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CRYONICS
SEPTEMBER 1984 ISSUE # 50
CONTENTS
Editorial Matters...............................................page 1
Postmortem Results: Some Perspectives...........................page 1
The French Reluctantly Enter the Cryonics Era...................page 4
The Question of Prepayment for Suspensions......................page 5
The Question Column.............................................page 7
BACS Begins Newsletter..........................................page 8
Evolution and Identity..........................................page 9
A Brief Overview of Recent ALCOR Research.......................page 13
New ALCOR Bylaws................................................page 14
ALCOR Meeting Calendar..........................................page 15
Postmortem Examination of Three Cryonic Suspension Patients.....page 16
Science Updates.................................................page 28
CRYONICS is the newsletter of the Alcor Life Extension Foundation, Inc.
Michael Darwin (Federowicz) and Stephen Bridge, Editors. Published
monthly. Individual subscriptions: $15.00 per year in the U.S., Canada,
and Mexico; $30.00 per year all others. Group rates available upon
request. Please address all editorial correspondence to Alcor, 4030 North
Palm #304, Fullerton, CA 92635 or phone (714) 738-5569.
Contents copyright 1984 by Alcor Life Extension Foundation, Inc. except
where otherwise noted. All rights reserved.
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EDITORIAL MATTERS
Frosty Thermometer
As you can clearly see, Frosty Thermometer is
continuing his recovery from suspended animation. Due to
the generous contributions which continue to come in, we
are now at $2,037! We are rapidly nearing the half way
mark! We hope to place our order for the concrete vault
and the trailer sometime in the next two weeks or so.
We'll keep you posted on further developments.
Drexler Error
One of the amazing changes we've experienced is a
big improvement in our efficiency as a result of
entering the computer age. While the computer has
almost eliminated many of the production gaffes we've
experienced in the past, there are still humans around,
and consequently still plenty of room for error. We can
blame the footnote error which occurred on page 25 of
the August issue on humans and not on the machine. The
footnote which should have appeared at the end of
"Transitions" by Mike Darwin was covered over in
a last minute paste up. Our apologies to
Eric Drexler since it referenced his very
excellent manuscript The Future By Design.
We understand that Eric still has not found a
publisher and we wish to point out that
copies of his manuscript will be unavailable
until he does so.
Meeting Schedule Error
The meeting schedule printed in the August issue contains an error for
the September meeting. The September meeting will be held on the second
Sunday, the 9th of September, not on the 2nd of September, which happens to
be on Labor Day Weekend!
Postmortem Results: Some Perspectives
Elsewhere in this issue we present a technical paper documenting
observations made on the bodies of frozen-thawed suspension patients who
were converted to neuropreservation. First, we should point out that long-
term care for all three of these patients is continuing and will continue
as long as we're around. Second, we should point out that while the
discovery of fractures in the bodies of all three patients is not good
news, it is the kind of "bad" news we've been prepared for all along.
While the fracturing problem is a serious one (many vital organs were
disrupted by one or more fractures) it is not overwhelming in the sense of
the bodies being heavily or minutely fractured. While the fractures we
observed would certainly disrupt gross functioning, they have little, if
any, impact on the stability and integrity of the fine structure and thus
the information
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content of the tissues. A good analogy to this kind of injury would be to
envision a phonograph record which someone has scored with a screwdriver.
The fidelity of the recording would appear to be hopelessly compromised if
it was placed on a standard stereo and played. Yet, the same record with
advanced Dolby (TM) noise removal would be virtually indistinguishable from
the original. The information is there; the breaks and glitches simply
need to be removed.
What these results DO point up is that it is time for those (hopefully
few) of us who have been thinking of cryonic suspension in terms of simple
viability and traditional surgical repair techniques to wake up and face
reality. Contemporary freezing techniques are disruptive and they will
require the development of very sophisticated repair techniques.
Undoubtedly we will discover damage on the molecular level which is
equivalent to or even worse than the fracturing problem we have encountered
on a gross level. Repairing such injury will require that we be able to
move atoms around almost on a one by one level. It will require that we
have tools and engineering capability on a molecular level and that we be
able to build molecular repair and fabrication machines--basically our own
version of enzymes.
While we may not be able today to design such tools, it is possible for
us to set the parameters for repair and to know what such tools will have
to do, as well as what their physical and design requirements will have to
be. Just because we don't yet have the capability to build something
doesn't mean we don't know if it can or cannot in fact be built. In this
respect we are in much the same position as Leonardo da Vinci in the 15th
Century. Leonardo could envision many, many mechanical devices (indeed he
envisioned ALL of them now known but two!) but the levels of engineering
and materials science available in his time were just not good enough to
build them. Leonardo lived in a time when ball bearings could be thought
of but the existing craftsmen were unable to cast and machine metals to
that quality and degree of precision. Indeed, it was to be hundreds of
years before metallurgy evolved to the point that metals hard enough to
withstand the loads required were even developed!
We are in much the same position today. We can see quite clearly the
kinds of repair techniques that will generally be required to recover
patients from suspension, and yet they are beyond our grasp today! But not
tomorrow! That is the beauty of cryonics: we, unlike da Vinci, can afford
to wait. It behooves all of us to realize that subtle and powerful
techniques will have to be developed to recover those of us frozen with
existing techniques. This is one reason why so many of us have elected for
neuropreservation as opposed to whole body storage: the kind of repair
technology which will likely have to be available to repair our brains will
make regrowth of a new body a trivial exercise by comparison. Indeed, new
bodies are grown every day in nature right now, while freeze-injured and
cryofractured brains are not repaired in nature at all. We urge everyone
who is whole-body to rethink the basis of their choice. If the basis of
choice is concern over a severed spinal cord or emotional concerns not
related to the hard facts, we urge you to reconsider.
On the other hand, we should point out that we intend to try and solve
the fracturing problem. At this point it is hard to know how easy this
will be to do, or even if we can do it in a fashion consistent with
existing resources and realities. Rest assured we are going to be looking
for solutions and we have some reasonable amount of optimism that we will
find them!
In the meantime, keep the issue of fracturing in perspective. While it
isn't the most pleasant thing to discover, it's far from the end of the
world and in fact just confirms what we were reasonably sure was happening
all along: existing freezing techniques cause injury on gross and
microscopic levels.
On a more optimistic note, histological studies done on tissues from
one of these patients demonstrated excellent cellular preservation on a
light
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microscopy level. Cell to cell relationships were well preserved and other
visible structures appeared intact as well. This work gives us much reason
for optimism. We hope to bring you the paper documenting the histological
findings in a month or two (it's written already but needs to be circulated
for review).
A word or two needs to be said about why it took well over a decade to
find out such a problem was happening! It cannot be emphasized too much
that many cryonicists don't take the need to do research seriously. They
are content to sit on their ----- and let "our friends in the future" fix
us up. Well, friendship is a two-way street. Our "friends" of the future
had better have some debt of gratitude to owe us or they're not likely to
have our reanimation as a high priority. Research work successfully
completed now helps everyone and is the foundation upon which future
capabilities will rest. Technical problems are solved a little bit at a
time. If we allow ourselves to be demoralized by the magnitude of the task
required, or worse if we sit back and wait for others to solve problems we
wouldn't tackle ourselves, we've failed before we've begun. By and large
no one is going to do the kind of work necessary to perfect cryonics except
cryonicists. In a very real sense the amount of injury YOU suffer and the
degree of recovery YOU experience IF you are revived depend upon your
actions NOW. The fracturing problem is just one example of the kinds of
problems which need to be and CAN be identified early and solved early.
Finally, a deep debt of gratitude needs to be acknowledged to the
husband of one of the suspension patients whose body we examined. All of
us owe him our thanks for his generosity in allowing such an examination.
That kind of courage and depth of commitment are rare. All of us will
benefit from his generosity. Reflecting on the stupidity and short-
sightedness of other relatives in similar situations, it is especially
apparent that this cryonicist made a major contribution. Our sincere
thanks to him, and to the patients themselves, two of whom I know were
strongly motivated to participate because of what could be learned by their
doing so. Our thanks to all of you.
THE FRENCH RELUCTANTLY ENTER
THE CRYONICS ERA?
In late July we received a call from a
reporter from the French equivalent of a
combination of Life and People magazines,
Paris Match. The reporter spoke very poor
English and communication was difficult but
several things seemed to emerge from the
conversation: something having to do with
cryonics was happening or about to happen
in France, and the reporter was not about
to give us any information. A few days later the July 28th issue of the
San Francisco Examiner contained a story about a French gynecologist, 62-
year-old Dr. Raymond Martinot, who had frozen his 49-year-old wife Monique
after her death in an automobile accident. Martinot is described not only
as a gynecologist but as a scientist "who has also studied hibernation and
body conservation at low temperatures." According to the UPI story
Martinot is maintaining his wife at -130 degrees (it doesn't say whether
Fahrenheit or Centigrade), presumably in a standard "dry ice" temperature
range mechanical freezer. The press got wind of the story when the freezer
malfunctioned and Martinot called in a repairman--who promptly reported him
to the authorities.
One of the major stumbling blocks to the development of cryonics in
France has been that country's bizarre and archaic burial laws. According
to French
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law no embalming may be carried out until the body has been held for 24
hours. The law regarding where and how bodies shall be disposed of is
equally strict and Draconian and can best be described as the nearly
unmodified leftovers of the Black Plague and the Middle Ages. It probably
also counts to mention that the French are rather conservative people who
do not take well to "alien or radically different" outside ideas. The
French have made national efforts in the past to prevent "contamination" of
their culture with "foreign" words and ideas and their initial reaction to
cryonics in the 1960's and '70's was even more hostile and conservative
than was the case in the U.S.
With that background, the French authorities quite understandably are
trying to pressure Dr. Martinot into burying his wife. According to the
UPI, French police inspected the freezer containing Mrs. Martinot and "took
pictures and strung new locks around the casket."
Martinot's motivation in freezing his wife seems to be rational
enough. He has commented to the press that "he put his wife's body into
the deep freeze hoping medicine could bring her back to life by the year
2030." While we may disagree with the doctor's optimism, as far as the
timescale is concerned, we can certainly admire his spirit.
As a final note, we understand that Martinot has appealed to other
countries to take over care of his wife's remains should the French force
him to bury her.
The Question of Prepayment For Suspensions:
An Editorial
by Mike Darwin
In the past it has been almost impossible to get cryonics
services paid for even after the patients has been frozen.
It's a sign that times are changing in that we are now
receiving requests to prepay for suspensions. In Northern California we
understand that Trans Time has already been prepaid by at least one person.
Prepayment raises a number of sticky ethical and legal questions.
First of all, if someone prepays, are they being guaranteed a service at
that rate? In other words, if an individual prepays and then doesn't die
for ten years do they owe more if the cost of cryonics services has risen
in the interim? How should prepayment monies be managed? What kinds of
investments and use of prepaid funds constitutes good ethical behavior and
good common sense?
