By Aaron Drake, NREMT-P, CCT Alcor Transport Coordinator
Ivy Gladys Eyre, age 92, born on September, 28th, 1916, a retired cashier and widow of George William Eyre, from Plumstead, London, U.K., legally died on October 6th, 2008, of Myocardial Infarction secondary to Ischemic Heart Disease.
Due to the overseas location of this patient and the lengthy process to have this member’s paperwork completed, there was a significant amount of time involved between legal death and bringing this patient to Alcor.
In late August of 2008, we were contacted by an existing member that his mother had experienced a minor heart attack the previous week and that there was a desire to have her signed up as a member of Alcor. A meeting was setup with the family’s legal counsel to establish a Power of Attorney (POA) relationship between the son and mother. At this point his mother was recovering and out of bed and moving around. However, on October 6th we were informed the mother had passed away suddenly and the intention was to have her shipped to Alcor on dry ice for neuropreservation once she was accepted as a member. Since the POA had not been completed prior to her death, the son needed the estate to be probated before he could obtain the financial resources to complete the cryopreservation arrangements.
During this time, instructions were given to immediately transfer his mother to a mortuary that could get her as cold as possible. (The son was advised to store his mother on dry ice, if possible, but that option was not pursued.) She was moved to F. A. Albin & Sons Funeral Home, (www.albins.co.uk), on the same day of her death at 1:30 pm and placed in cold storage at -20 deg C and maintained at that temperature until the membership arrangements could be completed. We continued to receive updates from the son until he received word on December 12th that the Probate had been finalized and he could now pay for the membership and complete Alcor’s documents on behalf of his mother. Albin’s indicated that it would cost approximately 8000 British Pounds to have her transported to the United States. Due to the excessive price quoted, the precarious nature of dry ice shipments and a previously established relationship with Rowland Brothers International, (www.rowlandbrothersinternational.co.uk), it was determined that it would be preferable to work with Rowlands. We would keep the patient at Albins until Alcor arrived with the shipping container and would then have her transferred to Rowlands to be prepared for shipment. In anticipation that this case would come to fruition, we began to prepare documents that contained instructions on dry ice shipping and container construction and forwarded these on to the mortuary.
The Alcor Board approved the membership with the waiver of the last-minute case fee at the January 3rd, 2009 board meeting.
On Jan 15th, 2009 we received the Alcor contracts from the son and the wire transfer of the cryopreservation funding was received on Feb 5th, 2009. This later date is significant as we were not able to complete any actions that incurred expenditures since pre-funding arrangements had not been established prior to death. Over the course of the next week, we began to establish primary and contingency plans for travel, shipping containers and local vendors to overcome a variety of unknown obstacles associated with overseas shipping, customs, international regulations, weight restrictions and specific dry ice shipping requirements.
After consulting with multiple airlines to determine their dry ice requirements, it was determined to use Continental Airlines. They had the best blend of dry ice allowance, flight times with appropriate connections and price. One important variable was the final weight needed to be less than 400 lbs in order to take a flight into Phoenix. This had to do with the size of the plane and weight restrictions. If the entire shipment would be in excess of 400 lbs, we would need to come as close to Phoenix as possible via a direct flight from Heathrow on a Wide-Body style of aircraft. It was determined that if this occurred, we could fly to LA, where the So Cal team could meet us and help us transfer the shipment to a vehicle where we could travel the remaining distance by ground. Initially, we were only going to book the outbound leg of the journey since we did not know the return date. However we discovered that a round-trip fare was significantly cheaper than just a one-way ticket, even after incurring a change trip fee.
The shipping container that was identified for use was Alan Sinclair’s dry ice shipper that he had constructed in the mid 80’s by British Oxygen. It was unknown if this case was still in sufficient shape for use given the age of the unit. The plan was to visit Alan’s house upon arrival and check on the condition and potential viability of the box. If its general appearance indicated that it might be usable, it would be moved to Rowland Brothers to be tested. If neither of these conditions passed, the previously sent instructions would be used to construct a shipping box specific for our purpose and subsequent tests would be performed on this newly constructed unit. The testing criteria were predetermined by Brian Wowk and Hugh Hixon.
