The future of Alcor

Alcor’s recent news item about its 2009 Annual Board Meeting and Strategic Meeting contains a number of encouraging statements. On the front of institutional reform, however, there is not much news to report. The passage about the need to balance recruiting new Board members and preserving institutional memory reads as a rather uninspired defense of the Board’s recent decisions. In light of the growing recognition that most of Alcor’s problems over the years can be tracked back to the composition and functioning of the Board of Directors, one would have expected more innovation on this front.  A major problem with a self-perpetuating Board of Directors remains that there are few mechanisms available in case a competent Board of Directors would change in an incremental fashion into a contra-productive Board. Perhaps the idea of term limits could prevent such scenarios.

In particular, there is an urgent need to adopt institutional changes that can prevent the highly variable quality of patient care that has been observed in the history of the organization.  Another challenge that remains is the recruiting of  additional Board members with a strong knowledge of Alcor’s technical operations and the delivery of standby services. Without this knowledge (and some degree of common sense) it is highly unlikely that the Board can do a serious job of overseeing such matters.

One of the most positive items in Alcor’s report is the recognition that Alcor would benefit from substantial cost savings in its operations.  Throughout most of Alcor’s history the organization has been dependent on (unpredictable) donations from wealthy members to sustain normal operations.  Obviously, this way of funding the operations of a cryonics organization (as opposed to long term patient care) constitutes an irresponsible gamble. Donors should be commended for being reluctant to contribute to Alcor (any further) until Alcor has shown evidence of getting its financial house in order. A number of sensible proposals were discussed to generate more structural income for the organization such as increasing membership dues, raising cryopreservation minimums, introducing a recommended funding level (as opposed to just a minimum funding level), and creating income-generating endowments.

One aspect that is largely ignored in this report, however, is the potential for substantial cost reductions in Alcor’s daily operations itself. For most of its history Alcor used to be rather transparent about staff member salaries in its communications and the magazine. It may not be a coincidence that this practice disappeared  during the period when Alcor saw substantial increases in compensation for (some of) its staff members. To give some perspective, the old Tim Freeman Cryonics FAQ included the following question and answer:

7-2.  Is anyone getting rich from cryonics?  What are the salaries at these organizations like?

In December 1990, Cryonics magazine reported that the Board of Directors of Alcor voted a 25% pay cut for all of the staff, so they could keep their budget balanced.  Many of the Directors are also on the staff.  The salaries after the cut ranged from $22,500 annually for the highest paid full-time employee (the President) to $14,400 for the lowest-paid full-time employee.  None of the Alcor staff are getting rich from their salaries.

It would be a worthwhile undertaking to do a comprehensive study of Alcor’s staff and consultant compensation history and policies (or lack thereof). There is never a shortage of arguments to justify higher compensation and ad-hoc decision making in cryonics, but it is doubtful that generous salary increases in the industry over the years were necessary to recruit or retain competent staff members. It might even be argued that a number of problems in cryonics are actually linked to offering wages that exceed what the employees who receive them would otherwise earn in the market place. Similarly, substantial cost savings can be obtained by increasing productivity and decreasing staff members. Issues of compensation and staff efficiency should be essential topics of consideration in any serious discussion about Alcor becoming more self-sustaining and less dependent on wealthy donors.

Another topic that deserves attention in this context is that all of Alcor’s major technologies (medications protocols, organ preservation solutions, vitrification agents) are licensed to the organization by independent research labs. Although Alcor itself is mostly to blame for not having developed competing technologies of its own since the mid-1990s, it is important to recognize this dependence. At the very least, Alcor could benefit from a cost-benefit analysis of some of these technologies and from developing contingency plans to deal with scenarios in which these technologies would no longer be available or cost-prohibitive.

During most of its history Alcor (and later, CryoCare) promoted the idea of cryonics as a medical procedure and criticized other cryonics organizations like the Cryonics Institute for being overly optimistic and reckless.  In an ironic twist of fate, some critics of Alcor now use this perspective to criticize the organization for not living up to the idea of cryonics as medicine. As a general rule, this is to be welcomed. Where this criticism can go off track, however, is when it is insufficiently recognized that knowledge of conventional medicine is a necessary, but not a sufficient, condition to do good cryonics. One of the worst scenarios for the future of cryonics is one in which regulators impose standards upon cryonics organizations that  actually increase the challenges of providing good patient care; something that has happened already in the case of the Cryonics Institute when the organization was forced to perform a complex technical procedure like cryoprotective perfusion at a funeral home.

Faced with the technical complexities of ramped cryoprotective perfusion, Alcor has decided to develop a system that not only uses software to record perfusion parameters (concentration, pressure, temperature, refractive index etc.) but to use the same software to control them as well. Provided that this new system lives up to its expectations, this development will be a major step towards a system that can use real-time feedback to adjust perfusion parameters in a manner that so far has only been available in small organ cryobiological research. The data that will be generated during cases can, in turn, be used to create cases reports that follow a consistent, formal standard. When these reports are used in an intelligent fashion, the prospect of developing technologies and protocols that can reduce the high variability in patient care will be feasible.

Buried alive?

According to this news item the Alcor Life Extension Foundation is taking legal action against the brother and sister of an Alcor member who “denied the foundation’s request for his body and didn’t notify them of their brother’s death until months after he was buried.” Although some may question the wisdom of pursuing this case in light of the current condition of this Alcor member, Alcor is honoring its contract with the member. As Reason points out in this excellent post about the issue:

I can only imagine that the lawsuit is being undertaken as a point of principle and for the purposes of education: don’t break contracts with Alcor or this will happen….Switching around a family member’s post-mortem arrangements is little different from bullying and controlling folk who are too old and frail to defend themselves. In the case of acting to prevent cryopreservation that was organized and chosen by the deceased, it becomes something like fractional murder: removing that person’s shot at whatever the unknown probability of future revival happens to be.

Spouses and relatives of an Alcor member should not feel confident that if they hide the death of an Alcor member long enough to make cryopreservation no longer meaningful or practical that the cryonics organization will just give up and refrain from pursuing the case. There have been too many cases where hostile, greedy, or indifferent relatives have frustrated the wishes of a person who wants to be cryopreserved. Cryonics organizations should not even give the semblance that this is something they let people get away with. Alcor is to be commended for fighting back and honoring this member’s wishes, even in the most miserable of circumstances.

This episode should be another important wake-up call for potential and existing members of cryonics organizations. There are various  ways situations such as these can be minimized and we should start thinking about them. Most of all, cryonics members should execute living wills that rule out scenarios where greedy relatives will benefit from the patient not being cryopreserved. Furthermore, cryonics members should execute a Durable Power of Attorney for Health Care to ensure that the person who is authorized to make medical decisions on the cryonics member’s behalf has a strong commitment to honoring this person’s wish to be cryopreserved. This often will require giving this authority not to the person who is closest to you but to the person who  is most knowledgeable and respectful of  your cryonics arrangements (such as a long time friend with cryonics arrangements). Last, but not least, cryonics organizations should further expand their methods of determining high risk cases and improve communication with existing members. Although it is not possible, nor reasonable, to expect from cryonics organizations that they can avoid scenarios such as these in every single case, there is an urgent need to beef up membership tracking and response capabilities.

Cryonics organizations are in a delicate situation. We expect them to fight for each of their members without putting existing patients at risk. One solution that has been pursued in the past, and may have to be revived again, is to separate the service delivery aspect of cryonics from long term patient care. If such changes would allow more aggressive action on behalf of existing members with no, or decreased, risk for existing patients, such changes should be pursued.