There has a been a lot of debate about these issues in the cryonics
community over the past six months or so. ALCOR has already received one
offer of prepayment and inquiries from several other members who are
interested in this option as a way of safeguarding noninsurance funds which
have been set aside for suspension.
As an aside, it is worth mentioning that personal assets which have not
been transferred to a cryonics organization via an irrevocable trust or
prepayment are subject to attack by health care providers, landlords and/or
other creditors. What this means is that if you become catastrophically
ill and require extended (or even very expensive short-term) medical or
other care then all of your assets, excluding $1,500 which the state allows
you to retain to pay for burial expenses, is subject to attack by your
creditors. If you have a stroke, become suddenly incompetent or otherwise
unable to act and require extended care, then funds provided for cryonic
suspension could be rapidly depleted. Life insurance, prepayment, escrow
and irrevocable inter vivos trust funds are immune from depletion in this
way.
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While prepayment will safeguard against such a resource drain, it
carries other risks. Principally, the solidity and good judgment of the
organization the prepayment is going to should be considered. Recently in
Northern California this issue has been brought into sharp focus.
BACS/Trans Time has been casting about for some months for capital to
purchase a facility. Despite vigorous efforts, the building fund has
remained at $25,000 for many months. Early this year it was proposed that
some of the prepayment money (perhaps as much as half) which Trans Time has
received be used to supplement the building fund and move BACS/TT closer to
a purchase.
Some BACS members, such as Thomas Donaldson, have vigorously opposed
this use of prepayment monies. Donaldson and others, including ALCOR, have
argued that prepayment monies should be managed very conservatively. A
conservative approach is doubly recommended when the individual for whom
prepayment is made is elderly or otherwise at increased risk of dying.
Loss of the principal through mismanagement or error in such a case could
mean the difference between being suspended and not being suspended.
ALL the directors of ALCOR feel quite strongly that regardless of the
particulars, prepayment funds should be very conservatively handled, even
if it means getting a lower interest rate or otherwise passing up
attractive investments. It cannot be emphasized too much that cryonics
organizations including ALCOR do not have exactly rosy Dunn and Bradstreet
ratings. Trans Time has been recording heavy losses over the last two
years and, judging from their 1983 Annual Report, cash flow is becoming an
increasingly severe problem. It may be tempting to use prepayment money to
"keep the doors open." However, in our opinion any realistic analysis of
the situation will show this to be a short-term answer to what is a long-
term problem, a problem which will ultimately destroy any cryonics
enterprise unless it is solved in a long-term fashion by realistically
spreading the cost for services around and/or attracting more clients.
To this end, ALCOR recently adopted standards and incorporated them
into our bylaws which govern handling and investment of prepayment funds.
Basically, we have stated that such funds (if they are liquid) shall be
maintained in a liquid state. This will probably also act to restrict
prepayment (as we feel it should be) to situations where individuals are
unlikely to live long and desire the security of having paid in advance.
In most situations the best solution to the "prepayment" dilemma will be
the creation of trusts or escrow accounts which place full responsibility
for management of the money on the person while he or she is alive and
removes from the money management picture questions of proper conduct by
cryonics groups. We believe such stringent and conservative standards are
a must at this point when the credibility and durability of any cryonics
organization are so much at question.
This issue points up yet again the urgent need for industry-wide
ethical standards. Certainly it has sensitized all of us at ALCOR to the
need for an ethical manifesto to guide and govern our own decisions. For
some time now we have needed guidelines on what constitutes informed
consent, reasonable and prudent investment practices for suspension fund
monies, rights to privacy of suspension patients and their families and
under what circumstances and conditions we should accept "research" cases
(i.e., people with inadequate or no funding whom we may wish to suspend in
order to do testing or take tissue samples which we would be unable to do
under normal circumstances in a suspension). Now, before these issues are
forced upon us, we should begin to think about how we handle them. It is
long overdue for us to begin drafting an internal set of ethical guidelines
and regulations. If we fail to do this, then in the long-run someone else
will. In any event, it is wise to note that when the state gets around to
regulating cryonics (and they will) they will probably
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base such regulations on whatever industry standards are already in place.
The question is, just exactly what kind of regulation will we get if there
are no standards? Unless we act and act in the near future, that may be
one of many questions we find abruptly answered for us. Until such time as
we have standards for ethical conduct to guide us, it behooves all of us to
be careful and conservative, particularly in the areas of prepayment and
suspension fund management.
THE QUESTION COLUMN
A question we have been asked by several people over
the last few months is why ALCOR doesn't charge a $1,000
or so "initiation" or "entrance" fee like virtually every
other cryonics organization?
As far as we know the practice of charging a $1,000
entrance fee was begun by the Bay Area Cryonics Society
(BACS) and Trans Time in Northern California. The
purpose of the fee was, among other things, to help
capitalize cryonics, encourage new suspension memberships
by allowing for payment of a finder's fee or commission,
and compensate for the administrative expenses involved in signing up a new
person. A significant fraction of the "up-front" money went into
commissions as an incentive for those already committed to go out and get
others signed up. When ALCOR contracted with Trans Time for suspension
arrangements in 1977, part of the agreement was that we too would charge an
up-front fee in order to pay TT's commission and prevent "unfair" advantage
over BACS (obviously few would sign up with BACS if they could get the same
coverage for $1,000 less with ALCOR). The Cryonics Institute in Michigan
has a similar policy, although they do not pay commissions for new
suspension members.
Shortly before it was initiated, the up-front fee resulted in a mini-
surge of people signing up. Most people who had been "putting it off until
tomorrow" quickly decided to save $1,000 and make arrangements today.
Beyond that, there was also an increased number of sign-ups due to
marketing zeal inspired by the promise of commissions. But after a year or
two, the number of new members declined to previous low levels.
Additionally, the $1,000 fee was applied somewhat capriciously. If you
were part of a group or had a useful skill to barter you might cut a deal
and end up paying far less than $1,000.
Several years ago, when ALCOR decided to begin offering its services
directly to members, ending our contract with Trans Time, we began to
reassess the utility of the $1,000 fee. Was it really acting as an
incentive to attract new members or was it turning them away? Would we
have a better chance of recouping administrative expenses involved in
signing someone up by spreading such costs out over time rather than by
asking for them up front in one big chunk? If someone doesn't think enough
of cryonics and of ALCOR to try to convince others around them to sign up,
should we encourage such people by offering to pay them? Of course, we
realized that the initial intent of Trans Time in organizing the finder's
fee program was to encourage "impersonal" sales (by a staff of TT sales
agents) much like insurance is sold (and indeed this may be a valid way to
market cryonics in the future). Unfortunately, no such sales force
materialized and few, if any, suspension memberships were sold in this way.
Perhaps most importantly, we realized that there were a number of
hardworking people who were interested in signing up with us who were being
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excluded because they found it difficult or impossible to get $2,000 to
$3,000 in one place (for a whole family) in order to sign up. Lastly, the
question of just how important the $1,000 was had to be considered. How
many thousands of dollars would we be losing if we gave it up? The answer
there was clear: fewer than one per year! On the other hand we stood to
gain a number of people if we dropped the entry fee--people who we could
probably count on to pay in far more through dues and contributions over
the long haul than the $1,000 we stood to "lose" in the short run.
We are pleased to note that we appear to have made a good decision. We
are now signing up people at a steady rate (over eight people in the last
two years alone) and we see no sign of that slacking off. Most of these
people would not be signed up now if we still had our $1,000 up-front fee.
Because the up-front fee was applied so capriciously, we have refunded
our share of it to all of our members who paid it.
We have found that there are other advantages to not having the $1,000
initiation fee. For one thing the absence of an entry fee keeps us on our
toes. We know that our members have no incentive to stick with us if our
service is bad. A fair number of our members have switched from other
cryonics groups after paying an entrance fee--and they can just as easily
switch back again. The fact that we have such members is also proof that
in the long run even the psychological ball and chain of having paid a high-
priced entry fee won't hold people to an organization they feel is not
meeting their needs or offering services they want.
We want to see cryonics grow more rapidly in the future and most of all
we want it to be affordable. So, we have avoided and will continue to
avoid the high priced entry fee approach. In the near future we hope to
offer a wider range of services and increase the number of low cost options
available to make cryonics even more affordable.
BACS BEGINS NEWSLETTER
We have received the first issue of BACS NOTEBOOK edited by Dr. Paul
Segall, Secretary-Treasurer of the Bay Area Cryonics Society. The first
issue is a hefty 10 pages long and contains news items and research
progress made by the Northern California group. According to Dr. Segall
the newsletter will be published bi-monthly after BACS meetings (and will
accompany the BACS Minutes). BACS NOTEBOOK is reportedly a joint project
between BACS and Trans Time with Trans Time "providing duplicating,
clerical and editorial assistance." We understand that the newsletter will
be available only with membership in BACS: $150.00 per year for full
members and $20.00 per year for domestic Associate Members ($25.00 per year
for foreign). Anyone who wishes to receive the newsletter should send
their remittance to:
Bay Area Cryonics Society
1098 Euclid Avenue
Berkeley, CA 94708
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It is in the half fools and the half wise
that the greatest danger lies.
--Goethe
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EVOLUTION AND IDENTITY
by Mike Darwin
"Dear, Dear! How queer everything is
today! I wonder if I've been changed in the
night? Let me think: was I the same when I
got up this morning? I almost think I can
remember feeling a little different. But if
I'm not the same, the next question is, Who in
the world am I? Ah, that's the great puzzle!"
--Alice
Alice in Wonderland
by Lewis Carroll
Cryonicists are more concerned with the questions
of identity and of our future evolution than just about
anyone else because we and we alone are confronted with
the personal prospect of losing some part of our
identity or finding ourselves in a position like Alice,
wondering if we've been changed in the night. If we are
to wonder what we will be like when and if we are
revived we must first ask into the nature of what we
are. What constitutes personal identity? If we can
answer that question, what can it tell us about what we
are likely to become or evolve into?
All cryonicists should be aware of the possibility they will not come
back exactly as they were. The vagaries of illness, postmortem delay and
damage done by the freezing process itself will almost certainly result in
the loss of some information. The extent to which memories or behavioral
repertoires or skills will survive freezing remains a total unknown. Some
less self-satisfied cryonicists do not want to come back as they are right
now. Some have made it quite clear that the reason they are involved in
cryonics is precisely because of the possibility of reworking their
"identities." Indeed, the question might well be asked: who is it that
will get suspended? It certainly isn't the "you" or "I" that exists here
and now. With luck, all of us will live many more years. We will develop
new skills, lose old ones. Memories will come and go, information will be
added and lost. As we age, a large fraction of the cells which make up our
brains and bodies will die and disappear. Not only will physical strength
diminish, but mental skill as well. If we live long enough we will be but
shadows of our youthful selves.
