Summary

Dr. Emil Kendziorra and Aschwin De Wolf talk about the process in cryonics and cryopreservation of organs, especially brains. They also address doubts related to the damage that can be caused in the tissues of cryopreserved people, and overall dive into the state-of-the-art solutions and research in cryonics, foreshadowing what is going to be needed further and finally for successful revival. They also answer various questions that span the most frequently asked questions regarding services offered by Tomorrow Biostasis and Alcor. The advantages of considering opting for a cryopreservation service from a young age are mentioned multiple times. Finally, the Drs. present what their companies are developing and how they are planning to further research and improve their technologies.

Presenters

Presentation: Aschwin De Wolf

Transcript

Personal introduction

  • I’ve been Alcor member since 2002, it was a long process with a whole lot of paperwork
    • A good topic for later discussion is why people have such a hard time signing up for cryonics – Emil’s organization is trying to work on that
  • CEO of Advanced Neural Biosciences, Inc., a neuro cryobiology research company, we are mostly focused on studying preservation of the brain
  • Editor of Alcor’s cryonics magazine, quarterly publication for Alcor members
  • Edited “Preserving Minds, Saving Lives” book with Alcor’s ex-president Stephen Bridge, which is probably the best introduction into cryonics on the market right now
  • Co-author of Alcor’s Cryonics Procedures Manual, the most comprehensive technical manual on how to actually do cryonics, which is a living document that is being continually updated – in a nutshell it should be possible to take the manual and start a cryonics organization from scratch
  • Co-author of Human Biostasis Protocol – advanced cryonics protocol that hopefully one day can be used as a medically elective procedure, when somebody is terminally ill, the hospital will cooperate with the cryonic procedure for smooth transition from the terminal state to cryonic protocol – not possible under current circumstances, but it is useful to have a document how the protocol would look like under ideal circumstances
  • Organizer of local New York Alcor group

 

Advanced Neural Biosciences, Inc.