Primary and secondary dry ice suppliers were identified and lodging arrangements were made with proximity in mind. An email was sent out to all of our contacts in and around London for assistance in the form of transportation, additional sets of hands, and general availability. We were able to secure the assistance of Alcor-UK member Sebastian Smit [a pseudonym] to help with transportation and provide a strong back. Alcor-UK member Theo Ibrahim also took photos of Alan’s dry ice shipper and emailed them to us so we could remotely assess the unit’s condition and viability.
On Feb. 12th, 2009, Aaron Drake and Hugh Hixon dropped Regina Pancake off at the airport and she departed for Heathrow airport, London, England, UK. She was scheduled for a flight from Phoenix to connect in Newark, however a storm on the East Coast was causing extensive delays and she would probably miss her connecting flight. Instead, she was changed to a flight in Houston and then flew direct to Heathrow. Her flight arrived early morning at 7:00 am on Feb 13th and sufficient time was allotted to accommodate time to clear customs. Sebastian Smit lives 170 miles north of London, and he traveled to Heathrow airport to pick up Regina and they traveled by private car down to the town of Croydon where the Rowland Brothers office was located. Regina met with one of the family owners, Tony Rowland where they had a cup of tea and chatted about everything he knows about cryonics. They have the ability to accommodate just about every religion, faith and language. To them, cryonics was viewed as just another version. She received a tour of their facility that handled the transfer of human remains from around the world. Rowland Brothers International has been in operation since the late 1800’s and will process some 60 to 70 individuals over the course of one week’s time. This facility was only one of multiple locations. They then proceeded with coordinating the plans of the Alcor patient.
Sebastian and Regina traveled to the hotel and called Alan Sinclair to discuss his dry ice shipper. He assured Regina that the unit was more than sufficient to do the job, no dry ice tests would be needed to be performed at his home, and that we should just plan on picking it up and transporting it to Rowlands. Sebastian then traveled to Alan’s home, around 50 miles away and spent the night.
Case Work (UK):
On Saturday morning, Feb. 14th, Sebastian rounded up some neighborhood kids to help him move the dry ice shipper from Alan’s shed and lift it into his van. He stated that it wasn’t any worse than moving a ‘fridge. By 10:00am, he was back at the hotel to pick up Regina and deliver the unit to Rowland Brothers. Due to the size of the box, at Rowland Brothers, they were unable to move the unit into the building as planned since there was a roll of sheet metal that blocked the rear loading area. Therefore, it was secured in the locked yard until Monday when the forklift operator could be there to assist. Normally this would not be an issue as most European coffins are quite small and their forklift was there only to accommodate American style coffins, which are significantly larger.
On Sunday, Eskimo Ice was contacted and an order of 120 Kilos of crushed dry ice was placed for delivery to Rowland Brothers between 8 and 9 am. This is the amount of dry ice we had been told the shipper could hold.
The process of obtaining all of the necessary documents for shipping out of the country was initiated by Rowland Brothers on Monday, Feb 16th. This included a non-infectious disease form, death certificate, cause of death, date of death and finally a visit to the American Consulate to submit for transit. They felt confident that all of this would be completed by the time we were ready to ship. Another travel modification was made by Rowland Brothers. Due to their longstanding relationship with British Airways, they have an established process to expedite shipping handling and they preferred to use them. The shipment was booked by Rowland Brothers and Aaron rebooked Regina’s flight to match the shipment. Continental Airlines was contacted and the remaining value of the ticket was converted into a credit for future use. The British Airways flight was cheaper in the form of a roundtrip ticket over that of a single one-way ticket. This also leaves us a credit to be used in the future from the return portion of the ticket.