If we look at ourselves in that way, as rivers of information in flux,
we begin to bound the problem of identity. Am I still me if can't walk?
Am I still me if I've lost 10% of my memory? 30%, 50% or 90%? Am I still
me if I forget how to play the piano or work an equation? At what point do
I stop being me?
Not surprisingly, a fair amount has been written on the question of
identity. Locke (1), Butler (2), Hume (3), Shoemaker (4) and Parfit (5)
have all made statements on the concept of personal identity. For Hume,
identity might be best described as an "invariableness and
uninterruptedness of any object, thro a suppos'd variation of time, without
any break of the view, and without being oblig'd to form the idea of
multiplicity or number." The fact
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that an individual consciousness was continuous and bounded by the mind of
one person was reason enough to believe in identity. However, are we
conscious when we sleep? Are we the same person when we wake? What about
anesthesia where even dreaming stops? Or, perhaps more to the point, what
of the consciousness and continuity of someone who has been frozen? What
happens to continuity if the person's mind is duplicated several times
during the repair process to provide backup in case the original is lost or
damaged during reconstitution after thawing? Is continuity a valid
criterion for identity? Then there is Locke's notion of memory as a
boundary to identity. What happens if some memories are lost? If all
memories are lost? Where does one draw the line?
In his book "The Prospect of Immortality" (6) Robert Ettinger raises
many of these issues and through clever scenarios draws the reader out onto
the thin ice of the question of identity. Ettinger's conclusion is quite
startling, quite at odds with that of the conventional philosophers: "Let
us then cut the Gordian knot by recognizing that identity, like morality,
is man-made and relative, rather than natural and absolute. Identity, like
beauty, is partly in the eye of the beholder. It is only partly existent,
and partly invented. Instead of having identity, we have degrees of
identity, measured by some criteria suitable to the purpose." In 1962
Ettinger arrived at a conclusion similar to that arrived at by the
philosopher Derek Parfit (5) nearly a decade later in 1971. I have long
found it a paradox that a book which is ostensibly about the preservation
of identity should contain so persuasive an argument that it doesn't really
exist. Perhaps it was these musings which prompted Ettinger to conclude
his Afterword to "The Prospect of Immortality" with a salutation and a
prophecy equally out of keeping with the tone of the rest of the book: "To
the hosts of the past, our gallant forebears, whom one day -- however long
deferred -- we can expect to join."
What of our forebears? What of the men and women and protohuman
creatures who came before us? What of the first "living" organism and its
fate? The world is a hostile place to us. It is hostile because of the
many states that exist in nature, only a few allow for life in general and
our lives in particular. The complex structure and highly ordered
interaction of molecules which living things represent require very
specific conditions to continue existing. In a world of rapid change and
nearly endlessly variable conditions, life's requirements limit it
severely. No doubt the first protocells formed and disintegrated countless
times as conditions became "right" and then shifted to "wrong." In a world
of chance, strategies were developed early on to cope with change, to cope
with alteration of the environment. Pumps, membranes, skins, spines,
poisons, shells, camouflage, and temperature regulating hypothalamuses all
attest to the diversity of living systems' approaches to minimizing the
impact of a capricious environment. But most important of all, the ability
to copy, to duplicate oneself, provided a path to survival. No matter how
good the defenses, no matter how careful the concealment, in the long run
the only route to continued existence in a capricious and unpredictable
world is to provide backup. All successful living things produce copies of
themselves. Some organisms produce copies with very high degrees of
fidelity, virtually duplicating themselves down to the molecular level.
Others have traded off near complete fidelity for variation which allows
for wider ranges of adaptation and the possibility of creating new
advantages to meet the challenge of survival where none existed before.
Living things made multiple copies of themselves because in the long
run it was the only strategy which allowed them to persist over time.
Thomas Donaldson has argued in The Genetic Evolution (CRYONICS, August
1984) that human beings in the future will be much as they are now because
they are well adapted to being human beings now. This kind of circular
reasoning in and of itself should make
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one wonder. It is all too easy to imagine a similar pontificator before
the age of chariots or automobiles arguing with equal force that when
automobiles are invented they will look just like horses, since horses are
so perfectly adapted to carrying men around. We can see our would-be
visionary carrying on endlessly and with pompous certainty about why
nothing with wheels will ever catch on because we would need to build
roads! The problem with such a "visionary's" "insight" is that it fails to
strip the idea of transportation down to its essentials and then proceed
imaginatively from there in speculating on the possibilities. If we accept
Ettinger's answer to the puzzle of identity, then the rules of the game
change radically. If the very root of our perception of ourselves lies in
false limitations, then what is to follow? Who will we be? What will we
become if we change the very yardstick by which we measure ourselves?
Unlike Donaldson, I cannot hope to guess that we would "actually LOOK very
much like people do now." All I can do is to venture a few general
speculations on the future of our evolution as survivors.
If we are to survive as individuals in the really long-term then we
must protect ourselves against catastrophe. Donaldson argues that our
bodies will be much as they are now, that we will be individual self-
contained units and that we will add to them or subtract from them with
tools. In so speculating he fails to ask the relevant question: what is
the purpose of a body? Is a body just a tool? If the answer to that
question is yes, then we will have many bodies. We may not use them all at
once, but we may well use more than one at once. And if our bodies are
just tools then what of our minds? Where shall we keep our minds if we
conclude that minds are the stuff we're made of? In a universe of
uncertainties are we always constrained to keep our bodies and our souls
together? In a world of "telepresence" is it safe or sane to always keep
the worker with the tool? In a world already reaching hazardous
environments by "remote control" will we choose to locate our minds in our
bodies? Indeed, will we choose to locate our minds in any one place at
all?
If we look around us we can see that one all-pervasive survival
strategy is the strategy of duplication and backup. Will we be any
different? Won't it make sense to copy ourselves and separate and protect
the copies just as every other living thing does? I think the answer to
that question will be yes and I think the consequences for human identity
and human evolution are profound. In the short run, as Donaldson rightly
points out, when the death rate falls our interest in traditional
reproduction will dwindle. But the death rate will NOT go to zero. In a
vast and largely uncontrolled universe there will still be plenty of room
for mistakes and catastrophes. Some mistakes will be internal: bad ways
of structural organization, bankrupt models or ideas about the way the
world "really" works. Others will be external: the sudden death of a
star, a terrible "industrial" accident. All life, by definition, is at
risk.
With time we will emerge from our complacency. If we wish to survive
for the really long-term, then we will be forced to provide backups.
Anyone who has ever lost a computer file will appreciate the safety which
comes from duplication. It will be no different with the information which
composes our identities.
Perhaps at first copying will be complicated. It will cost money and
it will take time. Emerging technology may not allow for continuous
updating. Copies may be updated only yearly or monthly or as often as can
be afforded, because as Donaldson rightly points out, every adaptation
costs something. But one thing seems clear, we will make copies.
The issue of memory loss due to freezing, old age and disease, as well
as the issue of copying, raise the question again of what comprises our
identity. A convenient way to look at the question of identity is to view
it in terms of a fidelity curve. If 100% of the information which composes
us is recovered and
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(12)
reconstituted into a working, functioning organism, then we have 100%
fidelity, or 100% identity. As less and less information is recovered we
have less and less identity. It is never correct to speak of identity as
lost until all the information is gone, though for practical purposes
individuals will be less and less satisfied with their degree of identity
down to the point where self awareness ceases and such debates become
personally meaningless.
Some copies of ourselves may be sent outside of the solar system as
packets of information, safeguarding against sudden explosion of our sun.
If they are awakened someday, they may bear little relationship to what we
became before our sun exploded and annihilated us. And yet, they will have
some fidelity, and like children, they will be a part of us that goes on.
If that seems strange and alien it is because it is. Like the world of
relativity or quantum mechanics, if you take the survival game to extremes
and try to play it for very long periods of time (relative to our current
experience) all kinds of commonplace assumptions don't apply. You end up
taking what you can get along the way to reaching the 100% mark on the
fidelity curve. Indeed, in a universe of uncertainty there will always be
information loss and we will always be dynamic rivers of information
(however slowly flowing) gaining and losing information as time passes. It
is a deep and basic instinct of living things to gain as much as possible
while losing as little as possible. It would seem that in the broadest
sense the goal of life is to eliminate uncertainty from the universe, to
control all of the variables, to know all of the answers. Until, and if,
that day ever arrives we will use many strategies for survival. These
strategies will make all such questions about what we will look like or
what vitamins we will or will not need seem trivial by comparison.
In the midst of this uncertainty some things seem clear, we will be
intensely protected creatures, duplicating and updating our identities
whenever and wherever we can afford to. We will wear many bodies and we
will strip "ourselves" down to whatever the minimum is. That minimum will
vary from individual to individual as much as night varies from day. For
some, identity will consist of flesh and blood, arms and legs, penises,
vaginas and eyes all linked by a continuity most of us now living would
find very familiar and reassuring. In the long run it seems likely that
individuals who choose this kind of identity will perish. For others there
will be changes, changes we can see only dimly now, like a faint smear of
light in the darkness of a long tunnel. For many of us, perhaps for most,
the light will never appear and the tunnel will be forever in darkness.
But for a few of us the darkness will end and we will emerge into the light
and revel in its abundance, for we will have found our identities at last
and we may well be quite surprised to discover who we are. As H.G. Wells
said so eloquently and well (7) "It is possible to believe that all that
the human mind has ever achieved is but a dream before the awakening... We
are creatures of the twilight... All this world is heavy with the promise
of greater things, and a day will come, one day in an unending succession
of days, when beings, who are now latent in our thoughts and hidden in our
loins, shall stand upon this earth as one stands upon a footstool, and
shall laugh and reach out their hands amidst the stars."
REFERENCES
1) John Locke, An Essay Concerning Human Understanding, I, ed. by
Fraser (Oxford: The Clarendon Press, 1894).
2) Joseph Butler, The Analogy of Religion (1736)
3) Terence Penelhum, "Hume on Personal Identity," Philosophical Review
(1955).
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(13)
4) Sidney Shoemaker, Self Knowledge and Self Identity, (Ithaca, N.Y.,
1963).
5) Derek Parfit, "Personal Identity", The Philosophical Review, 80,
(January, 1971).
6) Robert C. W. Ettinger, The Prospect of Immortality, Chapter VIII,
(Doubleday, New York, 1964).
7) H. G. Wells, "The Discovery of the Future", Nature, 65 (February,
1902), p. 331.
A BRIEF OVERVIEW OF RECENT ALCOR RESEARCH
Over the past year ALCOR has been steadily gaining expertise and
experience in subjecting dogs to extracorporeal circulation and deep
cooling. As far back as 1979, ALCOR and Cryovita have been interested in
evaluating extended bloodless support of dogs in deep hypothermia. This
kind of work is crucial to being able to assess viability after
cryoprotective perfusion and freezing or vitrification in the brain. Until
we know we have a pretreatment, cooling and surgical protocol, as well as a
perfusate formulation which is compatible with viability, we cannot begin
to move on to introduction and removal of cryoprotective agents.
