November 12, 2010
At the 2010 Strategic Meeting, the board and management discussed Alcor’s financial well-being at length. The majority of the meeting focused on specific budget cuts, fee increases, and plans for establishing an endowment. However, it was also necessary to discuss those policies and practices which affect Alcor’s bottom line. This article is intended to clarify Alcor’s grandfathering practice in general, as well as the benefits and limitations of Alcor’s Comprehensive Member Standby policy, specifically.
Alcor has a long-standing tradition of grandfathering its members. This means that as cryopreservation costs increase Alcor does not require existing members to obtain more funding in order to remain an Alcor member. Grandfathering prevents a long-time member from suddenly losing his or her membership when Alcor raises its required funding minimums. This is especially important for members who have retired, become ill or disabled, or cannot get additional life insurance.
It is important to understand that Alcor is not contractually obligated to follow this grandfathering practice. In fact, Alcor’s grandfathering practice allows the organization to limit its emergency response for members who are funded below the then-current minimum funding levels. For instance, Alcor’s current membership agreements read:
Cryopreservation Agreement, Section III: Representations, Warranties, and Limits of Liability, Article 8
“Alcor does not warrant or represent that the minimum required amount of the Cryopreservation Fund will be adequate to pay for the Member’s cryopreservation and maintenance. This amount has been suggested by Alcor with consideration to current costs and estimates of future costs. The actual future costs remain unknown; and some portions of the current costs, especially those which may arise from the special legal, medical, and practical circumstances of the individual Member, or difficulties in transport of the Member, cannot be known or even estimated in advance. It is the responsibility of the Member to exercise his/her best judgment as to what constitutes adequate provision of resources to achieve successful cryopreservation and storage.”
Cryopreservation Agreement, Section III: Representations, Warranties, and Limits of Liability, Article 10
“Alcor warrants and represents only that all procedures connected with cryopreservation, maintenance, and revival will be done with Alcor’s best efforts given the logistical, funding, personnel, knowledge and other constraints limiting it at any particular time.”
To reduce the financial burden of cryopreserving grandfathered members, Alcor may alter the cryopreservation process to reduce costs if the member’s payment to Alcor is below Alcor’s stated minimum in effect at the time of the cryopreservation. Such alterations may include, but are not limited to, using fewer personnel, less sophisticated procedures, less expensive cryoprotectants, no cryoprotectants, or limiting the extent of cryoprotection of whole body patients.
To help ensure optimal procedures will be available at time of cryopreservation, Alcor members are encouraged to plan for future increases in cryopreservation funding requirements in accordance with their life expectancy. In short, if you are not funded at or above current cryopreservation minimums at the time of legal death, you may not receive an optimum cryopreservation. The unsustainability of grandfathering without such cost mitigation measures was recently highlighted in a by Rob Freitas.
Comprehensive Member Standby: Benefits
In 2005, we were pleased to announce our “Comprehensive Member Standby” (CMS) program, a major initiative in our ongoing quest to provide more effective cryopreservation procedures to Alcor members. As the name indicates, CMS covers the “standby” phase of a cryopreservation, often referred to as “standby, stabilization, and transport.” Standby is a critical, and often costly, phase of the cryopreservation process.
During a standby, time is of the essence. Teams of highly-trained personnel are available around-the-clock, waiting nearby the Alcor member in need. Response personnel are outfitted with the necessary medications and equipment and stand ready 24 hours a day to stabilize the patient after pronouncement. The teams respond in an expeditious manner, very similar to the response expected for a person who donates their organs for transplant.
An expeditious response is critical because the chances of an effective cryopreservation – and thus a successful future resuscitation – increase with the promptness of the response. The faster an Alcor patient is cooled, treated with protective medications, afforded a blood washout for additional metabolic stabilization, and transported to the Alcor operating room for cryoprotection, the better the chances that a quality cryopreservation will result.
