Inspections during cryopreservation

[jordansparks]

I received the following email. It raises some interesting questions, so I thought I would post it here for everyone:

Inspections of patients after stasis
and long after status.

Having gone through the Oregon Cryonic
website; I found no information on inspections
after patient stasis.

I have traded emails with Alcor; and their
engineer says viewing a face after stasis
is not desirable because of wrinkling and
shrinking. He said they are planning on
doing cat scans on patients in stasis
but could not say how long after in
stasis; which sounds like an acceptable
alternative. Does or will Oregon
Cryonics plan on doing post stasis
checks of condition of the person in
stasis? And how often? Every year?
Every 5 years? Every 10 years?

Since Oregon Cryonics only takes
peoples heads, leads to the questions
of vertebrae, nerves, blood vessels in
the spin; and jugular reconnection in
the future. How do you decide where
to make the cuts? And are these cuts
sealed in such a way as to allow easy
reconnection at some future time.
Just assuming people will know what to
do in the future is not adequate. Using
the best current means appears
mandatory; and documenting the
method used is probably mandatory;
even if done by a third party or someone
previous to being at Oregon Cryonics.

A picture, once a quarter, or once a year,
of a person in stasis face seems desirable
for posterity to have an indication of condition;
preferably from two different angles.
Is this something Oregon Cryonics does or
may be considering?

If only a cat scan is desirable; how often
would Oregon Cryonics perform a cat scan
on a patient in stasis head? If no pictures
are available or desirable; once a year or
once every 5 years for a cat scan sounds
appropriate for and indication of the condition
of the person in stasis.

[jordansparks]

We do not currently plan on doing any checks while cryopreserved. The risks probably significantly outweigh the benefits. One risk would be accidental impact. Another risk would be allowing temperature fluctuation. The tissue must always remain completely submerged in liquid nitrogen. If a simple container is used instead of a small dewar, then the liquid would boil very quickly and would need to be continually topped off. This could be tricky and there would be very little room for error. If the liquid level falls, the temperature fluctuation could cause cracks in the tissue. It's also unclear what the benefit would be. I can't actually think of any clear benefit. Would the goal be to provide reassurance to someone? This is not a true benefit to the patient. Reassurance does not improve their current situation. Would the goal be to improve future patient care? Isolated case reports do not generally improve care. This goal would be better served in other ways. For example, we could put blocks of tissue in at one date, and then remove them at 10 yr intervals to look for some sort of degradation. But degradation of tissue in liquid nitrogen has already been shown to be essentially zero, so I don't really think this would be a good use of time either.

How do we decide where to make the cuts? Our goal is only to preserve brain tissue. There is no need to worry about easy reconnection because the technology required for that is much simpler than the technology required to fix damage inside the brain. For example, if we estimate that we will have the technology to grow a new body and reconnect the head in 70 years, then the complexity of brain repair dictates that we would probably need to wait much longer (another 70 years?) to be able to make those repairs. So, by the time we are able to repair the brain, the technology to reconnect the head will be very old and very mature. That part is easy. But if we were to try to make cuts in a way that was "best", I'm not even sure what that would mean. I can't think of any changes that would either improve or worsen future options. There's nothing to "seal".

I can't think of any utility for photos or CT scans during the cryopreservation period. I do know that Alcor is removing patients for CT scans, but that's because they didn't take any prior to cryopreservation. Our protocol is to take a CT scan prior to subzero cooling, so we will already have a record of preservation quality. Further CT scans would not yield any additional information.

This is not set in stone, of course. It could be that we discover a need to do periodic checks, and that we put in the required effort to reduce the risks as much as possible. I'm just not convinced yet.

[jordansparks]