The patient was also transferred from Albin & Sons to Rowland Brothers on Monday morning. The patient was placed into the Ziegler case which was inside the shipping container. All of the dry ice ordered was placed inside the Ziegler around the body, on the bottom, sides and partially covering the top. The level was marked to determine evaporation rates. There was still quite a bit of empty space inside the unit so we planned to add additional ice after an initial test to monitor how quickly the dry ice evaporated. Our goal was to ensure the dry ice would last the flight back to Alcor’s facility. This required waiting until the patient’s temperature had adequately descended. The test ran from 3:30 pm on Monday until 8:30 am on Tuesday. Upon examination, only a small amount of ice had evaporated from the top measurement. The most visible change occurred from the sides.
Regina’s attempt to place a thermocouple in the patient’s nose was unsuccessful, and since the patient is in a shroud, an insulated TC could not be put on her body to gauge the temperature descent either. It was estimated that an additional 30 kilos of the dry ice had evaporated by Tuesday Feb 17th afternoon. Another order was placed for 100 kilos, which was added at 4:45 pm. The priority was around the patient’s head and the remainder was placed between the outside of the Ziegler case and the inside of the shipping case.
On Wednesday, Feb 18th the manner in which the additional dry ice was added was determined to be incorrect as putting dry ice on the top of the Ziegler case caused the lid of the shipper to warp to the point where cold gas was leaving a trail of frost down the outside of the shipper. It was warped a bit before, but close contact with the dry ice caused the inner surface to really contract and bend the lid. It is important to avoid condensation, which could cause concern with the airlines. Regina then removed all of the dry ice she could get to that was in the shipper and placed it inside the Ziegler case, using the remaining air gap as an insulator. She also placed 1 1/2″ of Styrofoam sheet between the top of the Ziegler case and the shipper lid, which should allow the lid to straighten out significantly. A 24-hour test to let the whole thing come to equilibrium was conducted to see what would happen.
By Thursday, almost all of the dry ice spots on the exterior of the case had disappeared and the unit was ready for shipment. Small pieces of cardboard were inserted along the seal to prevent excessive pressure buildup due to dry ice evaporation. These areas were then boldly marked with a stencil to satisfy any airline or customs officials. In advance of the flight, Rowland Brothers took the unit and all of the paperwork off to Heathrow airport to be placed into queue for Customs for Friday morning’s flight.
Case Work (US):
Regina and A-2404 left Heathrow on British Airways, Friday Feb. 20th bound for Phoenix Sky Harbor airport on a direct flight. In the morning, Rowland Brothers faxed a copy of all of the documents to Alcor that were traveling with the shipment. These were subsequently faxed to Steve Rude to begin processing so that the patient could be transported from the airport to Alcor. During the day, Aaron Drake met with Steve Rude to discuss the pickup and delivery plans and to obtain all of the required signatures. US Airways handles the cargo shipments for British Airways in Phoenix and we stopped in to their office for the customs form. This form was then taken to the Customs office for signature and stamp. Proper corporate identification was required of Aaron to receive the shipment. Throughout the day, continual checks were made with British Airways and it appeared that the flight would arrive about 45 minutes late. Aaron and a group from Rude Family Mortuary met at US Airways cargo building around 6:30 pm. The flight arrived at 8:10 pm. The shipping box was the first item off of the plane. A large coffin van was brought to receive the shipment. It required two forklifts to maneuver the shipping unit into the back of van. Hugh Hixon was called at Alcor to let him know that we were on the way.
We arrived at the Alcor facility at 9:06 pm and were met by Hugh Hixon, Mike Perry, Todd Huffman, Bruce Cohen, Jerry Searcy and Simone Syed. The neuroseparation was completed inside the mortuary vehicle which saved the trouble of moving the patient (as a whole body) inside. The patient and shipping unit were then moved into the facility.
The cool down process lasted through the next seven days. There was a brief power outage that occurred during the cooling process on Feb. 23 at 01:58. There was a thirteen minute period where there was no power until it was switched to different circuit. Power to the original circuit was restored at 03:45 the same morning. A decision was made to purchase a UPS with two battery packs was purchased to mitigate the same risk in the event of another power outage during this or future cases. It took several weeks for delivery.
