Earlier this year, Alcor engaged in some long-term organizational planning. The result was the drafting of a three-year plan for development. Our plan broke operations into four main categories: membership, clinical readiness, research and technical development. It considered strategic positioning and facility improvements that would be necessary to transitioning Alcor from a small start-up into an organization that is capable of surviving successful outreach and mass marketing.
During the development of this plan, technical aspects had to be looked at in detail, because they affected nearly every department. Dr. Mike Perry, Alcor Patient Caretaker, prepared an analysis of the current membership and mortality statistics in an attempt to estimate the requirements for performing cryopreservation procedures at various membership growth rates. (See Cryonics, Spring 2006, for a brief summary of that analysis.) Dr. Perry’s analysis told us that we would face significant challenges if the membership grew faster than the technical capability could handle. His results encouraged us to hone our commitment to improving the foundations of our emergency response capability, in terms of both equipment and personnel. Once that infrastructure is in place, then we can consider improving the membership aspects and engaging in directed marketing.
Though the three-year plan itself will not be released in full because it was intended as an internal planning document (and will likely be subject to significant modification as time passes), we intend to update our members and supporters on elements that have been implemented or are being implemented in the near-term.
Research and Development
Aside from our standard administrative tasks and special projects like the conference, our time has mostly been spent on engineering improvements for the cryopreservation processes. We have begun automating collection of data during the cryopreservation process and control of the perfusion process, and this has necessarily included acquiring new equipment. In addition to progress made on those projects, we’ve needed to add a couple of items for the improvement of patient stabilization processes.
We’ve built a prototype of a partial liquid ventilation system for rapid cooling while performing cardiopulmonary support during a patient stabilization. Partial liquid ventilation is a process involving the introduction of a cooled, oxygenated liquid into the lungs, where the massive surface area can facilitate extremely rapid cooling. It’s partial ventilation, because the oxygen-carrying capacity of the fluid is insufficient to support metabolism, and so a patient has to have additional oxygen support.
Our mechanical system for partial liquid ventilation will allow us to cool patients during the critical first-minutes of the stabilization procedure, a vital capability that has the potential to drastically improve a patient’s overall cryopreservation. This system is expected to provide nearly the cooling rate of the blood washout, at an estimated half degree C per minute, with none of the invasive surgery or time delays. The prototype has now been submitted as Alcor’s first patent and is based on earlier work done at Critical Care Research. It is simpler to deploy, requires significantly less training to operate, is less expensive, and considerably more portable than any other device patented for this purpose.
We’ve also nearly completed a re-design of the portable ice bath (PIB), a lightweight bathtub on wheels which enables a patient to be cooled with ice and treated while being moved, such as in a hospital setting. The new design is based on an idea by Michelle Fry and was built by Randal Fry (with the help of Diane Cremeens). Our previous PIB was one of the least efficient pieces of our stabilization kit, and our new design should meet the requirements of being portable, easy to assemble, and capable of whole-body cooling. It should provide for more weight-carrying capacity than previous versions and has the bonus benefit of being able to go over curbs or a couple small steps and other surfaces, like grass, significantly improving our mobility. Once the design and testing of this ice bath are complete, we intend to replace all previous versions in the field. (We may actually build a couple extra units, because a local fire chief has expressed an interest in using one for their remote rescues and donating one to their cause would be good for community relations.)
Our research team is working hard on the development of a cardiopulmonary bypass laboratory. This development is important to beginning comprehensive testing of every aspect of the cryopreservation procedure, from the impact of different cooling methods or medications to the advantages and disadvantages of various cryoprotectants. Using our cardiopulmonary bypass laboratory, we intend to replicate the total body washout experiments performed by Cryovita and Alcor in the late 1980s and early 1990s in the rat model. We have acquired most of the equipment necessary to establish the model, and the protocols are being drafted for experimentation. Setting up the perfusion system has been the most complicated factor, and Chana Williford, Alcor’s Research Associate, has developed a design that seems likely to avoid one of the major problems of rat perfusion: priming volumes. This volume reflects the amount of fluid contained within the perfusion circuit, and should be as low as possible. Her circuit has an extremely small priming volume, and the design alone should be publishable in scientific journals if it holds up under scrutiny.
