Chapter 2: Transport Overview
Alcor 1997 Stabilization and Transport Manual
Table of Contents
The foundation for cryonics is partially based upon an unproven assumption: that preserving the physical structure of a human being may be sufficient to enable future revival of that individual, even if they were considered “dead” by other standards. Thus, the goal of every cryonic suspension is to preserve the unique physical structure of the individual patient. Unfortunately, no clear guidelines yet exist for determining exactly what aspects of the body’s structure will be needed in order to revive a patient in the future.
Current cryonic suspension procedures seek an elusive “suspended animation.” Perfect preservation would ensure that the identity and personality of a cryonically suspended individual would be intact upon revival. We don’t know what makes an identity unique, and perfect preservation is presently beyond our reach. This means that we don’t even know if an ideal cryonic suspension, according to current criteria, preserves enough structural information to enable us to preserve identity. Facing many unknowns, we must still strive for a “perfect” transport each and every time.
No two transports or cryonic suspensions are alike. We learn from each and use our new knowledge to improve our procedures. Without a dedication to learning, we could never improve our techniques, or our chances for revival. Current cryonic suspension techniques build upon past cryonic sus-pensions, medical technology, and much research. Many developments in transport and suspension protocols were adaptations based on related research, since little research examines the problems specific to cryonics. Much of this research is useful, but when applied to the special goals of cryonics, may result in major compromises. (Some specific compromises in current cryonic suspension methods are discussed below.) The wisdom of such compromises may not be determined for many years. Even the seemingly simple choice of liquid nitrogen as the patient storage medium was not so simple.
Liquid nitrogen is a proven medium for storing blood, embryos, and human tissue over long periods of time with a high degree of viability. There is virtually no metabolic activity at that temperature (-196°C or -320°F). It is inexpensive, readily available, and nontoxic. Cryonic suspension patients, once frozen in time and nitrogen, will experience virtually no structural deterioration over thousands of years . However, this cooling process causes significant damage to the patient’s tissues.
Human tissue contains a large amount of water. Taking unprotected tissue to ultra-low temperatures results in that water turning to ice, which damages the tissue by dehydrating the cells and compressing them between advancing ice crystals. Even with the best techniques available today, this type of freezing damage is experienced by every cryonic suspension patient to some degree. While freezing damage cannot yet be repaired, it can be partially prevented.
Reducing Freezing Damage
Water turning to ice is the problem, so removing the water from the tissues should reduce the damage done to a cell when this phase change occurs. Cryoprotectants, like glycerol and dimethylsulfoxide, are chemicals which protect tissues from some of the damage associated with freezing. Through diffusion, they are able to remove water from tissue and protect against the extreme cold. But, they are toxic at warm temperatures.
Distributing cryoprotectants throughout a whole body would be nearly impossible without a viable circulatory system. The circulatory system is an integrated transportation network within the body. Billions of vessels, using a fluid medium, deliver nutrients to the cells. The same system is used to deliver cryoprotectants throughout the body. This perfusion process is also useful for removing excess water — water in the circulatory system as a by-product of cryoprotective diffusion — from the body.
Cryonic suspensions are performed on individuals who have been declared legally dead. When applying the broadest possible criteria, death is pronounced only after the cessation of heartbeat and breathing. Heartbeat and breathing are good indicators for how well circulatory and respiratory systems are performing. These organ groups provide a continual supply of oxygen and glucose to the cells, without which health and life cannot be sustained. All body functions are affected by the constant, complex micro-adjustments which keep the cells happy and the body healthy. These cellular-correction mechanisms are so well balanced that even a few minutes without circulation or breathing frequently results in currently irreversible damage. If the initial imbalances aren’t quickly reversed, the ischemic damage will result in death for cells and, eventually, for the self.
Fortunately, an entire industry has evolved to assist with restoring function and health to damaged bodies. The Emergency Medical System (EMS) — present in fire departments, police stations, clinics, and hospitals around the world — has numerous techniques for re-storing metabolic balance to people who fall ill. The immediate stabilization of a patient is a common goal for EMS personnel and transport team members. With an emergency response system of its own, Alcor has been able to adopt some techniques used in resuscitative medicine and apply them to transport procedures.
Hypothermia is a condition of abnormally low body temperature. Metabolic activities, like energy consumption, are slowed down in an hypothermic body. Children have suffered severely lowered body temperatures while lost in blizzards or submerged in freezing lakes and still survived. Low body temperatures will help to reduce body metabolism (and thereby reduction in the rate of cellular decay).
Cardiopulmonary support (CPS) offers artificial means to restore circulation and respiration and is also useful in stabilizing a patient. (CPS may be contrasted with cardiopulmonary resuscitation (CPR), which is a term used in conventional medicine. While the support protocols are quite similar, it is important to recognize the difference in purpose.)
Standard CPS requires establishment of an airway (through which 100% oxygen is delivered to the lungs), application of a mechanical CPR device, and administration of medications to reduce or reverse the damage caused by the cessation of independent heartbeat and breathing. As stated above, this closely resembles an emergency response by EMS personnel; however, some interesting differences do exist.
A cryonic suspension patient is legally dead. As a result, all cryonic suspension procedures are classified as research. EMS personnel practice medicine and are thereby limited in the lifesaving measures and medications they may use on a patient. Alcor personnel have no such constraints. Each suspension patient has access to a sophisticated — and fairly effective — array of cell-stabilizing medications and cardiopulmonary support options unavailable to conventional EMS personnel.
Even sophisticated medications, cardiopulmonary support, and cooling don’t provide an adequate level of structural protection, but they do buy some time. Once a patient is transported to a local funeral home, the patient’s blood is replaced with an organ preservation solution. Although few transport team members are qualified to perform the necessary surgery and perfusion required in this last step, a willing mortician should be able to help (see Chapter 9).
As an overview of transport procedures, this may seem a rather dark account of the state of cryonics today. It’s true that many compromises have been (and will continue to be) made between short-term and long-term viability without guarantee of success. Transport personnel must focus their efforts on things that are known to help patients, employing every resource at their disposal. And they must do so quickly, as the recoverability of a cryonic suspension patient’s identity is almost certainly dependent upon the efficacy of protective measures and the time it takes to apply them. Data from past transports show widely varied information about the circumstances of death, speed of emergency response, and stabilization measures taken. With numerous variables and few guidelines, evaluations of past transport procedures provide inconclusive results. A patient population of 29 is too small a statistical pool for reliable data.
Much of what can be gleaned from such disparate data has some application. There are a lot of headaches and heartaches associated with performing a transport. Some people can overcome them and some cannot. Many of those who’ve chosen to participate in transports share common traits: intelligence, a flexible brain, and a good sense of humor. Trans-porting a cryonic suspension patient is never easy, nor is it predictable, and each of these qualities will invariably factor into the final results.
Anyone who has realistically examined the problems and obstacles of cryonics and believes that the risks, uncertainties, and alternatives are outweighed by the chance that it could really work are welcome to lend a hand. And every hand can make a difference.
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