the concept of death becomes more like a subjective “decision” than an objective property of the brain.

To someone sympathetic to cryonics these debates are mildly infuriating because it shows the reckless medical myopia with which matters of life and death are approached. When bioethicists debate what constitutes “permanent and irreversible loss of the capacity for consciousness and self-awareness” there is little recognition of the possibility that what looks hopeless and irreversible by contemporary medical technologies may be rather straightforward to repair or recover by future medical technologies. Would we abandon a patient if a cure would be available tomorrow? What about next month? Next year? 50 years?

The standard rejoinder to this position is that cryopreservation of the patient (cryonics) itself produces irreversible damage to the brain and is thus not suitable to stabilize the patient longterm until more advanced treatments are available. But how can we know what will be considered irreversible damage in the future? Should we simply pull the plug based on our guesswork about the limits of future technologies? Would it not be more prudent to let future doctors make that determination?

This does look a lot like saying that cryonics is just an argument in favor of prudence based on ignorance. A sophisticated way of saying, “well, you never know!” Not quite. If a healthy brain without damage gives rise to consciousness and identity, it follows that if the original state of the brain can be inferred from the damaged state, the capacity to restore consciousness and identity is preserved in principle. Ice formation undeniably alters the structure of the brain but it does not make the ultrastructure “disappear.” In fact, at cryogenic temperatures nothing “disappears,” a point that is not even sufficiently recognized by many cryonics advocates. Today we can do better than freezing, though, and use vitrification agents, which solidify into a glass upon cooling to cryogenic temperatures. While these vitrification agents exhibit some toxicity, at the ultrastructural level this expresses itself at most as alteration of cell membranes, protein denaturation, etc., not wholesale destruction.

Where does this leave us on the issue of brain death? For starters, looking at a monitor and concluding that the patient is dead because of the absence of organized electrical activity will tell us little about the ultrastructure of the brain (case in point, at 15 degrees Celsius even a healthy brain will show a flat EEG). It is true that in some cases of brain death absence of electrical activity corresponds to substantial decomposition of brain tissue but it is important to recognize that in many such cases the brain has been permitted to self-destruct at body temperature as a result of trauma and ischemia. When a hospital is faced with a traumatic event of such magnitude that profound cell death can be expected, the most prudent action is to quickly cool the patient and prevent “information-theoretic death.” If the capacity for consciousness and awareness resides in the neuroanatomy of the brain, the first mandate of medicine is to preserve this.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, March, 2015