Intermediate temperature storage is something else we’re working toward and has been discussed for some time, but it is important to mention that providing long-term care of patients at higher temperatures, like -140 degrees C, does not actually eliminate fracturing in patients. We believe annealing, a process whereby strain can be relieved in glassy materials through raising and lowering temperature in a controlled fashion, may be the solution to eliminating fracturing in patients.
In order to test that hypothesis, we have completed construction on a prototype annealing test cell that will allow us to investigate the physics of fractures in our patients. We intend to begin testing our cryoprotectant next week. If this prototype is effective for its intended purpose, we will replicate it to allow for multiple samples to be processed during fracture experiments. Our hope is that we can develop a reliable protocol for minimizing – or even eliminating – fractures in our patients. This work is expected to take some time, as learning how to cool a pure cryoprotectant (our first step in the lab after building the equipment) is very different from learning how to cool a complex organ system.
In many ways, our research and development program is being built up from nothing. Lack of focus, changes in personnel and lack of serious commitment all contributed to poor development in technical areas in the past. Rather than leading the drive for improved cryopreservations, we were relying on external organizations for research and largely languished in areas of development. We have begun to repair this serious deficit and intend for the new research and development efforts to aid in our goal of becoming recognized as a serious scientific research organization.
Clinical Readiness
Our new operating room has been assembled and is prepared to perform two cryopreservations simultaneously, one whole-body preservation and one neuropreservation. There are, however, two pieces of equipment that are not duplicated between the stations: the chiller (which provides cooling for the perfusion circuit) and the computer control system. We are not planning to duplicate the chiller, because it will be insufficient in the near-term to reach the depths of cooling that we have in mind for the new operating room table. The computer control system is being significantly re-designed; and once the new system is built and tested, that is the one we will replicate. Computer control will allow us to monitor more directly every aspect of the cryoprotection process; and alarms will be set to inform us when critical milestones are reached or if there are failures in the system. Aspects of the cryopreservation to monitor will include, but are not limited to, perfusion pressures, vascular resistance, cryoprotectant uptake and water loss, temperatures (naturally), and flow rates. This should allow for more comprehensive analysis of future cryopreservation cases.
Improving the emergency stabilization kits is also well-underway. We’ve designed a smaller version of the remote kit that will be more widely deployed, especially into new regions. This small kit will ensure the capability to administer surface cooling, cardiopulmonary support, and medications. It will not include washout capability at this time, as the more remote regions do not yet have personnel trained to carry out a washout procedure. The washout capability will arrive with Alcor personnel, in case of an emergency. Once the new kit has been tested in a field situation, then we will deploy it more widely. We intend to build twelve of these smaller kits, deploying them to places like New England, Nevada and Texas as supplements to fuller kits like the ones stored in California.
Expanding the field capability also requires training more emergency response personnel across the country and world. This expansion of the training schedule is well-underway. In 2006, we expanded training to include several regions, like Texas, Florida, and the United Kingdom. In 2007, we’re coordinating expansion to include Australia, New England, eastern and western Canada, and the Pacific Northwest. This will be in conjunction with the existing regions. Because this expansion will place a strain on personnel and training equipment, we’re strongly encouraging emergency response team members in the regions to gather periodically between Alcor-attended sessions, to review the training materials and practice the skills, and to contact Alcor when questions arise. Teams are responding well to this encouragement, and new people are contacting us nearly every week for training opportunities in their area.
And in Conclusion….
Much of this progress to date has been made possible because of the success of our matching grant earlier this year. It is still the case that the three-year plan is ambitious and will take significantly longer than three years to implement if additional funding is not obtained. We are cautiously optimistic about our chances for securing the necessary funding, because we’re improving our reputation for fiscal management; adhering to the financial controls that were set in place late last year; showing consistent progress on projects; and basically, sticking to the business at hand.
We still have a lot of work to do, but we have a good staff that is fully capable of handling the load. We’re pleased with the progress that has recently occurred, and we intend to keep the momentum going. Developing the plan has helped hone our focus on the things that matter, and everyone on the staff has great ideas on how to continue improving our procedures.
Needless to say, we’re excited about the current direction Alcor is headed, though we’re fully aware that there is still a tremendous amount to do. We hope you’ll stay tuned and see how this all develops.