On Friday, Feb. 27th, patient A-2404 was placed into a neurocan a transferred to long term care.
Conclusions and Findings
Dry Ice Shipper: The unit that we used from Alan Sinclair is too large, too heavy and too expensive to realistically utilize on cases. Hugh developed and tested a dry ice shipper that could be constructed remotely with common items that could be obtained almost anywhere. This new unit performs better, is lighter, will cost less to ship and is a single use item that can be discarded after use. A nine page manual was developed to show how to construct and use this shipper when needed on a future case.
International airlines: Although preliminary shipping arrangements can be made as a case develops, mortuaries that ship on an international basis have fostered long standing relationships with the airlines and can have more options available to them than we can hope to establish on an occasional basis. Utilizing the mortuary’s expertise in the planning and execution of the shipping process is preferred.
Round-Trip tickets: Throughout this case, it became abundantly clear that roundtrip tickets are far cheaper than two one-way tickets and even single one-way tickets. It may be difficult to predict the return date on a case, however it still may be cost effective to purchase a round-trip ticket and pay the change fee or utilize the second half of a ticket on a future trip.
Location of the Neuroseparation: It was determined late in the case that performing the neuroseparation in England would have been preferable. This would have eliminated the need to borrow a dry ice shipper, the time needed to acquire and test the shipper, the additional cost of shipping due to the weight, the need to cremate the remainder of the body locally, the need to ship the cremated remains, the cost of returning the borrowed dry ice shipper back to England. On a straight freeze of a Neuro, this option should be considered early, however considerations will have to be taken with respect to the views of the participating mortuary. We may need a field design for a Neuro dry ice shipper, such as a cooler chest, with subsequent tests.
Wide Body Aircraft: When shipping dry ice shippers containing human remains, weight is of major importance when selecting an airline. Most airlines have a weight limitation of 400 lbs when it comes to shipping cargo on a narrow body style aircraft. If the weight exceeds this amount, a wide body style aircraft needs to be used which greatly reduces the choices available that fly into Phoenix Skyharbor Airport.
Colder; Quicker: We may need to become more aggressive about getting the body down to dry ice temperature on a quicker timetable. Although the body was kept at -20 C, a neuroseparation and dry ice could have been completed much earlier on this case. This would have substantially reduced the storage, handling and shipping charges.
Albin and Sons has freezers, Rowland Brothers does not.
Late August, 2008
Mrs. Eyre had a minor heart attack.
16 – September
Roger with his attorney to set up Power of Atty (POA) for his mother.
17 – Sept
Diane instructed Roger to have POA forms sent and processed by the U.K. government. Reported that mother was out of bed and moving around.
5 – Oct (6- Oct in U.K.)
We were informed that Mrs. Eyre in England has died and will be shipped here on dry ice for neuropreservation once she’s accepted as a member
1506. Tanya directs Hugh to do guesstimate on dry ice usage.
We received an update from Roger that the paperwork is still tied up in Probate and that he should be hearing from his government soon.
12 – Dec
Received word that Probate has been completed and they are ready to go.
17 – Dec
Roger indicated he had received the contracts and he had some additional questions that were answered by Diane C.
Mrs. Eyre has been moved to Albin and Sons’ Funeral Home in London. Roger states that Albin’s will charge 8000 BP to transport Mom to the U.S..
1028 talk with Regina, Jennifer about Mrs. Eyre’s case and Tony Rowland
18 – Dec
1145 helping Regina with dry ice shipping instructions to Rowland Brothers
3 – Jan 2009 (Sat) Alcor Board approved the membership with waiver of the last-minute case fee.
