For decades Alcor has welcomed members residing overseas, and pledged to attempt to cryopreserve members who suffer legal death while traveling outside the United States. However options for responding to overseas cases have been very limited. Historically there has been a choice between shipping on water ice near 0 degrees Celsius (with or without blood replacement) and attempting subsequent cryoprotective perfusion at Alcor to eliminate or minimize ice formation, or so-called “straight freezing” to dry ice temperature of -79 degrees Celsius without cryoprotective perfusion and shipping to Alcor.
Cryoprotective perfusion after a prolonged period of cold ischemia is usually very difficult, typically leading to the difficult decision to “straight freeze” overseas cases to dry temperature prior to shipping. Freezing without cryoprotectant is extremely damaging to tissue. About all that can be said for it is that it is better than the alternative of not being cryopreserved at all.
There is now a better alternative. As described in this issue of Cryonics, Alcor has developed a simple system for perfusing cryoprotectant solution in a remote field setting instead of requiring patients to first arrive at Alcor’s facility. After completion of this field cryoprotection, patients can be cooled to dry ice temperature (-79 degC) for shipment to Alcor with less time urgency and a slower rate of biological damage than at 0 degrees. Once at Alcor, cooling is resumed to the temperature of liquid nitrogen (-196 degC) at which temperature tissue is stable for practically unlimited lengths of time.
Alcor’s initial implementation of field cryoprotection is still crude compared to cryoprotective perfusion in Alcor’s operating room. Temperature and pressure control are limited, the cryoprotectant concentration rises more rapidly than is ideal, and the perfusion time is comparatively brief. Very importantly, the present field cryoprotection procedure only perfuses the head and brain with cryoprotectant, so the body of whole body members receiving field cryoprotection will still be frozen without cryoprotectant. However, this is obviously a better outcome than the entire body, including the brain, being frozen without cryprotectant.
Upgraded Canadian and European Response
The logistical challenges of implementing field cryoprotection internationally are substantial. Only future experience will reveal whether we are able to apply FCP in a majority or a minority of international cases. Here is the current situation: The Alcor board has authorized the use of FCP for cases taking place outside the United States. We have stationed a kit in Canada in the Toronto area, and another one in London, England. The contents of the two kits is similar, with minor differences that depend on supplies already present locally. (For instance, the current plan is to make use of the Thumper that is owned by the Cryonics Society of Canada (CSC) and which fits their own ice bath.)
The Toronto kit includes step ramp-based perfusate; a neuro surgical kit; a field neuro tubing pack; perfusate administration supplies; refractometer; DuaLogR temperature recorder; burr hole equipment and supplies; stabilization medicines; administration supplies; stabilization equipment; ice bath liner; neuro dry ice shipper (designed to hold dry ice temperature for almost a week); personal protective equipment; Cardiopump; Squid (SCCD); refrigerator and freezer; and preprinted shipping placards. Although the perfusate can be stored indefinitely when refrigerated, we will check its condition every six months by ensuring that a visual inspected is performed locally. Medications will be replaced as needed.
CSC will be hosting a training session on August 15 and 16 to learn how to use the FCP kit and perform the procedures involved. In England, we will conduct a training session with members of Cryonics-UK on November 15, and hope to conduct an additional training session the day before in London with the international morticians where the FCP kit is currently stored.
Having a kit located in Canada means that we can respond to Canadian members needs without worrying about essential supplies being held up in customs. This is equally important in England. The England kit may also be used to respond to members throughout Europe. Even so, we aim to eventually store another kit in Continental Europe, perhaps in Germany.
Who responds to a critical member in England or elsewhere in Europe? The answer depends on how much advance warning is available. In some cases, we would expect our Medical Response Director to fly to London and pick up the FCP kit and take it to the location where a standby or immediate stabilization is required. If time is too short, we may make use of the staff of the international mortician where our kit is stationed, including their highly skilled embalmer. A third option is to call upon the trained members of Cryonics-UK. Of course, we may use two or all three of these options, as circumstances indicate.
We are still in the very early stages of using field cryoprotection. However, assuming that we respond quickly, our Canadian and European members should benefit from a very substantial improvement in the quality of their cryopreservation, should they need it. Our first priority is to ensure that all necessary items of the FCP technology are in place and that local persons are adequately trained in using them (in case we cannot reach them quickly enough). Beyond that, we would like to position new kits in more locations. We would also like to improve the FCP technology to address some of the shortcomings of this approach in comparison to conducting closed-circuit cryoprotection in Alcor’s operating room. For instance, we may be able to improve chilling of the perfusate, and improve control over flow rate and pressure.