Benefit: No out-of-pocket expense for standby services at the time of need
Prior to initiation of the CMS program, Alcor members paid out-of-pocket for their standby needs with a credit card or prepayment. Standby expenses could range from $15,000 to $40,000, depending on the location and duration of the standby. It was often very difficult for members to incur these expenses at a time of great emotional stress and competing financial needs. Further, not every member had the financial means to make such arrangements.
The core concept of CMS is to provide standby coverage to eligible members for no additional charge at the time of need. (Eligible members are those residing in the continental U.S. and Canada. Standby response to Canada may be delayed by customs and immigration delays.) In exchange, members pay an out-of-pocket cost of $10 per month, which is waived for minors and eligible students. For this modest fee, Alcor members receive standby coverage that would otherwise cost tens of thousands of dollars at the time of need.
Benefit: CMS includes up to $5000 for relocation assistance
Further, the CMS program has a built-in benefit for terminal members. Alcor is a staunch advocate of encouraging its members to relocate to the Scottsdale area, especially in the event of a terminal illness. The benefits of relocation include greatly reducing ischemic injury to the patient through expeditious application of Alcor’s post-pronouncement response protocol (known as bedside care), reducing the potential for unexpected logistical challenges, and minimizing cost.
Our members are warmly welcomed at a variety of highly cooperative hospice facilities in the Phoenix and Scottsdale areas. These hospices will immediately pronounce our members upon clinical death and provide a supportive atmosphere before and during the critical first moments of our stabilization process. If it is not yet time for hospice care, we can help our members find local resources to meet their living space needs.
We believe so strongly that a successful standby sets the stage for a successful overall cryopreservation that our CMS policy provides up to $5000 of relocation assistance to any terminal member (with a prognosis of 90 days or less) who relocates to the greater Phoenix area. We realize relocation at the end of life can be a difficult decision. We offer this relocation benefit to increase the quality of the cryopreservation, while reducing the burden on families.
Comprehensive Member Standby: Limitations
The level of standby care that can be provided beyond basic CMS may depend upon how much funding the individual member has provided. Basic CMS coverage, for instance, does not include transport to Alcor after legal death by a charter jet and may not include field blood washout before transport.
Limitation: CMS does not include expedited transport to Alcor by charter jet
The need for cryopreservation is often unpredictable. Legal death may occur as the last commercial flight of the day is departing. Even if Alcor is present at a patient’s bedside and immediately begins the stabilization process following pronouncement, the patient may ultimately suffer several hours of ischemic injury before transport to Alcor if no commercial flights are available. If the delay is significant, cryoprotective perfusion, i.e., the vitrification process, may not even be possible.
Depending on the circumstances, an overnight delay may be enough to significantly impair the cryopreservation or result in a straight freeze. A straight freeze does not provide any of the protective qualities of the vitrification solutions and is believed to require more advanced technologies to attempt future resuscitation. In fact, any delay in the onset of perfusion is undesirable and best avoided.
To receive the best cryopreservation possible, transport to Alcor for cryoprotective perfusion needs to happen as expeditiously as possible. How can that be achieved for those who do not live in the immediate Phoenix area? There are a few ways to increase your chances of receiving expeditious transport to Alcor: (1) Relocate nearby the Alcor facility or (2) fund a charter flight.
As previously indicated, we actively encourage our members to relocate nearby the Alcor facility when the time of need can be foreseen. Although relocation nearby Alcor is the ideal outcome, it is not always possible. For remotely-located members in danger of suffering a considerable delay while awaiting a commercial flight, we recommend providing funding for a charter flight after legal death.
Charter flights within the continental U.S. can cost as much as $40,000, depending on the distance to be traveled. Alcor can arrange for a charter flight at the time of need, but only if the member has provided adequate funding. It is important to realize that funding for a charter jet must be provided above and beyond the required cryopreservation minimum.
A charter flight can often be available in as little as 2-4 hours. When moments count, and the next commercial flight is several hours away, a charter flight is your best bet. At this time, only members who have provided $40,000 in additional cryopreservation funding have secured charter jet services within the continental U.S., should the need arise.
