A science without a deadline

The year is 2058. Masked and gowned medical personnel work eagerly around a still figure lying on a grey, sterile operating table. These doctors and nurses are repairing the patient's damaged organs, one by one.This operation is more complex than usual: this patient was declared dead more than 60 years ago, the latest victim of cancer.

Today, he is being 'reanimated' - brought back to a state where he can rejoin society and live on.

This scene might seem like science fiction, but it could one day become reality as science and medicine evolve at a dramatic pace.

The case for life

The field of cryonics, which made its debut in the 1960s, continues to push the envelope and search for a solution to death. The process consists of preserving legally dead humans or pets at very low temperature (below -130°C) in the hope that future science can restore them to life, youth, and health.

"The advancement of medicine and science is so much faster than it used to be. Science fiction is becoming science fact on a daily basis," says Tanya Jones, Alcor Life Extension Foundation's executive director. "All of a sudden, cryonics doesn't look quite so far-fetched."

Jones, who has been involved in cryonics for more than 17 years, helps create and balance Alcor's budget and monitors the organisation's ongoing research and clinical work. She also runs the team that collects patients and then performs cryopreservation.

Alcor, a non-profit organisation founded in 1972, uses vitrification (ice-free freezing) to cryopreserve human life. Considered the major player in the cryonics industry, Alcor's membership currently sits at 850 people from around the globe, including the United States, United Kingdom, Canada, and Portugal. Today, the organisation's Arizona HQ is the host to 80 cryopreserved patients.

Alcor's most famous patient, Major League baseball player Ted Williams, was cryopreserved after his death on 5 July 2002. Williams' body was separated from his head in a procedure called neuroseparation. The head was stored in a steel can filled with liquid nitrogen, while the body stands upright in a nine-foot tall cylindrical steel tank, also filled with liquid nitrogen.

A long-standing urban legend maintains that Walt Disney was cryonically frozen as well. However, Disney was actually cremated shortly after his death on 15 December 1966.

Most of Alcor's members are not famous: doctors, engineers, computer programmers, TV repairmen, musicians, and librarians. Demographics have shifted over the years, moving from mostly technical individuals to those from all walks of life. Jones has also seen a rising trend in families becoming members as well.

"The main thing our members have in common is that they love life and they want more," Jones notes.

A symbol of hope

The first human to be cryopreserved under controlled conditions with the intent of future resuscitation was Dr James Bedford, a 73 year-old retired psychology professor, land investor, and cryonics adherent. When Dr Bedford died on 12 January 1967 from kidney cancer, his body was cooled, while preservatives were injected over a four-hour period with the aid of the cryopreservation team: Dr Renault Able, attending physician; Dr Dante Brunnol, director of the perfusion; Robert Prehoda, author of three books supporting reduced metabolism research; and Bob Nelson, a cryonics pioneer.

The Cryonics Society of California (CSC), which went defunct in 1979 due to lack of funds, housed Dr Bedford inside a dewar - a containment unit originating from an invention by Scottish chemist and physicist Sir James Dewar - until he was moved to the Alcor Foundation, which now provides a free capsule and continued cryopreservation in liquid nitrogen for the "first man ever frozen."

This milestone case made the cover of a limited print run of Life magazine before the presses were stopped to report the death of three astronauts in the Apollo 1 fire.

Robert CW Ettinger, heralded as the father of cryonics, popularised the concept of cryonic preservation with his book, 'The Prospect of Immortality' (1964), in which he suggested that freezing was the easy part of the process and could in fact be accomplished with present technology. Ettinger believed that the complicated process of "thawing" could be worked out at a later time.

"Most of us now breathing have a good chance of physical life after death - a sober, scientific probability of revival and rejuvenation of our frozen bodies," he wrote. "No matter what kills us, whether old age or disease, and even if freezing techniques are still crude when we die, sooner or later our friends of the future should be equal to the task of reviving and curing us."

The original methods of cryopreserving Dr Bedford were crude, and since the 1960s, cryonics research and practice has grown substantially. There are now organisations around the world supporting the cryonics movement. Most of them are in the United States, but KrioRus began operation in Russia in 2006, and there are plans for another organisation in Australia to offer perfusion and storage of cryonics patients within a few years.

The process

Depending on the organisation, typical cryopreservation process costs range from $20,000 to over $120,000. Because legal death is required for cryopreservation to take place, a death certificate is issued, which usually allows life insurance to cover all costs of cryopreservation and storage.

Cryonics is considered an anatomical donation, and members must sign written documentation and a legal contract giving Alcor the authority to act when they are pronounced dead. Alcor offers its members 'standby' services, whereby a trained team is available nearby a terminal person's bedside or hospital room, ready to act if Alcor's services are required.

Similar to organ transplants, time is of the essence to give the patient the best possible chance of receiving a good cryopreservation. Alcor transports remote patients to its facility using a customised emergency transport vehicle that looks similar to an ambulance on the inside, but is tailored to enable Alcor to provide care and monitoring consistent with the cryopreservation process.