30 – Jan (Fri)
1400 questions about dry ice shipping – with Aaron, Regina, weigh Ziegler case – 65 lbs
1618 search for prior dry ice shipping experience
1723 search for prior dry ice shipping experience
2 – Feb (Mon)
1030 with Jennifer, Regina, Aaron, discuss dry ice shipping from England
10 – Feb (Tues)
1129 discuss England dry ice case with Regina, Jennifer, and Aaron
1216 Jennifer checked wording to Research re above meeting on dry ice shipping
11 – Feb (Wed)
1040 put new batteries in dualogrs and set up for Regina’s England trip
1451 with Regina, bring DuaLogRs, adapters, TCs and boxes together
12 – Feb (Thurs)
930 with Aaron, pick up Regina and get her off to England
13 – Feb (Fri)
0700 (UK) Regina arrives Heathrow
1300 (UK) Regina arrives Rowland Brothers Mortuary
1317 call from Regina in England – can’t get through to Aaron – passed to Aaron, tested phone connections – Aaron can call her, though – headed for bed
1319 Regina called to see if Todd had come in – not yet, he’s going to talk to Tanya
14 – Feb (Sat)
Dry Ice Shipper delivered to Rowland Brothers
16 – Feb (Mon)
735 Regina calls – 120 kg dry ice is not near enough to fill Alan’s box
748 Check back with Regina on possible winding sheet problem
1000 conference call with Regina, Jennifer, Aaron, and then with Steve Rude
18 – Feb (Wed)
324 Regina calls -lid warping, cold spots
332 call Regina – solution
552 Regina calls – progress
640 Regina calls – progress
823 Regina calls – admin stuff – looking for Diane
940 brief Aaron, Jennifer – Regina calls – other stuff
1011 email on morning’s activities
19 – Feb (Thurs)
411 Regina calls – cold spots almost completely cleared up, going in to put inside insulation in place
843 Regina calls – what is hazmat number for dry ice?
904 callback – dry ice is UN1845
1338 Regina calls – patient off to Heathrow
20 – Feb (Fri)
414 Jennifer calls – check Fax from Rowland Brothers for A2404 paperwork
445 Jennifer calls – check Fax from Rowland Brothers for second set of A2404 paperwork
451 Jennifer calls – and fax to Steve Rude
1000 Aaron meets with Steve Rude to preplan arrival and delivery plans
1111 called Aaron re body removal – Plane running about an hour late
1200 Aaron and Steve obtain shipping documents from US Airways (for British Air)
1230 Aaron and Steve obtain customs acceptance stamp and signature for delivery
1623 setting up in PCB for A2404 ETA here ~2000hrs
2010 A2404 on the ground, ETA here ~2200. Bruce came and went back home till 2200
2043 loading difficulties – prep RV to go get her – they got her on with two forklifts – will have to use the RV lift gate to get her off
2106 A2404 arrived at Alcor facility
2126 Neuroseparation procedure initiated
2225 A2404 transfer completed without incident – cool down in progress
21 – Feb (Sat)
A2404 cool down in progress
22 – Feb (Sun)
A2404 cool down in progress
23 – Feb (Mon)
158 lost power on one phase – cool down lost
211 cool down restarted
213 called Jennifer re power loss
300 Jennifer comes, leaves
345 power restored
500 APS calls to check
1000 put Randal on looking for uninterruptible power supplies
1350 with Todd and Aaron, look at what Jennifer got quoted for a commercial UPS ($2700)
1405 look at phase monitor and latching problem
1420 Looking at UPS systems
1524 order UPS for cool down from Gruber (Steve Ray) in Deer Valley 602-863-2655 x396 Base unit plus two battery packs ($2000)
1731 check A2404 cool down
24 – Feb (Tues)
1340 clean out Sinclair shipper, new batteries in scale – looks OK – for dry ice usage
1401 Steve Rude drops off A2404 ashes, ring
25 – Feb (Wed)
508 A2404 cool down 4.4 inches LN2 in bottom
648 end A2404 cool down
930 pull cool down lid and top off A2404 Dewar
27 – Feb (Fri)
1154 prep for A2404 move to neurocan
1441 Transfer A2404 Eyres to neurocan
Alcor Life Extension Foundation
7895 E Acoma Drive, Suite 110
Scottsdale, AZ 85260