ALCOR, in cooperation with Cryovita, has also had the unexpected and
welcomed opportunity to examine human remains which had been cryopreserved
for a number of years. Within the next few months we will conclude our
presentation of findings generated as a result of these studies.
On the weekend of July 21-22, we undertook another total body washout
experiment, this one designed to complete evaluation of the new perfusate
formulation developed for human suspensions published in the July issue of
CRYONICS. This perfusate is designed to allow for extending storage (1 to
3 days) at temperatures just above the freezing point of water. Since one
of our major research objectives for next few years is to develop
reversible techniques of suspended animation for the central nervous
system, we were anxious to find out if this perfusate would be compatible
with complete recovery of the brain following blood washout and deep
hypothermia.
We are pleased and proud to report that the ALCOR suspension team again
delivered and we had recovery of an animal from total body washout
(hematocrit between 4 and 5) and cooling to a temperature of 4.2 degrees
centigrade. We are especially pleased with this success because the
procedure was so technically demanding and this was our first time using
this approach.
Because the perfusate employed has a composition very different from
normal body fluids with respect to salt and other electrolyte content, we
had to connect the animal to an artificial kidney machine and "dialyze" him
as we rewarmed. This allowed for normalization of blood glucose and
electrolytes. Since the animal was intended to recover in order to allow
for extended evaluation of general health and mental status, we employed
sterile technique. In the future, when we are working with isolated head
preparations to establish brain viability, simpler and far less costly
protocols can be used. Even with the use of sterile technique the total
cost for the experiment was only around $1,000.
At this time the dog, whose name is "Star" (courtesy of Anna Tyeb) is
fully recovered and shows no neurological or other deficits. As far as we
know this is the first time anyone has succeeded in cooling a large,
nonhibernating animal to a such low temperature, carrying out blood washout
with a very "alien,"
-----------------------------------------------------------------------
* The photos which accompany this article appear in the center of the
magazine.
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(14)
nonphysiologic perfusate, perfusing for one hour, and then successfully
rewarming. We are quite surprised at our success as we had expected many
complications and failures before the first long-term recovery.
Our success with Star, and with the other dogs we have surface cooled
and perfused recently has led to increased funding support for this area of
research. Over the next six months or so (time more than money permitting)
we hope to complete a series of five or six animals who have been similarly
treated. We will delay a full technical presentation until this work is
completed, but we will keep everyone posted on the general nature and pace
of our progress, as well as reporting on any unforeseen developments which
may impact suspension patient care.
NEW ALCOR BYLAWS
On Sunday, August 5th, the ALCOR Board of Directors voted
to adopt new bylaws. The new bylaws basically reflect major
changes in the California Nonprofit Public Benefit Corporations
Law which went into effect in 1980. The new bylaws are much
more comprehensive than our old ones (17 pages single-spaced
versus 6 pages double-spaced) and provide guidelines for basic
administration. One change of importance is that the new Bylaws
provide a detailed summary of our purpose for existence. We
would like to share those purposes with you:
"The primary objectives and purposes of this corporation
shall be:
(a) to promote, foster and conduct basic and applied research in all
areas of the life extension sciences including but not limited to cryonics,
cryobiology, gerontology, molecular engineering, and cell repair
technology;
(b) to engage in the application of whole-body cryonic suspension,
neuropreservation, morphostasis and other postmortem and premortem
biopreservation techniques as allowed by law and to provide these services
to the general public;
(c) to promote, encourage, further and carry out research to develop
techniques for short-term and long-term fully reversible arrest of
metabolism in man and other mammals, i.e., the development of suspended
animation;
(d) to promote, encourage, further and conduct research to allow for
repair, recovery, and rehabilitation of humans placed into cryonic
suspension, neuropreservation, morphostasis or other biopreservation
techniques;
(e) to protect the legal rights, including the right to life, of humans
in cryonic suspension or suspended animation and to encourage and promote
legislation to facilitate continued care for and revival and rehabilitation
of humans placed into cryonic suspension, neuropreservation, morphostasis,
suspended animation or other biopreservation techniques;
(f) to act as a bank or storage facility under the California Uniform
Anatomical Gift Act (Section 7153.5(a) of the California Health and Safety
Code) for tissues, organs, and all other human remains as may be required
to further the purposes of (a) through (e) above;
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(15)
(g) to engage in the dissemination and administration of techniques and
information for extending human life span, health and quality of life;
(h) to act as a trustee, conservator, guardian, executor, power of
attorney or medical surrogate as may be required to further the purposes
above;
(i) to sponsor seminars, exhibits, workshops, displays, and other
activities to educate the general public about the life extension sciences
in general and cryonics in particular;
(j) to provide financial support, research facilities and equipment and
supplies required to carry out all of the above objectives."
We feel this statement of objectives in our Bylaws goes a long way to
establish on record what we have had as our guiding philosophy and purpose
for some time now.
OCTOBER-NOVEMBER 1984 MEETING CALENDAR
ALCOR meetings are usually held on
the first Sunday of the month.
Guests are welcome. Unless otherwise
noted, meetings start at 1:00 PM.
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The OCTOBER meeting will be at the home of:
(SUN, 7 OCT 1984) Paul Genteman
535 S. Alexandria, #325
Los Angeles, CA 90020
Tel: (213) 386-2265
DIRECTIONS: From Santa Monica Freeway (Interstate 10), exit at Vermont
Ave. and go north to 6th St.
From Hollywood Freeway (US 101), exit at Vermont Ave. and go
south to 6th St.
Go west on 6th 4 blocks to Alexandria and turn right. 535 is
the first apartment building on the west side of the street.
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The NOVEMBER meeting will be at the home of:
(SUN, 4 NOV 1984) Jerry and Kathy Leaf
13152 S. Blodgett
Downey, CA 90242
Tel: (213) 531-2708
DIRECTIONS: From the Long Beach Freeway (Hwy 7), get off on Imperial
Highway and go east to Lakewood Blvd.
From the San Gabriel Freeway (605), get off on Imperial
Highway and go west to Lakewood Blvd.
Go south on Lakewood to Gardendale (1st light) and turn west
(right) on Gardendale. Blodgett is the 2nd street on the
left. Turn left on Blodgett. 13152 is on the left (east)
side of the street about midway down the block.
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*** TYPIST'S NOTE: THE CENTER TWELVE PAGES OF THIS ISSUE CONTAINED
PHOTOGRAPHS. THE FOLLOWING TEXT IS REPRODUCED FROM THESE PAGES. ***
PAGE ONE:
THESE PHOTOS ACCOMPANY THE ARTICLE "A BRIEF OVERVIEW
OF RECENT ALCOR RESEARCH," WHICH BEGINS ON PAGE 13.
We thought it might help our readers better understand "what goes on" at
ALCOR if we published a few pictures of a "typical" research/training
weekend. For the first time we're able to give you a panoramic view of the
operating room thanks to Saul Kent's skillful photography and wide angle
lens. For those of our members who've never seen the facilities available
to us -- here they are!
*** PHOTO LEFT ***
Paul Genteman (foreground) and Mike Darwin (background) begin external
cooling of the animal as Bill Jameson looks on following the
anesthetization and pretreatment with the same medications used during
initial transport and cool down of suspension patients. (Photo by Saul
Kent.)
*** PHOTO ABOVE ***
As external cooling proceeds surgery begins to raise both femoral arteries
and veins so they can be cannulated (a tube inserted) and the animal can be
connected to a heart-lung machine for further cooling and blood washout.
Al Lopp (foreground) provides manual ventilation for the animal with an
"ambu" bag. (Photo by Saul Kent.)
PAGE TWO:
*** PHOTO ABOVE ***
Once cannulation is completed the animal is further cooled from 26 degrees
centigrade to 12 degrees centigrade at which time blood washout takes
place. The heart-lung machine is the somewhat cluttered looking device in
the bottom left of the photo. Carlos Mondragon, Brenda Peters, and Erin
Connoughton (left to right) look on as Paul Genteman and Jerry Leaf prepare
to give the go-ahead for blood washout. (Photo by Saul Kent.)
*** PHOTO LEFT ***
Mike Darwin reaches over to open up the flowmeter on an RSP kidney
machine. This allows premixed dialysate (blood washing solution) to begin
flowing to the artificial kidney (which can be seen pressed against Mike's
chest protruding from a pole on the machine). (Photo by Hugh Hixon.)
PAGE THREE:
*** PHOTO LEFT ***
Old Faithful. This is a Travenol RSP artificial kidney machine. These
machines were the first widely marketed "workhorse" dialysis machines ever
built. They were the standard of the industry up until a decade ago. In
Mike Darwin's opinion they're still the best machine around! Dialysate is
mixed in a 120 liter quantities in the bottom tank and then pumped up to
the top (stainless steel bucket) tank where it is heated and then delivered
to the artificial kidney. The artificial kidney is the dark (blood filled)
cylinder on the right (see arrow). (Photo by Saul Kent.)
*** PHOTO ABOVE ***
Seventeen hours after the start of the session two stalwarts (Al Lopp and
Erin Connoughton) grab a bit of shut-eye. The excellent cuisine on the
table was courtesy of Pizza Hut and Al Lopp. We ordered three large pizzas
and and then found we were too tired to eat them. There is still pizza in
the freezer! (Photo by Hugh Hixon.)
PAGE FOUR:
*** PHOTO ABOVE ***
Yum Yum doughnuts (yes, we know the picture is "backwards" but that the
halftone man's fault not our) provided that low fat, high nutrition energy
so essential to good performance. They were so delicious even Mike
(Pritikin) Darwin broke down and ate a few. We'll have you know we do stop
short of Twinkies. (Photo by Hugh Hixon.)
*** PHOTO ABOVE ***
Having one's tail washed by Mike Darwin following a "little accident" can
be an embarrassing thing. Here we see Star's revenge (as Hugh Hixon looks
on with glee) a few days after his revival from 4.2 degrees centigrade.
Ahh the indignities of a life in research! (Photo by Saul Kent.)
PAGE FIVE:
Plate 1. Arrows A and B indicate massive fractures of abdominal skin and
subcutaneous fat observed in P2. These fractures penetrated to the body
wall. A thorough external examination at -40 degrees centigrade failed to
disclose these fractures.
Plate 2. Arrow A indicates fracture of skin and subcutaneous fat observed
in P1. The fracture penetrated almost to the body wall. This fracture as
well most of the others observed in P1 were clearly visible at -40 degrees
centigrade.
Arrow B points to areas of lividity which outlined the course of veins
in the legs. Much of this network of lividity is not visible in the
printed photograph owing to loss of fidelity during printing. The
discoloration of the left hand and forearm is lividity apparently secondary
to a venous infiltration probably sustained during the patient's
hospitalization.