Here was their response (I removed carriage returns to save space):
Thanks. But I am not buying your rebuttal; or your additional explanations because: As a consumer, things need to be the way I request, or it is not happening. The below must be able to be incorporated into a contract with you or anyone on this subject. Meaning: doing my best to show up at a hospital near your services just before I am ready to die for your preparation of me is the plan. Which includes a full cat scan for future reference to later cat scans and for comparison. I also need to be placed in a clear Lexan or other polycarbonate or equivalent dewar for visibility of my entire body and occasional picture taking; once a year will suffice of my head and body; from two different angles; close up and close ups of skin to show skin condition at at least three different locations. Full front, full sides, and full or complete back pictures of my body once a year are required plus the close ups mentioned; as a minimum. Re-animation surgeons shall have the right to request additional testing before re-animation; but not less. A full body picture including my genitals is requested; as the genitals are likely to be one of the first places to show any anomalies from the super cold temperature. The pictures I expect would be forwarded at least once a year to my relatives and posterity to show my condition to them. Sent by mail or electronic device to three different locations is required. And confirmation from these three locations they have received the pictures and the pictures are of sufficient definition to be useful to the end users is required in their confirmation to you. And if they see anything they do not like; their displeasure shall be registered with your organization; and several other institutions. I do not expect this to affect my freeze unless surgeons say they can re-animate me in writing. I expect a written response from at least 3 surgeons saying my re-animation has a high success rate of working as detailed below before any thawing is started as detailed below. In 100 years, I would expect to be removed from the dewar for several minutes with a cat scan scanning me as I am hauled out of the dewar and then immediately replaced in the dewar after the cat scan is confirmed complete and readable by at least three surgeons; no more than 5 minutes is my requirement to be out of the dewar. And then again every 100 years until re-animation is attempted. And if the re-animation fails, I would be placed back in the dewar as soon as possible no more than 5 minutes after the surgeon has decided the re-animation will not work. Two choices exist: move my dewar with me in it to the hospital where the surgeons would attempt re-animation. Or the surgeons would attempt re-animation at your or my dewar location. The surgeons will make this choice in writing to you and my relatives; at least 3 each. It would be up to you to convince the surgeons to try re-animation at your/my dewar location. I expect the re-animation to take 2 to 3 times as long as the initial freezing procedure; since the freezing procedures takes 5.5 days or 132 hours; the re-animation at minimum would be 264 hours and as much as 396 hours or more and monitored by the three surgeons and they decide that the re-animation is going correctly; with the right to stop the re-animation at any time for any reason or no reason. One dissent shall govern and the re-animation shall be stopped and my body returned to its dewar with the refreezing procedure used including tissue annealing. The surgeon's experience and intuition shall govern the re-animation. Later information may require taking as long as five times the initial freezing procedure for pre re-animation set up. Or a quick thaw; 10 minutes or less; may be required to avoid essential tissue deterioration in order to gain re-animation. The surgeons will decide this in writing before or during the re-animation; by at least three surgeons who are present. The surgeons shall decide amongst themselves which will lead and if switching off is warranted. Except three surgeons need to be present during the entire procedure. The surgeons shall tell you and my relatives how they have decided. And you must inform them that they must say this to you and my relatives in writing. If any emergencies; at least two surgeons shall be within 20 miles to replace one having an emergency; and be alerted they are backup for short notice show up. The emergency must wait for the backup surgeon to show up before the on site surgeon can leave. All surgeons must agree to this in writing. The backup surgeon shall be fully briefed by the surgeon that is leaving before that surgeon leaves to the satisfaction of the show up surgeon; and in front of you and 3 of my relatives. Three surgeons shall decide re-animation only after at least 100 re-animations have been attempted and at least 95% or 95 of them have been successful to the point of people resuming normal lives for at least 6 months. Which means 95 continuous successful re-animations in a continous row would decide my re-animation and must be documented to you and my relatives and posterity before starting re-animation. Re-animation shall be defined as not bed ridden and not wheel chair ridden; able to walk, talk, use arms, use all fingers, all toes and comprehend what is said. And able to remember my past self as decided exclusively by me; same for all people re-animated. At the glass temperature of my tissue, similar for most humans and animals; I expect the freezing process to move below and back above this glass temperature of my tissue several times during the initial freeze as a tissue annealing process to help prevent any tissue cracking. And if a re-animation fails; the same annealing process would be accomplished during the new freeze procedure and for any followup refreezing. A cat scan shall be performed at the final temperature for a view of all of my tissues and organs before final immersion at the final very low temperature with tissue annealing as previously described. Three surgeons shall provide their written opinion of my cells, organs and entire body before and after full freeze; before and after full freeze and with human specialists input included; at least three specialists for each surgeon. So two cat scans immediately after death will be needed to satisfy myself and any future surgeons that my full body cells and organ's conditions are satisfactory for re-animation. One before freeze, and one after freeze with tissue annealing. And two cat scans are required for re-animation; one immediately after removal from the dewar and then a second after the thaw is complete. The surgeons and you shall not have the right to modify this contract in any way. This contract is not modifiable; once signed; except by me before death; or after re-animation; and only with my clear mind as decided solely by me. Three of my relatives shall witness my signature after re-animation; if any changes. I expect at least 3 of my relatives to be present for the entire time of this preparation and freezing process of my body; and to sign off that they were present; and to record anything that appears to be an anomaly to them. I do have AFIB; which is slowly getting worse. I expect I have at least 10 years and maybe as many as fifty years of life; currently age 69; 10/12/2021. I am looking for a cloned or several cloned human hearts so a surgeon can pick the best one and so spares are available if any anomalies develop; and my heart cloned only so no rejection considerations are present. But this business is just in its infancy. Maybe in 5 to 10 years I may have an answer on my cloned heart and will be able to decide on freezing my body after that time. I am also prone to kidney stones and may need a new kidney also; or two new kidneys. Lungs, liver, stomach, and intestine replacement may also be a consideration. If the time ever comes that you can do all of the above and include it in a contract as written above; let me know. I will be willing to be suspended at very low temperature until at least three surgeons think they can re-animate me; in writing; after I have received a new cloned heart; new cloned stomach; and new cloned small intestines; if at all possible.