Limitation: CMS may not include field blood washout
Blood replacement with an organ preservation solution is known as blood washout, or simply washout. The main immediate benefit of washout is rapid cooling. As previously indicated, the faster an Alcor patient is cooled, the better the chances that a quality cryopreservation will result. Placing ice around the body is not nearly as effective as circulating cooled solutions throughout the body using the vascular system, as occurs during a washout.
Washout is the single most logistically challenging aspect of a standby. It requires personnel trained to access the vascular system and operate the necessary perfusion equipment. It often requires securing an appropriate facility where the procedure can be performed on short notice. In deciding whether to proceed with a washout, Alcor must balance the benefit of expedited cooling against the potential detriment of delaying transport of the patient to Alcor for full cryoprotection. Alcor must also consider the cost. Retaining the necessary personnel and facilities can be expensive, particularly if the standby lasts longer than expected.
In some circumstances, a patient who would have benefited from a washout will not receive one, simply due to financial constraints. At this time, those who have provided less than $80,000 for a neuropreservation or less than $200,000 for a whole body cryopreservation may not receive a field washout. As Alcor raises its rates, members who want to have the best chances of receiving an optimum cryopreservation will need to increase their funding to match Alcor’s new rates.
Limitation: CMS may include limited standby personnel or technologies
CMS can provide limited standby personnel for limited periods of time and may not include improved technologies. It is anticipated that new technologies will become available in the future that will cost more. For instance, it may one day be possible to expeditiously cool a cryonics patient internally much faster than even a washout can achieve, such as using lung lavage technology. Thus, Alcor will use its best judgment, considering the amount of funding provided by the member, to determine the level of care that can be provided.
Recommendations for Securing Your Optimum Cryopreservation
The above explanations are only examples of ways in which your cryopreservation may be impacted due to funding limitations. All aspects of Alcor’s cryopreservation protocol, including standby and operating room procedures, are eligible for modification in accordance with your available funding. In general, Alcor will make best efforts consistent with funding available. It remains each member’s responsibility to ensure the accuracy of Alcor’s records regarding available funding.
This article is not meant to be an exhaustive list but to give you a sense of the importance of contacting Alcor today regarding increasing your cryopreservation funding. In some cases, it may be as simple as changing the beneficiary on your existing insurance coverage to allocate a greater percentage to Alcor. In other cases, you may need to seek additional coverage through your life insurance agent. Cash prepayment and credit card authorization are also options.
Recommendation #1: Provide Alcor with funding well in excess of current cryopreservation minimums at all times
If you already have a life insurance policy with a death benefit that exceeds the existing cryopreservation minimum, you may be okay. However, make sure that your funding is consistent with your remaining life expectancy. The longer you expect to live, the more funding you should provide, or expect to provide, for your cryopreservation in the future. The following tables show historical price increases for Alcor’s neuropreservation and whole body cryopreservation procedures.
Neuropreservation Funding Minimums
1970s – $25,000
1982 – $35,000
1991 – $41,000
1994 – $50,000
2005 – $80,000
Whole Body Funding Minimums
1970s – $60,000
1982 – $100,000
1991 – $120,000
2005 – $150,000
2011 – $200,000
Similar price increases driven by inflation and improving technology are inevitable in the future, and must be planned for. We encourage you to contact Alcor to confirm the status of your funding and make any necessary changes without delay.
Recommendation #2: Even if you plan to relocate to the greater Phoenix area at your time of need, fund a charter flight
Funding a charter flight can be achieved by ensuring Alcor has access to at least $40,000 above the current cryopreservation minimum. Charter flights can be funded by life insurance, cash prepayment, or credit card authorization. (Contact Diane for the necessary credit card authorization form.)
Diane Cremeens, Membership Services Coordinator
Toll-free: 877-462-5267 x 132
Local: 480-905-1906 x 132