PAGE SIX:
Plate 3. All of the great vessels in P2 were seriously fractured adjacent
to the heart. Arrows indicate where the pulmonary artery and aorta were
almost completely severed by fractures. Numerous small longitudinal
fractures were noted elsewhere in the great vessels such as in the
descending aorta and inferior vena cava.
Plate 4. Arrows indicate small circumferential fractures observed in
numerous locations in both arteries and veins. This photo is of the
pulmonary artery of P2.
PAGE SEVEN:
Plate 5. Large fracture almost completely severing the right lung of P3.
The arrow point out the small band of tissue which uniting the nearly
severed tip of the lower right lobe with the rest of the lung.
Plate 6. Fractures in the mesentery and mesenteric fat adjacent to the
ileum. The ileum was also fractured in numerous locations.
PAGE EIGHT:
Plate 7. Cutaneous fractures of the hands and wrist of P3. These
fractures penetrated only a millimeter or two below the skin surface.
Plate 8. Two small fractures 2 to 3 mm wide in the wall of the left
ventricle. The myocardium was riddled with fractures of this kind.
PAGE NINE:
Plate 9. The liver was separated by a large, sinuous fracture which
penetrated the full thickness of the anterior lobe. Several other lobes of
the liver were similarly disrupted by fractures.
Plate 10. The arrow indicates a fracture of the serous coat of the lung in
P3.
PAGE TEN:
Plate 11. Fracture of the renal cortex (arrow) observed in P2. The
fracture did not quite penetrate the cortex to the medulla. Note the
excellent blood washout as evidenced by the solid white appearance of the
renal cortex.
Plate 12. The right kidney of P3 showed very poor blood washout with one
pole of the kidney being very dark and the other 2/3rds of the organ
showing extensive red mottling. The flap of membranous tissue at the top
of the photo is the renal capsule which has been removed to facilitate
examination of the cortex.
PAGE ELEVEN:
Plate 13. A 12 g angiocath has been positioned in the axial artery to
allow for reperfusion of the left arm of P3. Drainage was via the axial
vein which was opened at the point of the incision. The arrow indicates a
fracture which is leaking perfusate containing dye. The skin of the arm is
mottled with dye.
PAGE TWELVE:
Plate 14. Deeply dye-stained brachial muscle of the upper left arm
following reperfusion. Note the mottled appearance of the subcutaneous fat
which failed to perfuse well with dye.
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(16)
POSTMORTEM EXAMINATION OF THREE CRYONIC SUSPENSION PATIENTS*
by Michael Federowicz, Hugh Hixon and Jerry Leaf
INTRODUCTION
Since the first person was placed into cryonic suspension in l967, well
over 30 intact (whole-body) humans have been cooled to liquid nitrogen
temperature (1). At the time of this writing, only 3 whole-body patients
remain in liquid nitrogen storage (2). Despite the fact that the majority
of patients treated by cryonic suspension have been removed from liquid
nitrogen storage and interred conventionally, to our knowledge, no previous
efforts have been made to subject these individuals to a postmortem
examination in order to determine the efficacy of the cryonic suspension
protocol used to prepare them.
Postmortem examination of cryonic suspension patients being removed
from long-term storage could serve to answer many important questions and
could facilitate quality control just as it does in medical practice (3).
Key questions of concern to cryonicists are:
1) How effective are various approaches to perfusion in achieving
blood washout and cryoprotective agent (CPA) equilibration?
2) How is CPA distributed during "optimum" perfusion vs. post-
ischemic or "suboptimum" perfusions?
3) What are the gross and microscopic effects of CPA perfusion and
freezing and cooling to liquid nitrogen temperatures?
4) What is the impact of transport or other handling techniques on the
gross integrity of the body?
While answers to many of these questions may be approximated by the use
of small animal models (4), many problems and complications introduced by
the advanced age of many suspension patients and the large mass of adult
humans cannot be easily answered in this fashion.
Due largely to the unfortunate circumstances which usually surround
removal of patients from cryonic suspension (5), it has not been possible
until very recently to subject patients being removed from cryonic
suspension to autopsy. During November and December of l983 the authors
were afforded the opportunity to conduct a postmortem examination on the
remains of three whole-body cryonic suspension patients who had been
converted to neuropreservation.
PATIENT HISTORIES
On November 2, 1983 two whole-body cryonic suspension patients who had
been maintained in liquid nitrogen storage for 5 and 9 years respectively,
were removed from storage and converted to neuropreservation. PATIENT 1
(P1) was a male, caucasian, 65 years of age who suffered a lethal
cerebrovascular accident in 1974. The patient was not near a cryonics
facility when he deanimated and it was necessary for a team to be flown a
considerable distance to perform perfusion, resulting in a delay of almost
24 hours after declaration of legal death. Perfusion was complicated by a
number of technical difficulties and equipment failures as well as by
severe edema, secondary to the use of a
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* Photographic plates which accompany this article appear in the center of
the magazine.
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(17)
colloid-free DMSO-based perfusate (6). Vascular access for perfusion was
via the left common carotid artery and was achieved by a local mortician
who assisted with the case. Perfusion was open circuit and drainage was
via both the left and right internal jugular veins. Perfusion consisted of
initial blood washout with 32 liters of bicarbonate-buffered Ringer's
solution and cryoprotective perfusion (also open circuit) with 32 liters of
a glycerophosphate-based perfusate containing 15% DMSO (v/v). Standard
embalming equipment (Porta-Boy embalming pump) was used for perfusate
delivery. A total of 64 liters of perfusate was employed. Effluent
samples collected at the time of perfusion were lost late in 1983 when they
exploded (as a consequence of rapid boiloff of liquid nitrogen which had
leaked into the vials) during a transfer of the patient from one storage
dewar to another.
The protocol for cooling the patient to dry ice temperature consisted
of wrapping in a thin insulating blanket and packing in crushed dry ice.
The patient was prepared for cooling to liquid nitrogen temperature by
being wrapped in multiple layers of fiberglass cloth, polyethylene, and
aluminum foil. Following wrapping, the patient was placed on a heavy gauge
aluminum stretcher and cooled to liquid nitrogen temperature by placement
in a cryogenic dewar which was gradually filled with liquid nitrogen over a
period of 5 days (Figure 1).
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*** TYPIST'S NOTE: ORIGINALLY THIS SPOT CONTAINED A GRAPH OF TEMPERATURE
IN DEGREES CENTIGRADE VERSUS TIME IN DAYS, FOR COOLDOWN OF THE PATIENT'S
HEAD. ***
Figure 1. First Cooldown of P1.
Thermocouple probe placed externally on head. Vertical marks on
horizontal axis indicate midnight. "Start" indicates beginning of
cooldown.
-----------------------------------------------------------------------
PATIENT 2 (P2) was a female caucasian 68 years of age who was
pronounced legally dead in 1978 in a location remote from cryonics
facilities. Deanimation
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(18)
was sudden and reportedly due to an acute myocardial infarction. There was
approximately a 72-hour delay between the time of death and the time
perfusion was begun (all of this delay period was in the presence of either
air or ice cooling). Vascular access for perfusion was via the aortic root
and the right atrium following median sternotomy (7). Perfusion was
accomplished utilizing a heart-lung machine with appropriate 40 micron in-
line filters and a Bentley Q-100 "bubbler" oxygenator. The perfusate was a
glycerophosphate type with PVP-40 as the colloid. Perfusate was filter-
sterilized by passing through a 0.2 micron filter. The patient was exposed
to three open circuit passes of perfusate consisting of 10 liters of 5%
DMSO (v/v), 10 liters of 10% DMSO (v/v) and 40 liters of 15% DMSO (v/v).
Following completion of perfusion the patient was cooled in an isopropyl
alcohol bath at an average rate of of 2.27 degrees centigrade per hour.
Following cooling to dry ice temperature, the patient was removed from the
cooling bath, wrapped in two layers of 1/4" closed cell nitric rubber
(ensofoam) and placed in a mylar bag. Via a lifting block attached to the
feet the patient was then lowered into a cryogenic dewar and cooled to
liquid nitrogen temperature very rapidly by partial submersion. The
temperature descent curve to -196 degrees centigrade are not available on
this patient as a result of loss of records by the contract company which
prepared this patient for long-term storage.
In 1982 P1 was removed from liquid nitrogen storage due to inadequate
maintenance funds, placed in a sleeping bag and immediately transferred to
a dry ice storage chest which had been filled with dry ice previously
cooled to near liquid nitrogen temperature. The patient was stored on dry
ice for 19 days and was then transferred to a cryogenic dewar and again
gradually cooled to liquid nitrogen temperature over a period of 8 days at
a rate of 0.9 degrees centigrade per hour (Fig. 2).
-----------------------------------------------------------------------
*** TYPIST'S NOTE: ORIGINALLY THIS SPOT CONTAINED GRAPHS OF TEMPERATURE IN
DEGREES CENTIGRADE VERSUS TIME IN DAYS, FOR COOLDOWN OF THE PATIENT'S HEAD
AND ANKLE. ***
Figure 2. Second Cooldown of P1.
Thermocouple probes placed externally on head and ankle. Vertical
marks on horizontal axis indicate midnight. "Start" indicates
beginning of cooldown.
-----------------------------------------------------------------------
(19)
Both patients were maintained in the storage dewar in a head-down
position in order to minimize any thermal cycling of the central nervous
system which might result from fluctuating liquid nitrogen levels. The
distal 1 to 1.5 meters (i.e.-knees to feet) of the patients bodies were
alternately exposed to vapor and liquid nitrogen as a result of normal boil-
off/fill cycles. Both patients were maintained in the same cryogenic dewar
during the last year of their liquid nitrogen storage. Prior to this both
patients had been maintained in separate storage dewars and both had been
transferred on two occasions owing to logistic needs or vacuum failure of
the storage vessels.
PATIENT 3 (P3) was a 36-year-old caucasian female who deanimated
suddenly in 1980 following numerous chronic illnesses including profound
immune deficiency, multiple opportunistic infections, adenocarcinoma of the
throat, therapeutic radiation overdose, idiopathic liver disease, and an
unclassified central nervous system myelopathy. Since deanimation was
sudden and remote from cryonics facilities there was approximately a 24-
hour delay before the start of perfusion during which time thorough
external cooling with ice was carried out.
Perfusion consisted of blood washout and extracorporeal circulation
with a heart-lung machine, employing the aortic root and right atrium for
vascular access (8). Perfusion was closed-circuit, employing a
glycerophosphate-based perfusate using PVP-40 as the colloid glycerol as
the cryoprotective agent. The concentration of glycerol was gradually
increased in the recirculating system until the venous concentration
reached 2.85M. Following perfusion the patient was cooled to dry ice
temperature at a rate of approximately 2 degrees
-----------------------------------------------------------------------
*** TYPIST'S NOTE: THIS SPACE ORIGINALLY CONTAINED GRAPHS OF TEMPERATURE
(DEGREES C) VS. TIME (DAYS), FOR COOLDOWN OF THE PATIENT'S HEAD, ESOPHAGUS,
RECTAL, ANKLE. ***
Figure 3. Cooldown of P3
Thermocouple probes at head and ankle placed externally on skin.
