September 11, 2010
In April of 2009, we learned that Alcor member Orville Richardson had been buried in February of that year by his siblings. After a protracted legal dispute over the past 15 months, which was ultimately concluded in Alcor’s favor by the Iowa Court of Appeals, Orville was finally transported to Alcor. This case exemplifies the extreme importance of our members establishing relationships with individuals who support their cryopreservation arrangements. It was a tremendously difficult situation, and one that we hope is never repeated. Orville is now Alcor’s 99th patient.
We received two last-minute, non-member emergency calls last month, both post-mortem situations. These are always challenging calls and neither resulted in a cryopreservation. First, in early August, we were contacted by a woman whose brother had passed away suddenly about 24 hours prior in Massachusetts from heart failure. She had never discussed cryonics with him, but she said he was “into science.” She wanted to know more about cryonics. After coming to understand the cost and biological challenges of the case, the family decided not to proceed.
The second emergency call was about ten days later, on August 16th. We were contacted about an elderly man who had died twenty minutes prior of sepsis in Wisconsin. His son was a Ph.D. and educated about cryonics, more so than the average person. He decided to take a proactive role in pursuing cryonics for his father. He even attempted to convince the hospital to administer the medications in Alcor’s emergency response protocol, a request that was ultimately denied. Although Alcor strongly discourages last-minute cases and carefully weighs several factors when determining whether to accept a given case, this situation looked more promising than most for several reasons. Alcor had been timely notified post-mortem, the son was informed about cryonics, the father had apparently expressed a desire for cryopreservation, and the family expressed no reservations about the financial burden of paying for the cryopreservation and last-minute surcharge. Given all the favorable signs, we collected a down payment and deployed Aaron Drake to aid with expediting transport to take place following membership approval. In the end, certain family members who were authorized to make the decision whether to proceed wavered in the decision-making process. This lack of clear support contributed to the decision not to proceed with the case.
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 response protocol following pronouncement (known as bedside care), reducing the potential for unexpected logistical challenges, and minimizing cost. We have established positive relationships with local hospices and have access to multiple Phoenix/Scottsdale locations. Relocation at the end of life can be a difficult decision, we realize. To reduce the burden on families, our Comprehensive Member Standby program offers reimbursement of relocation expenses up to $5,000 for eligible members.
The percentage of cases Alcor has been at the patient’s bedside (whether locally or remotely), and initiated its stabilization procedure immediately following pronouncement, increased by 20 percent over the past 19 months when compared to the previous eight years. Our standard of offering bedside care whenever possible is significantly preferable to the team arriving even hours (or sometimes days) after pronouncement, as can occur if Alcor is not notified in a timely manner of an impending health concern. Alcor’s “watch list” program initiated by Aaron Drake monitors the health conditions of our members and has greatly contributed to our ability to anticipate their emergency response needs. We will continue to place strong emphasis on maintaining member communication and offering bedside care into the future.
The percentage of cases involving terminal perfusion has also improved by 16 percent over the same date range. This means that more members are receiving full cryoprotection according to pre-determined standards. The Alcor team has done a commendable job over the past 12 months, achieving these improvements while simultaneously handling the highest caseload in Alcor history.
As we work to issue reports for our cases over the past year, members of the R&D committee offered the below recommendations for additional technical data to be included:
• Time of cardiac arrest/when breathing was first observed to stop
• Time at which the nurse could no longer detect a pulse
• Time of pronouncement
• Time between cardiac arrest and pronouncement
• Medications, dosages, and times administered (including in the O.R.)
• Time CPS started (including time of any interruptions)
• Temperature measurements throughout
• Name of the cryoprotectant and the carrier solution
• Data graphs showing temperatures during stabilization/transport
• Data graphs showing temperatures during cryoprotective perfusion
• Data graphs showing temperatures during cool down
• Data graphs showing pressure, flow, and concentration graphs during cryoprotectant perfusion
• More detailed discussion of cryoprotectant perfusion
We appreciate their recommendations and plan to incorporate this data in future reports, if it is available. Last month, our dewar manufacturer declined to bid on manufacturing additional dewars for Alcor. Steve Graber expeditiously developed detailed digital schematics to aid with seeking bids from competing manufacturers. We subsequently contacted eight dewar manufacturing firms and received a few bids. One of the companies operates overseas and would have to invest in the required manufacturing equipment. As a result, we opted to order three dewars from a US-based firm. The estimated manufacturing time is about four months. We also purchased a used dewar from Cryonics Institute (CI). This dewar is immediately available for shipment to Alcor after CI receives our payment. It was in working order when last in use, and we will commence testing shortly.
In early August, Eric Vogt worked on readiness-related projects at Alcor in support of our ongoing efforts to improve inventory control and vastly expand Alcor’s documentation library. He reorganized suite 105 earlier this year and took a detailed inventory. During his recent visit, Eric confirmed the inventory count and identified items to be reordered. He established a temporary system of monitoring inventory levels using a spreadsheet format, which will be useful until Steve Graber develops a functional database. Indicators or “flags” on the physical bins will be used as visual reminders when inventory levels are low. Aaron recently modified our medication kit to include partitions, which keep the contents neat, organized, and easily accessible. Eric diagrammed the contents of the redesigned medication kit for easy reference during kit construction. He also updated the inventory sheets for our remote response kits, eliminating duplicative items, and prepared shipments of medications and field equipment for our field teams.
Alcor has long faced the imperative challenge of overcoming financial instability. Over the past decade, it has sustained largely as the result of membership dues from its loyal membership base, donations from its generous benefactors, and a handful of large bequests. Membership dues remain a fairly stable source of income for the organization. However, donations and bequests are difficult to predict and, therefore, relying on them results in a precarious situation.
In June 2011, the LEF/Miller/Thorp grant will expire and we must plan accordingly. The three-year grant, begun in 2008, contributes to salaries, training events, and a host of readiness-related projects, equipment, and activities. Needless to say, the grant has benefitted Alcor’s general operating budget tremendously and we are appreciative to the donors for their generosity.
My recent efforts have largely focused on developing a budget and budget balancing strategies to address the nearly $400,000 deficit Alcor will face in 2011 and 2012, should it receive no income from cases. Although it is unlikely that there will be no cases in a given year, it is Alcor’s tradition to prepare for the worst case scenario. Due to the unpredictable nature of cryonics caseloads, we start with a baseline assumption that no cases will occur. The deficit we face is only partially due to expiration of the grant. Even in 2010, Alcor would have experienced a deficit were it not for case income.
Although the challenges we face are significant, they are not insurmountable. After submitting a detailed analysis of our budgetary situation to the Alcor board and proposing a budget balancing strategy, I am confident Alcor can finally resolve its budget deficit without relying on unpredictable donations or bequests. I look forward to meeting with the Alcor board this weekend during our annual Strategic Meeting to discuss this and other challenges facing the organization.
To review previous Executive Director’s board reports, visit the alcor staff page.