Alcor's mobile cryopreservation process begins when a patient is declared legally dead. The patient is then placed in an ice water bath, and blood circulation and breathing are artificially restored by a heart-lung resuscitator. The combination of simultaneous cardiopulmonary support (CPS) and rapid cooling are known to be effective for protecting the brain during cardiac arrest. Intravenous lines are established and protective medications are administered.

 If the patient is in a hospital, he or she is moved to an alternate location while CPS and cooling are maintained without interruption. Femoral arteries and veins are surgically accessed, and the patient is placed on cardiopulmonary bypass. This means that blood is circulated through a portable heart-lung machine that takes over the function of the patient's own heart and lungs. External CPS is no longer necessary and is discontinued.

Within minutes, a heat exchanger in the heart-lung machine reduces the patient's temperature to a few degrees above the freezing point of water. The blood is replaced with an organ-preservation solution that is specially designed to support life at low temperature. If the patient is located outside of Arizona, he or she is covered in ice for air shipment to Alcor's facility in Scottsdale.

 Once at Alcor, a surgeon connects major blood vessels to a perfusion circuit. A perfusate similar to the preservation solution used during transport is circulated through the patient at a temperature near 0°C for several minutes. This washes out any remaining blood. The cryoprotectant concentration
is then linearly increased over two hours.

This slow introduction minimises osmotic stress and allows for the cryoprotectant concentration to equilibrate inside and outside cells. A rapid increase to the final concentration is then made. Temperature, pressure, and cryoprotectant concentration data are continuously monitored by computer.

 The status of the brain is monitored visually through two small holes in the skull made using a standard neurosurgical tool. This permits verification of brain perfusion and observation of the osmotic response of the brain.

"A healthy brain slightly retracts from the skull in response to cryoprotectant perfusion," Jones explains. "An injured brain swells, indicating that the blood-brain barrier has been compromised. This injury is often seen in patients who suffered a long period of untreated cardiac arrest."

 After cryoprotective perfusion, neuropatients are cooled under computer control by high velocity nitrogen gas at a temperature of -130°C. The goal is to cool all parts of the patient above -124°C (the glass transition temperature) as quickly as possible to avoid any ice formation. This requires approximately three hours, at the end of which the patient will have 'vitrified' (reached a stable, ice-free state). The patient is then further cooled to -196°C over approximately five days.

If the patient has selected whole-body preservation, they are cooled in a two-stage process (first rapid, then gradual) temperature descent using nitrogen vapour. The patient will then be transferred to a cryogenic Dewar for further cooling in nitrogen vapour to a temperature of -196°C over two weeks. Broadly speaking, whole-body preservation is the same as the neuropatient procedure, but takes around twice as long.

"Patients are monitored by sensitive instruments during this long cooling period to detect tissue fracturing events that tend to occur when large objects are cooled below the glass transition temperature," Jones says. "And, contrary to media reports, fracturing is not a result of mishandling. It is a universal problem for large organs cooled to liquid nitrogen temperature."

Following cooling, patients are transferred into liquid nitrogen at a temperature of -196°C. They are thereafter kept in Alcor's Patient Care Bay. Since Alcor uses liquid nitrogen to keep cryonics patients cold, electricity is not required for current patient care systems.

Deanimation

Another cryonics pioneer, Cryonics Institute (CI) based in Clinton Township, Michigan, offers its members DNA or tissue storage and pet cryopreservation. Incorporated in Michigan in 1976, the organization has grown to 727 members and 89 patients.

Robert Ettinger, one of the original founders of CI, remained president of the organistion until December 2003 when Ben Best took over. Best is also director of the Cryonics Society of Canada and president of the Institute for Neural Cryobiology.

One of the organisation's most recent cryopreservations involved an 89 year-old cancer victim from Ohio who was cryopreserved by her son and daughter. The patient had breast cancer that spread to her bones, kidney, and the base of her skull. Her daughter became inspired to cryopreserve her mother after seeing a Barbara Walters special on cryonics.

The patient was declared dead on 29 May, and ultimately placed in liquid nitrogen, the final step of cryopreservation, by 2 June.

CI President and CEO Ben Best explained that, because cryonicists do not believe that cryopreserved animals or humans are dead, they often refer to a person declared legally dead and who is cryopreserved (or destined to be cryopreserved) as being in a state of deanimation.

"Conversely, the process of bringing a person or animal out of cryopreservation into a state of animate living is called 'reanimation,'" he said. "These terms are cryonics-jargon, used among many cryonicists. 'Revival' could be used rather than 'reanimation'."

The possibility of revival

Currently, it is impossible to revive cryonics patients due to damage done at the cellular level during cryopreservation. Advanced nanotechnology and stem cell therapy are needed to repair this damage. To make that happen these technologies must progress far beyond their current capabilities. Cures for conditions such as cancer, AIDS, diabetes, heart problems alongside simple old age will also need to be developed to treat diseased organs.

"Stem cell research has provided insight into the fact that growing a new body around the brain is possible," Jones says. For years, researchers have injected stem cells into hearts to repair damaged muscles. And now, entire organs can be grown in the lab and transplanted. However, putting it all together to grow an entire body is much farther down the road.