Esophageal and rectal probes placed internally. Vertical marks on
horizontal axis indicate midnight. "Start" indicates beginning of
cooldown, with LN liquid level below head of patient in upside
down position. "Add LN " indicates addition of more liquid.
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centigrade per hour by submersion in an isopropanol bath and gradual
addition of dry ice.
Five days following cooling to dry ice temperature the patient was
placed in a urethane (open cell) foam insulated aluminum cassette,
positioned in a storage dewar and gradually cooled over a two-week period
to liquid nitrogen temperature (Figure 3).
REMOVAL PROTOCOL
P1 and P2 were removed from the storage dewar using a high-reach
forklift and lowered to the ground on their supporting stretchers in a
supine position. The head and upper torso of each patient was unwrapped
and conversion to neuropreservation was achieved using a high speed
electric chain saw while the patient's head was lavaged with liquid
nitrogen. A block of tissue approximately 12 by 16 cm. was cut from the
decapitation site on the body and banked with the heads as a reference
sample. Following conversion to neuropreservation the bodies were wrapped
in several layers of 4 mil plastic tarpaulin and allowed to rewarm for 21
hours on a concrete floor. All insulating wrappings (sleeping bags, foil-
fiberglass, Ensofoam) were allowed to remain in place. After 21 hours of
rewarming, the insulating materials were removed, the patients were
examined externally, samples were taken, and surface and "core" temperature
measurements were made. After 21 hours, "core" temperature was -47 degrees
centigrade and surface temperature was -46. (Core temperature was
approximated by inserting the thermistor probe into deep cuts made as a
consequence of sample taking.) At the time of unwrapping, numerous samples
were removed by chiseling with a precooled steel chisel and were thawed in
fixative at 22 degrees centigrade for possible light/electron microscopy at
a later date.
Samples of tissue were also allowed to thaw out at room temperature and
fluid collected from them for examination by light microscopy.
P3 had been placed into long-term liquid nitrogen storage in an
aluminum cassette which was lined and heavily packed in open cell urethane
foam to act as a thermal barrier. Inside the cassette P3 was wrapped in a
1/2-inch thick layer of Ensofoam and two ethylene vinyl acetate (EVA) bags.
The cassette containing the patient was removed from the storage dewar
using an overhead crane and lowered to the ground with the patient in a
supine position within the cassette. The cassette was then opened and
sufficient urethane foam was cleared away to facilitate removal of the
patient. The patient was removed to an isolation tent with specially
constructed supports, where a rapid conversion to neuropreservation was
done using a high speed electric chain saw.
After conversion to neuropreservation, the body of P3 (still enclosed
in a 1/2-inch Ensofoam wrap and EVA bags) was transferred to an insulated
rewarming chest for attempted controlled rewarming to 0 degrees
centigrade. This was done in an effort to minimize the possible effects of
large thermal gradients during warming.
The rewarming box consisted of a cavity 24" in width and 74" in
length. The container was insulated with 2" of Styrofoam and 2" of
urethane foam on the bottom and sides. The body was placed in the box,
which had been precooled with dry ice and liquid nitrogen, on two
thicknesses of R-19 fiberglass insulation with a wooden support block
across the shoulders and buttocks to prevent crushing of the insulation.
Following placement of the body in the rewarming box, the body was covered
over with three layers of R-19 fiberglass insulation and the box was
closed.
The temperature of P3 was monitored via copper-constantan thermocouple
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probes placed rectally, on the external abdomen and on the ankle. Another
probe was placed midway in the covering R-19 insulation to monitor the box
temperature. P3 was allowed to gradually rewarm over 19 days following
removal from liquid nitrogen storage. The course of rewarming is shown in
Figure 4.
-----------------------------------------------------------------------
*** TYPIST'S NOTE: THIS SPACE ORIGINALLY CONTAINED GRAPHS OF TEMPERATURE
(DEGREES C) VS. TIME (DAYS), FOR REWARMING OF THE PATIENT'S CONTAINER
(BOX), EXTERNAL ABDOMEN, RECTAL AREA, AND ANKLE. ***
Figure 5. Rewarming of P3.
Thermocouple probes for ankle and abdomen were placed on the
skin. Rectal probe was internal. Box probe was next to
inside wall of box. Vertical marks on horizontal axis
indicate midnight. Vertical (temperature) scale changes at
-80 C. Arrow at -145 C indicates addition of LN .
-----------------------------------------------------------------------
POSTMORTEM EXAMINATION
During examination of P1 following unwrapping, it was noted that full
thickness fractures of the skin had occurred. These fractures were most
unusual in appearance and can best be described as resembling the type of
cracking observed in deteriorating coatings, such as is seen in paint
peeling away from a wall. The skin adjoining the fracture fissure was
somewhat raised from the underlying fat and gave the appearance of having
"peeled away" slightly. Another striking feature about these fractures was
their symmetry. Fractures were observed in either identical or nearly
identical locations bilaterally. (Figure 5) Fractures were observed in the
skin along the inner aspect of each upper arm and lower arm, in the skin of
the hand just below the wrist in the fleshy area between thumb and
forefinger, on the inner aspects of the upper thigh and on the upper aspect
of the feet. Many of these fractures were 2 to 3 inches in length.
External examination of P2 revealed only one similar fracture, which
measured only a few millimeters in length and was at the edge of what
appeared to be a diabetic ulcer. Several other areas on the lower
extremities which looked slightly "crazed" were noted, but no gross
fractures
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were observed with separation from subcutaneous fat comparable to the ones
-----------------------------------------------------------------------
*** TYPIST'S NOTE: THIS SPACE ORIGINALLY CONTAINED LINE DRAWINGS OF A MALE
BODY AND TWO FEMALE BODIES, WITH ARROWS POINTING TO EXTERNAL FRACTURE
LOCATIONS. ***
Figure 5 Figure 6 Figure 7
External Fracture Locations
-----------------------------------------------------------------------
observed in the remains of P1. At the time of initial examination we
attributed the presence of visible fractures on P1 to be due to an episode
of thermal cycling (up to dry ice temperature and then down to liquid
nitrogen temperature again) which had occurred a year before when funding
for this patient became exhausted and the contract company caring for him
removed him from liquid nitrogen storage.
Following thawing, numerous large fractures were observed on the
surface of P2's remains (Figure 6) and additional fractures were noted on
P1's remains. These fractures were also often bilaterally symmetrical. In
some instances these fractures penetrated more than 4 cm into the
subcutaneous fat, usually ending at the body wall or at the next underlying
tissue plane (such as the fascia covering the musculature) (Plate 1). Both
patients' remains exhibited massive cutaneous fractures over the pubis
(Plate 2(A)). In the remains of P1 a fracture separated a large flap of
skin and subcutaneous fat over the pubis and in P2 these fractures
penetrated the mons and labia majora to the underlying musculature.
External examination of P1 following thawing revealed much more
extensive surface fracturing than was visible at first examination in the
subzero state. In the limbs of P1, particularly in the lower limbs, a
tracery of veins was etched in bright red on the skin surface, apparently
as a result of the release of hemoglobin into the tissue adjacent to the
vessels (Plate 2(B)). The skin of P1 also exhibited an overall pink cast
which was absent from P2 and P3.
Internal examination of these patients' remains disclosed multiple
fractures in almost every organ system with only the livers being
completely spared and the kidneys only slightly affected. In the remains
of P2 fracturing was so severe that numerous organs were often completely,
or almost completely transected by fractures. The pulmonary artery had
fractured and completely
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separated from the heart (Plate 3). A large fracture had almost completely
severed the aorta. Numerous small fractures were observed in other great
vessels of the chest (Plate 4). The lungs (Plate 5) and spleen were at one
point in each organ virtually severed by fractures. The intestine,
mesentery, mesenteric fat (Plate 6), peritoneum, abdominal wall, and
pancreas were riddled with fractures too numerous to count. P1 was
similarly fractured, although not as extensively.
In sharp contrast to P1, P2 exhibited excellent blood washout with
small blood-filled vessels being exceptional rather than the rule, as was
the case with P1. The circulatory system of P1 was filled with blood or
perfusate containing large amounts of blood. The partially frozen contents
of the pulmonary artery and aorta were collected from both patients, thawed
and subjected to osmometry. Additionally, a fluid sample from the femoral
artery of P2 and a sample of interstitial fluid draining from a right thigh
muscle fracture were also subjected to osmometry. Osmolalities for these
body fluids are shown in Table I. These osmolalities must be regarded as
only approximate at best due to the fact that the samples were collected in
the partially frozen state. Nevertheless, the data does at least provide a
basis for comparison of the two perfusion techniques employed and
unequivocally supports the use of great vessel perfusion utilizing large
quantities of perfusate if the open circuit approach is used.
------------------------------------ Other findings of interest were
Table I. BODY FLUID OSMOLALITIES that both patients apparently
suffered from pathologies which
------------------------------------ contributed to or caused their deaths
Patient Collection mM Me2SO which were not listed on the death
Site certificates. In addition to having
------------------------------------ suffered a cerebrovascular accident
P1 Pulmonary Artery 20 P1 was also found to have suffered a
large, "recent" infarct of the
" Aorta 40 posterior wall of the left ventricle.
The heart was also hypertrophied
" Pericardial Fluid 0 secondary to chronic heart failure.
------------------------------------ P2 apparently died as a result of a
P2 Pulmonary Artery 900 massive intra-abdominal hemorrhage,
not of an acute myocardial infarction
" Aorta 760 as listed on the death certificate.
Examination of the liver of P2
" Femoral Artery 800 revealed it to be severely fibrosed
and shrunken, having a knobby, scarred
" R. Adductor Muscle 250 appearance.
(fluid drainage) The autopsy results of P1 and P2
____________________________________ prompted us to attempt to remove too
rapid rewarming as a possible cause of fracturing in P3. To this end a
mathematical model of rewarming was generated by Art Quaife of Trans Time
(9) which indicated that the rewarming scheme which was eventually employed
with P3 would yield a rate of temperature rise between -196 and -120
degrees centigrade in the range of 2 to 3 degrees centigrade per hour. It
was also hoped that the surface-to-core temperature gradient could be held
to a maximum of 10 degrees centigrade. As can be seen in Figure 4 neither
of these objectives was met. However, rewarming was still much slower than
in P1 and P2. Results of the postmortem examination lead us to believe
that rewarming is not the primary event responsible for massive internal
fracturing observed in these patients.