[jordansparks]

None of the cryonics organizations would be able to meet your requirements. Many of the requirements are impossible even if we were willing. There's no such thing as a transparent dewar. It is theoretically possible to place the body in an open container of LN2 and take photos from above, but the quality is not good. Also, bodies are stored vertically, so it would be very difficult to safely rotate 90 degrees for such photos. Your requests are virtually impossible.

As for reanimation requirements, any patient is free to write out their requirements and we will include it in their chart. I will assume that any reanimation would be performed by future physicians and would involve the future legal system. Patient wishes are always taken very seriously by physicians and the courts. But when requests are infeasible, physicians must also consider what is best for the patient. An infeasible request is usually disregarded so that proper treatment may continue. So if you stipulate that 100 reanimations must be performed prior to yours, that seems like an easy request to accommodate. It's more of a legal request than a change in how the procedures are to be performed. But if you specify a procedural change such as an annealing process, your answer, for the most part will simply be that we are not able to do that.

Imagine if you went to a hospital for treatment and included a list of demands similar to those above. Do you think that the staff would go ahead and include all those non-standard procedures? Or would they kindly inform you that they were not able to do that? In medicine, the patient's requests are taken seriously, but at the end of the day the response is usually that you can either follow the protocol that the doctors and hospitals provide, or you are free to leave the hospital and not let them treat you. Just about the only "choice" a patient gets is to either allow certain treatment or not -- that's it.

I think the general consensus of physicians is that cloned hearts are at least 30 years in the future, just for proof of concept, and probably a few more decades to get more than experimental approval. So at least 50 years from now. I suppose we could get lucky, but how often does that happen?

[dennis]

>But I am not buying your rebuttal; or your additional explanations because: As a consumer, things need to be the way I request, or it is not happening.

If this is a young person under, say 20, I'd cut some slack. If not, I'd totally avoid dealing with this person, it's more trouble than what it's worth. A consumer/provider is a 2-way street, which many people don't realize. Notice the choice of words 'surgeons shall have the right', 'govern' etc. indicates a person steeped in legalize/bureaucracy. This person is unlikely to have ever dealt with any technical complexity, and does not understand tradeoffs.

[jordansparks]

Dennis, this person will also read your post and will probably be offended by it. I'm not here to criticize customers. We provide services out of compassion, and we try to help people understand the limits of what we can do. In any case, yes, this person has plenty of experience with technical complexity and tradeoffs. He's an electrical engineer and has an MBA.

[dennis]

>Dennis, this person will also read your post and will probably be offended by it.

I'm personally ok with offending someone, ( not that I go out of my way ). I've noticed that when it comes to immediate people around oneself( friends, family and in this case a potential long term customer) it's best be honest as to tell what apprehensions one has, about the person. People who are easily offended with also misinterpret/misjudge you some point of your intentions and turn their ire at you. Not fun in the long run as far my observations go.

>He's an electrical engineer and has an MBA.

If he can actually can deal with technical complexity, I'm baffled. Either he's brilliant and doesn't (honestly) realize that mere mortals cannot possible comply with all his instructions or he's an ivory tower thinker.
( I wouldn't place much weight on the MBA, it's another junk degree where the only useful goal is be more employable for some employer.)

In any case there are elements to what he has mentioned that is worthy of consideration, though not novel.