"While we are seeing that stem cells can actually revive every organ in the body, we still have many years of research until cryonics is a reversible procedure," Jones says. "However, recent testing has proven that it is already reversible for an individual organ down to -130°C, based on the testing of rabbit kidneys."

According to Ben Best, a future nanotechnology of molecular-sized machines might be able to repair freezing or other damage associated with cryopreservation - as well as damage due to disease and ageing.

"Bull sperm have been successfully cryopreserved in liquid nitrogen and used for fertilisation since the early 1950s," he said. "And, since 1982, human embryos stored in liquid nitrogen have been used by fertility clinics with much success. Additionally, nematode worms have been successfully cryopreserved in liquid nitrogen and then revived."

Medical and technical advances continue to give cryonicists hope for future successful revivals. In fact, last year, scientists at the J Craig Venter Institute successfully transferred an entire genome from one bacterium to another. In Maryland, scientists recently built an entire microbial chromosome.

The genome project provides scientists and researchers with many statistical variables, and offers a view of the divergence of the human genome across an extremely broad population, according to Jones.

"Researchers have recently discovered that there are three or four other markers for the onset of Type 2 diabetes that they hadn't recognised before," she explains. "This might eventually lead to a comprehensive cure for diabetes."

Alcor itself is heavily involved in its own research, and recently created a cardiopulmonary bypass lab to test its entire cryopreservation process from start to finish, and actively work toward making the process reversible.

"We take great pains to do research and technical development that will support the viability of the brain in an emergency medical situation," Jones said.

The chance that cryonics will work depends greatly upon the conditions under which a person is cryopreserved, as well as on how much money and effort is put into the technologies and organisational enhancements that can make cryonics work, according to Best.

"It is possible that true reversible cryopreservation may be perfected within 30 years," he says. "If so, the reanimation of those preserved under this superior cryopreservation technology would occur on a 'last in, first out' basis."

Most cryonicists believe reanimations will occur within 50 to 100 years for those currently being cryopreserved.

"Within that time frame, virtually all current diseases should be curable and elderly people can probably be rejuvenated to a youthful condition," reckons Best.

Cryonics for sceptics

There is a fair share of criticism about cryonics that comes from a myriad of sources, including scientific sceptics, incredulous doctors, and outraged religious figures. Some even view cryonics as occultish.

A major objection many Christians have concerning cryonics hinges on a perception of death. Because cryonic suspension cannot yet take place until after legal death, cryonics is often viewed as "going against God". And, because Christianity teaches that the soul departs the body at the time of death, this issue plays a major role in shaping the Christian view of cryonics.

In an article in Scientific American, Dr Michael Shermer, founding publisher of Skeptic magazine, compared freezing people immediately after death and reanimating them later to thawing out a can of frozen strawberries. "During freezing, the water within each cell expands, crystallises, and ruptures the cell membranes. When defrosted, all the intracellular goo oozes out, turning your strawberries into runny mush. This is your brain on cryonics."

In fact, Shermer calls the theory behind cryonics "borderlands science, because it dwells in that fuzzy region of claims that have yet to pass any tests but have some basis, however remote, in reality." While he admits that it is not impossible for cryonics to succeed, he thinks it is extremely unlikely.

Alcor's Board was deeply concerned by Shermer's description, saying it was materially inaccurate and seriously damaging to Alcor because it omitted any mention of vitrification.

The ethics of cryonics

While questions pertaining to the ethics and religious implications of cryonics continue to abound, Jones and Best stand behind the high standards of their organisations and the protocols they follow.

"With full disclosures and signed consent, it is highly ethical," Jones says. "When you think about the grand scheme of things, cryonics is a lot more conservative than burial or conventional cremation."

And with programmes to help revived patients integrate back into society, Jones believes strongly that there is a place for current cryonics patients 50 to 100 years down the road.

According to Best, there is absolutely no conflict between religion and medicine - even for medical procedures that can extend life for hundreds or thousands of years.

"Cryonics is a medical procedure, a radical form of first-aid, and is no more an affront to religion than a heart transplant," he says.

The bottom line for Jones is, if cryonics doesn't work, it doesn't work, and patients have lost nothing. "But if it does work, they've gained so much.We're here to find that out."

Ralph Merkle, Alcor Life Extension Foundation director, told E&T: "Cryonics is there to save lives and restore health. Today's medical technology can't always keep us alive, let alone healthy. A future medicine based on a mature nanotechnology should be able to preserve life and restore health in all but the most extreme circumstances.

"Tissue preserved at the temperature of liquid nitrogen does not deteriorate, even after centuries of storage. Therefore, if current medical technology can't keep us alive, we can instead choose to be preserved
in liquid nitrogen, with the expectation that future medical technology should be able to reverse any cryopreservation injury and restore good health."

"If sceptics don't want to pursue this area, that's fine, but I ask them not to interfere with my own efforts to save the lives of myself and the people I love," he concluded.