When the rectal temperature of P3 reached 0 degrees centigrade the body
was removed from the rewarming box and subjected to a thorough external
examination.
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The initial examination gave us considerable cause for optimism concerning
the prospect for minimal internal fracturing. P3 had only a few external
fractures: one of the skin on the dorsum of each hand approximately 3 cm
in length (Plate 7); one between the thumb and forefinger of the right
hand; and bilateral fractures of the skin and subcutaneous fat in the
brachial area (Figure 7). The rest of the body was free of fractures.
Careful external examination also failed to disclose the livid tracery of
veins under the skin which was observed on P1.
Of particular interest was the fact that no fractures were observed
adjacent to the decapitation wound. This seems especially remarkable
considering the amount of mechanical and thermal stress introduced by
application of a chain saw at liquid nitrogen temperature. The absence of
fractures associated with sawing at liquid nitrogen temperature confirms
for humans what had been found in earlier, unpublished animal work
conducted by the ALCOR Foundation at Cryovita Laboratories in Fullerton,
California.
Examination of the internal organs of P3 revealed fractures present in
almost every organ. The spinal cord, aorta, thoracic inferior vena cava,
pulmonary artery, myocardium (Plate 8), right lung, liver, pericardium,
stomach, ileum, colon, mesentery, spleen, skeletal muscle, and pancreas,
were all seriously fractured. In some organs, such as the spleen, lung,
liver (Plate 9) and great vessels, fractures penetrated the organ to the
point of completely or almost completely severing them. In other instances
the fractures were confined to the capsule, serous coat, or first two or
three millimeters of the organ (Plate 10). The only organ which was
consistently spared gross fracturing in all three patients was the kidney:
in P1 and P3 the kidneys were free of visible fractures and in P2 the left
kidney suffered only one small fracture of the cortex (Plate 11). The
kidneys of P1 were free of any fractures and were somewhat fibrotic and
shrunken showing evidence of renal disease.
A length of spinal cord approximately 20 cm in length was exposed in P3
and was collected for later evaluation by light and electron microscopy.
When the dura was opened it was noted that the cord had fractured into
three pieces, each approximately 6 cm long. These fractures completely
transected the cord giving the impression of a broken glass rod.
----------------------------------- During the course of the autopsy on
TableII.BODY FLUID OSMOLALITIES,P3 P3 two sets of tissue samples were
---------------------------------- collected from the left ventricle, lung,
Sample Source Glycerol M liver, kidney, spleen, diaphragm, spinal
---------------------------------- cord, skin and fat. One sample of each
Abdominal fluid .729 set was fixed in Karnovsky's solution
(10) and the other sample of the set was
Pericardial fluid 1.367 fixed in buffered formalin (11) for later
evaluation by light and electron
Femoral Artery 1.967 microscopy. Fluid was also collected
from the femoral artery, hepatic artery,
Hepatic Artery B .690 abdomen and pericardium and subjected
__________________________________ to light microscopy and osmometry.
Light microscopy revealed numerous intact red cells in the femoral artery
and pericardial fluid with few ghosts and little debris present. Many of
these cells were noted to be agglutinated upon initial examination, and
progressive clumping and agglutination of the red cells was noted with
continued exposure to ambient temperature on the stage of the microscope.
Osmometric determinations are shown in Table II.
The abdominal and thoracic viscera of P3 showed numerous areas where
blood washout was incomplete. The distal two-thirds of the right kidney
appeared very dark and infarcted and the upper pole of the left kidney also
appeared to have
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been poorly perfused (Plate 12). There were numerous areas in both lungs
which were atelectic and unperfused. The liver, mesentery and
gastrointestinal tract appeared well perfused and free of any obvious
blood. The spleen was very bloody on sectioning and demonstrated many
intact red cells on microscopic examination.
In 1980, when cryoprotective perfusion of this patient was carried out
by the authors, a large, firm abdominal mass was noted both on external
examination and during median sternotomy. At that time we elected not to
perform a laparotomy to investigate the nature of the mass because of both
time constraints and concern over our ability to close the abdomen should
edema develop. This mass, which was severely compressing the diaphragm was
found to be the massively hypertrophied anterior lobe of the liver. The
liver was sectioned and it was demonstrated that the lobe was indeed
hepatic parenchyma and not tumor or cystic material. Histological
examination of liver sections taken from this lobe later demonstrated
severe liver disease with massive areas of necrosis interspersed with small
islands of apparently histologically normal tissue. The other lobes of the
liver were similarly enlarged, and the liver was noted to have a dusky
brownish-yellow color rather different from that normally seen following
blood washout.
Prior to the discovery of massive internal fracturing in P3 we had
hoped to reperfuse the remains with a high molecular weight dye solution
with a glycerol concentration comparable to what the glycerol concentration
in the patient's venous return had been at the conclusion of cryoprotective
perfusion. We hoped to determine if reperfusion was possible and if any
small fractures were present in organs which might not be readily apparent
on gross inspection. Due to the disruption of the great vessels and cracks
in the abdominal and thoracic viscera, complete reperfusion of the remains
was not possible. Instead, we elected to reperfuse the left arm by
cannulating the axial artery and vein. Unfortunately, the dye used
(2,000,000 molecular weight blue dextran) did not impart enough stain to
adequately determine distribution of perfusate into the limb. Consequently
we continuously added methylene blue to the perfusate as it was delivered.
Distribution of the dye was quite striking. Dye penetration was first
noted in the hand and a few small patches of skin on the brachial and
dorsal aspects of the arm. Perfusate began leaking from the brachial
fracture almost immediately (Plate 13).
Within 1 minute following the start of perfusion massive edema was
noted in the limb. Little venous return was noted at any time during the
perfusion. Due to edema, perfusion was stopped after 5 minutes, 21 seconds
and the limb was dissected in order to evaluate dye distribution.
There was very poor distribution of dye in the skin and subcutaneous
fat with the exception of the hand and distal portion of the forearm, which
showed moderate staining with patchy distribution. The deep musculature of
the upper arm showed staining with dye with very even distribution (Plate
14). Virtually all of the extensor and flexor muscles of the forearm
perfused very poorly if at all. In the case of the brachioradialis and the
flexor pollicis, perfusion was confined to an area approximately 2 cm in
diameter in the center of the muscle.
During dissection of the arm immediately following perfusion several
highly pressurized blebs of perfusate were encountered, apparently the
result of fractured vessels within the limb.
DISCUSSION
The most unexpected finding as a result of these autopsies is the
discovery of serious fracturing in all of the suspension patients. While
the cause of these fractures has yet to be established, two explanations
may be put forth.
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The first, and most obvious cause would be shell deformation effects
resulting from expansion of water in the core of the body following phase
change on the outside of the body (12). Unfortunately, this fails to
explain the presence of many internal fractures in tissues which should
have frozen more or less simultaneously and at high enough temperatures to
have accommodated any expansion of ice. A more likely explanation is that
fracturing occurred long after freezing was complete and the patient was
being cooled to below dry ice temperature. As cooling proceeds below the
glass transition phase of water (TG), different organs and tissues within
the patient's body will begin to contract at different rates. However,
because the system is now in a solid state, these materials, bonded to each
other by ice/cryoprotective agent mixtures, will be unable to contract
independently. A logical consequence of this would be the development of
tremendous mechanical stress in tissues contracting at differential rates.
As a result of the inflexibility and low tensile strength of frozen tissues
at or below TG, fracturing occurs.
If the latter explanation is indeed the correct one, then cooling to
very low temperatures in the absence of serious fracturing may be extremely
difficult in large biomasses. Perhaps the solution to this problem may be
to anneal the patient for a prolonged period of time at or near TG prior to
completing the descent to -196 degrees centigrade. Alternatively, it may
be determined to be both safe and feasible to pursue storage at higher
temperatures, perhaps in the region of TG, where there will be no available
liquid water/cryoprotective agent to allow for appreciable propagation of
chemical reactions.
It should also be noted that in the case of P3 there were surface to
core temperature gradients of 20 degrees centigrade or greater during
descent from -100 to -196 degrees centigrade (Figure 4). Head to foot
gradients during cooling below - 100 degrees centigrade were consistently
in the range of 40 to 60 degrees centigrade. It should be emphasized that
these gradients were probably not as extreme in P3 as in P1 and P2 due to
the fact that P3 was surrounded by multiple layers of insulation and a
metal cassette. Large head to foot gradients, as well as surface to core
gradients should be carefully examined as a possible cause of fracturing.
It may be that simply by eliminating large temperature gradients during
cooling much of the fracturing observed might be avoided. Clearly, much
additional research is needed in this area.
One puzzling observation for which we have no explanation as yet is why
none of these patients experienced any fracturing on the dorsum of the
body. The entire back side of the bodies was completely free from
fractures, including fatty areas such as the buttocks which would seem
prime candidates for fracturing. Additional areas which were consistently
free of fractures were the palms of the hands, soles of the feet, and
genitals in the male patient. A cursory examination of the patient's
severed heads under liquid nitrogen revealed no sign of fracturing (such as
was observed in the subzero state in the case of P1), however it seems
unlikely that the head would occupy a privileged position in this respect.
Since these patients have been converted to neuropreservation and their
care continues it was not possible to examine the brain and head for post-
thaw fracturing.
The first two patients were cooled to liquid nitrogen temperature while
strapped to heavy aluminum stretchers which completely covered the dorsum
of the body. P3, who experienced far less external fracturing than P1 and
P2, was enclosed in an insulating container which, as shown in Figure 3,
resulted in a much slower rate of temperature descent. It remains a
possibility that the stretchers may have acted in some way to mitigate
fracturing on the dorsum of P1 and P2.
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(27)
On gross external and internal observation, all of the remains appeared
well preserved post-thaw. The skeletal muscles in both P1 and P2 had a
softened, somewhat "mushy" feel which was not present prior to freezing and
which was noted only to a slight extent in P3. The remains of all three
patients exhibited considerably less rigor post thaw than was observed at
the conclusion of perfusion. The change in tissue texture and reduction in
rigor suggest the possibility of autolytic degradation of skeletal muscle.
The texture and appearance of the heart and the other abdominal and
thoracic viscera were for the most part unremarkable. The pancreas of P3
appeared edematous with separation of the parenchyma into rosette-like
islands imbedded in a clear, gelatinous matrix. This type of edema has
been observed during ischemic glycerol perfusion of animals (4) and during
failed total body washout experiments. In contrast to the experimental
situations where such edema has been observed, it appeared confined to the
pancreas in P2. All three patients exhibited some degree of pulmonary
edema.
It was difficult to find free fluid available for sampling in any of
the peripheral vessels of any of the three patients. Cut tissues exhibited
very little weeping of fluid and even with the application of pressure,
oozing was negligible. This observation suggests absorption of
extracellular fluid by the tissues. Transcellular water in the form of
intestinal chyme was noted in all three patients. The bladder of P3 was
noted to contain a small amount of urine which was still partially frozen
at the time of autopsy suggesting absence of cryoprotective equilibration.
The spinal canal of P3 contained only a small amount of very viscous fluid
(too small for sampling) and the cord was shrunken to approximately 1/2 of
normal diameter. The dura of P3 had a dark, abnormal reddish cast and
areas adjacent to fractures in the cord were similarly discolored. The
virtual absence of significant amounts of CPA in P1 are very disappointing
in view of the amount of perfusate used. It seems likely that failure to
introduce meaningful amounts of CPA in this patient are a result of both
the postmortem delay and the mode of vascular access used: the internal
carotid artery. The absence of adequate blood washout and significant
levels of cryoprotective agent point out the inadequacy of embalming
equipment and techniques in human cryoprotective perfusions.
Both P2 and P3 showed good blood washout when contrasted with P1.
However, in both of these patients numerous infarcted and nonperfused areas
were noted. In P2 the CPA concentration was, not surprisingly, very low,
no doubt as a consequence of the low volume of DMSO perfusate which could
be delivered prior to the development of obstructive edema. A greater
disappointment is the low levels of glycerol observed in the body fluids
from P3. Despite four hours of closed circuit perfusion, the highest
concentration of glycerol observed was still under 2M. These preliminary
indications of poor CPA distribution should serve to again point out the
devastating effects of long postmortem time delays to perfusion in the
absence of adequate cardiopulmonary support. It is unfortunate, but not
surprising that these results with humans bear out work conducted earlier
with animals subjected to long ischemic times prior to glycerol perfusion
(4). In the future, greater efforts should be made, where possible, to
provide good postmortem cardiopulmonary and metabolic support in order to
avoid the complications of inadequate perfusion and CPA distribution
observed in all three of these patients.
-----------------------------------------------------------------------
Our thanks to Trans Time, Inc. and the Bay Area Cryonics Society, Inc.
for their co-operation and support. Special thanks to Art Quaife of Trans
Time for his thermal modeling efforts and to John Day and the rest of the
BACS-Trans Time crew for their outstanding organizational efforts.
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(28)
REFERENCES
1) Personal communication with Robert C.W. Ettinger.
2) Personal communication with Cryovita Laboratories, Inc., Trans Time,
Inc., Cryonics Society of South Florida and the Cryonics Institute.
3) "The Autopsy in Clinical Quality Control," Scottolini A.D. and
Weinstein S.R., "Journal of the American Medical Association," 250, pp.
1192-1194 (1983).
4) "Cryoprotective Perfusion and Freezing of the Ischemic and Nonischemic
Cat," Federowicz M.G. and Leaf J.D., Cryonics, issue 30, p.14, 1983.
5) "Berkowitz Removed From Suspension: Lawsuit Settled," "Cryonics,"
December 1983 p.1.
6) "Suspension Records of R.M. Sr. 3/27/76," Unpublished, ALCOR Archives.
7) "Case Study: K.V.M. Suspension," Leaf J.D., "Cryonics," August 1981,
pp. 8-18.
8) "Case Report: Two Consecutive Suspensions, a Comparative Study in
Experimental Suspended Animation," Leaf J.D., In press.
9) "Heat Flow in the Cryonic Suspension of Humans: Survey of the General
Theory," Quaife A., Manuscript in preparation.
10) Modified from the original (Journal of Cell Biology 27:137A, 1965):
10g paraformaldehyde, 100 ml 25% glutaraldehyde, 8.39 g sodium chloride,
1.42 g disodium phosphate, .5 ml 22.2 calcium chloride, glycerol
concentration adjusted to 3.0M, pH adjusted to 7.4, final volume 1 liter.
11) "General Zoological Techniques," Weesner F.M., p. 30, Williams and
Wilkins Co. Baltimore, 1965 (4% formalin in 3M glycerol/water, acid
neutralized with calcium carbonate).
12) "The Ductility of Mammalian Tissue in Dependance on the Deformation
Temperature," Thom, F. et al, "Cryo-Letters," 4, 341 (1983) pp. 341-348.
SCIENCE UPDATES by Thomas Donaldson
Barney Clark
Readers of CRYONICS cannot have escaped noticing
the recent experiments in which deVries, Jarvik, et al
implanted a mechanical heart into a retired dentist,
Barney Clark. Many cryonicists and even many
immortalists will have strong reservations about this
research. An interesting editorial by Pierre M.
Galleti of Brown University in the NEW ENGLAND JOURNAL
OF MEDICINE (310 (1984) 312) gives us a mainstream
view of the significance of Barney Clark's artificial
heart.
Galleti points out that the experiment
demonstrates only the feasibility of an artificial heart, not its
usefulness. He argues that artificial hearts could only become common
after the year 2000, so that this discovery will probably not have any
immediate influence on medical costs. And he addresses the ethical
problems which doctors and review boards (why not PATIENTS?) have had to
face. Of course he has little to say about that problem. Doctors felt
uneasy about allowing Barney Clark to turn off his heart, and Galleti draws
a comparison with kidney transplants and dialysis, in that doctors were
really not willing to undertake transplants unless the consequence
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(29)
of failure was not death, but a return to dialysis.
As a cryonicist, these moral struggles seem to me very much like
watching people through the wrong end of a telescope. Barney Clark chose
to have an artificial heart implanted, in the full knowledge that he was
not a candidate for transplant (the FDA would not permit implantation of
artificial hearts in people who were candidates for transplantation) and
that when this heart failed he would die. He furthermore knew that in no
way could this artificial heart replace his own heart. It wasn't even
portable, and he would probably not have even a full year left to him on
the artificial heart. To do such experiments on dogs is one thing: much
could be learned and someday artificial hearts may have a very useful role
as a form of temporary support. A fully functioning implantable mechanical
heart would be extremely useful, but of course that's not what was
proposed. Instead, it was proposed to do on a person what really should
have been done on dogs. By choosing to do this experiment, I feel that the
doctors who treated Clark, and Clark, himself suffered from a gross
perversion of values.
Of course I'm not questioning, here, that doctors had the right to do
what they have done, nor am I questioning that Barney Clark gave his
informed consent, nor am I questioning the idea of experimenting upon human
beings. Not all experiments, however, are equal.
The story of Barney Clark's artificial heart shows a totally
shortsighted view of life, death, and the options available. If life is so
valuable, why don't they consider suspension? Suspension is not
acceptable, but it IS acceptable to engage in a costly attempt to postpone
death for three months, an attempt which will guarantee death after that
time elapses. The proponents of these experiments might defend themselves
by saying that Barney Clark had the alternatives of death or the artificial
heart. WE know that is not true, and therein hangs the tale. Defenders of
this experiment lie in much the same position as a witch doctor who refuses
penicillin out of hand, and then argues that his patient requires
trephination because the only alternative is death.
We have all faced this problem of death and choices. We've come to our
resolution of it, which is cryonics. It is a superior resolution. This
superiority comes not because we can solve problems which doctors want to
solve now, far from it. Rather, it comes about because we have come to
understand that these problems, which seem so central to doctors and
thinkers of the 20th Century, are the wrong problems, that their resolution
is merely a side issue or perhaps even that they should not be solved at
all.
Research on artificial mechanical hearts compares to research on iron
lungs. Not long ago, many polio victims ended up in iron lungs; they cost
a lot to maintain, and the patients had nothing like a normal quality of
life. IN THEORY a fully artificial diaphragm could make it possible to
lead a more normal life; but that wasn't what was actually produced. Salk
discovered a polio vaccine; iron lungs became not totally obsolete, but
certainly a side issue in medicine. We did not find a vaccine for polio by
researching improved, high technology iron lungs. Artificial hearts aren't
really a triumph of technology at all; they are a debacle, a rout, an
ignominious defeat. Why not a cure for heart disease? Why not a cure for
aging? Why not transplants with fully controlled rejection?
In terms of the problems which they've considered as crucial and
important, the whole of the medical establishment has spent 30 years
barking up the wrong tree, and all their papers on cancer and heart disease
will one day lie neglected in libraries. One more forgotten fatuity of our
ignorant predecessors!
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The 20th Annual Meeting of the Society for Cryobiology: An Outsider's View
Recently, CRYONICS presented a thorough report by a cryobiologist of
the 20th Annual Meeting of the Society for Cryobiology. I am an outsider
and could only read the Abstracts of this meeting. Of course this is a
very different and truncated view of the meeting. However from reading the
Abstracts, which have just appeared in CRYOBIOLOGY (20 (1983) 698-752) some
points stood out to me very strongly.
I would like it understood that this report is in the spirit of Ithiel
deSola Pool or Eugene Garfield, who do such things as count the number of
papers in a particular subject and draw conclusions about what's happening
on the basis of statistics. In this light, the most outstanding thing
about the meeting was not any individual research result presented (the
very important work of Fahy at the Red Cross Blood Center on vitrification
seemed represented more by a review than by an actual presentation of new
work; I use the term "freezing" in the loose sense in this report and
therefore include vitrification as a special case) but by quite a
considerable increase in the number of papers devoted to organ freezing and
preservation. In fact, I've read these conference reports avidly for years
and furthermore looked through the back issues of CRYOBIOLOGY for the older
reports, and I cannot recall ever seeing so many papers on the problems of
kidney and organ preservation by freezing and other methods.
It seems to me that this increase in organ preservation work is very
significant in and of itself and would remain very significant even if each
individual paper were utterly trivial. A lot of people are finally
starting to get interested in organ preservation. Even people from New
Zealand and Australia, countries not previously noted for cryobiological
research, came to the conference to present their ideas. A large contingent
of Germans also came, again unlike previous years.
Again, speaking as an outsider, I can suggest some underlying reasons
for this (which reasons may have nothing to do with the conscious
intentions of the scientists participating). I believe that cyclosporin
and other recent advances in immunology coupled with the constant growth in
kidney and heart transplants is driving this current interest in organ
preservation, even AGAINST THE WILL of some of the participants.
It also seems to me (despite a comment in the earlier CRYONICS report)
that there is essentially no way to meet the desire for long-term storage
of organs other than by freezing them. I don't mean that other means of
preservation are not possible, but rather that economic preservation is
unlikely to be attainable except by freezing.
If cryobiologists can freeze kidneys, brains will not be far behind.
A further point of interest to cryonicists, although it doesn't tell us
anything unexpected, is a report by Arthur Rowe and Leslie Lenny of the New
york Blood Center on the long term viability of red blood cells. They
tested a sample preserved for 15 years and found that at -196C their sample
remained unchanged for that long. However, at -20C red blood cells tended
to break up 24 hours after thawing. At -80C, glycerol frozen-cells could
last for less than a week. This fact may suggest caution in carrying out
temporary storage of suspension patients on dry ice.
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"Even the lion has to defend himself against flies."
-- German Proverb
HoMEҹͳƵ
ENTER NUMBET 0020