  • Bootstrapped beginnings: Started in 2008 in Portland, Oregon. People said the location is not going to work, better to go to the Bay Area, LA, etc. – we didn’t want to do that. It was centaintly price to pay, we didn’t have any money or funding. But then Yuri Pichugin, a researcher who used to research protocols at the Cryonic Institute in the USA left for Russia. That was instrumental since they donated their equipment to us. And there was an individual Cryonic Institute member named Alan Mole who made some funds available to start our research. Then Jordan Sparks, who now has his own cryonics organization Oregon Cryonics, was a dentist at the time and since doctors and dental offices are ideal for small animal research, he gave us some extra space in their lab, so that’s how we started.
  • Initial research – speed of cryonic intervention: We worked on weekends and gradually became private researchers for other cryonic organizations like Alcor with the emphasis on what are the results of cryonic protocols under normal suboptimal conditions, because most cryonics protocols were initially developed under lab conditions where there was no ischemia, no delay between circulatory rest and the stroke procedures, but in cryonics that’s generally not the rule at all. We were researching what would happen under these different scenarios – if you intervene an hour later, two hours, 24 hours or cold ischemia, and what are the things you can do to improve outcomes. That was pretty illuminating and allowed us to later look at Alcor’s comprehensive stabilization medications protocol and to see actually which of these medications are the most effective and which ones are not. We did that by cryo protecting the brain after various periods of delays and used all these different medications to see if we could improve outcomes. A lot of the medications did not show strong impact, but some of them did – like sodium citrate and heparin – that was a very good learning opportunity for the community, because these medications became a lot more important.
  • First paper – length of circulatory rest effect on structure: We also gradually started collecting our data and putting some papers out. First paper occured in 2020, which was basically the most comprehensive study of what actually happens to the structure of the brain after various periods of circulatory rest. We looked at room temperature, body temperature, full temperature – through electron micrographs. We also introduced a deep learning algorithm to see if we could just by looking at the micrographs distinguish between different periods of ischemia – so you could say whether this sample is 3 hours after death, 6 hours, 48 hours at cold temperature, etc. It was a successful study that goes part of the way in answering the question of at what point is it no longer useful to do cryonics. One thing we tried to address in the paper is regarding information theoretic death – can we give that an empirical definition? Can we say room temperature or cold temperature – how long does it take for the fine structure to decompose in a way that you can no longer infer the original state?
  • Second paper – full brain vitrification: The second paper was about all brain cryopreservation, there are actually almost no papers out on that yet, and the aim of that paper is to just show that it’s actually relatively easy to vitrify the brain, you can even do it with relatively low toxicity.
  • Third paper – straight freeze: The third paper is aiming to show the ultrastructure of just the straight freeze when there is no cryoprotection or vitrification at all, because it usually assumes that straight freeze leads to very significant damage, maybe even information theoretical death. And one thing we have found – which is consistent with some preliminary data that was floating around in the community – is that it actually doesn’t look too bad at all. This is still work in progress and paper still has to be finalized, but I think it is pretty exciting, because it really broadens the scope of when cryonics can still be a successful procedure.
  • R&D for cryonic organizations – field vehicle for cryoprotection: vWe also do some R&D and contracting work with cryonic organizations just to fine-tune the procedures and develop equipment. One thing we’re working on in particular is the development of whole body field cryoprotection – basically when you do all of the important cryonics procedures remotely, including cryoprotected perfusion of the brain, and then the patient is shipped back on dry ice to the facility where the long-term cooling and storage happens. Clearly there’s a very big advantage of doing it that way because you pretty much eliminate all the cold ischemia that you normally would have if you have to transport someone on ice for like 18 or 24 hours. We’re pretty excited about that, it’s a pretty significant logistical challenge to create that kind capability in a vehicle.
  • Cryoprotection without dehydration shrinkage: Another project we have started with Alcor quite recently – if you actually cryoprotect the brain with the vitrification agent under the ideal circumstances, it leads to a lot of shrinking, and one way to get around that is to open the blood brain barrier with what we call blood brain barrier modifier. For the last couple of years we’ve been looking at how these molecules work and we’re now getting closer to a point where we might be introducing that in the field. One thing my lab is looking at right now is what happens when you administer these agents under various durations of ischemia. Hopefully that will lead to some interesting results and we will see that kind of technology being used in cryonics soon. I think it is very important, Brain Preservation Foundation had a series of conventional vitrification electron micrographs and what these images show is a very extreme dehydration. Some people in the community hypothesized that you can reverse that, but clearly it’s a lot better if you don’t have to produce that extreme amount of shrinking when you cryoprotect the brain.
  • Novel methods of biostasis: One thing I want to close with is a topic that increasingly comes up and that was not really that important let’s say 15 years ago. When we talk about biostasis, we no longer talk just about cryonics, because there are other approaches. “Classical cryonics” is still the most popular one – you basically cryoprotect the patient or brain for long term storage. But now there is a relatively new technology with “LDI stabilized cryopreservation”, in which you first use a chemical fixative and then do cryoprotection and go to very low temperature. That is an option as well nowadays, and as we are speaking right now, the best images of the brain can be only achieved with that technology so far. So there is a lot of debate whether “classical cryonics” organizations should switch to that technology or are there any drawbacks to that? Can we catch up when we open the blood brain barrier to match that kind of ultra structure? There are warm methods of biostasis, the most obvious is just to do chemical fixation and then store at room temperature or refrigerator temperature. I think there are a lot of drawbacks in that, because to my knowledge even chemically fixed tissue degrades over time – and so if we don’t know how long it’s going to take, that might not be the best approach. I think the bigger drawback is that if you have an ischemic brain, then it’s actually very hard to introduce fixatives in all areas. So if you’re storing a fixed brain long term, there are pockets that don’t get fixed and they kind of decompose pretty quickly. One advantage of cold is that it can preserve brain structure regardless of the ischemic condition of the brain.
  • Misunderstanding about hypothermia: There is sometimes a misunderstanding that hypothermia as practiced in emergency medicine – just pulling someone down with the organ preservation solution and using perfusion – that it can be prolonged for a very long time, but as far as we know these are procedures you can do (as far as the brain goes) for hours at most a day. So you could not put someone in that state and put them on the machine for centuries – at least not now.
  • Complete molecular biostasis – far future: You could have a technology that would be a complete molecular biostasis, and that would be based on a very mature nanotechnology in which nanobots basically enter the bloodstream of the patient and lock everything into place – I’m mentioning that only for the sake of completeness – we’re not anywhere near here. But it is interesting to mention because it is these technologies that later we’ll have to use to revive pretty much everyone who has been cryopreserved.

Presentation: Emil Kendziorra

Transcript
  • Dr. Emil Kendziorra, a medical doctor by training, studied medicine and cancer research in the past to go into the longevity field, that was the plan since he was 17 years old. He did a detour in the past years starting relatively traditional tech companies from data analysis to medical medical networks and telemedicine. 
  • In 2018 then he decided to look at the longevity field and go into the biostasis field.
  • He might have contention with people who are in the traditional longevity space, not in principle that it will not work, rather how long it will take until figuratively you just take the pill and do the treatment every year or every 10 years and then live longer than you can now. 
  • This is already happening with health span a bit – the squaring of the curve is already what has been going on – and probably will be the easier problem to solve.
  • My primary interest is always in maximum lifespan.
  • Biotasis means using some amount of cryoprotective agent or an aldehyde stabilization method to achieve chemical fixation and then usually very low temperatures somewhere around at least minus 130 or minus 140 degrees celsius with the idea being that some medical diseases that currently lead to death like terminal cancer, end-stage heart diseases, including old age, will arguably in the future be curable. Then arguably at some point in the future it will also be possible we will fix and then revive these patients.
  • You could argue it’s an insurance policy for the time that the normal health insurance doesn’t cover or if the longevity technology doesn’t come around in time or should you die prematurely. And even if 20 years down the line we can take a pill to live significantly longer, until such a time a lot of people will die – and not only old people. There are also half a million children under the age of five who die every year due to cancer – just cancer.
  • Historically this was always a relatively niche field, right there are a couple of thousands of people signed up to be cryopreserved.
  • The big difference that we see in this field is that in our belief there’s a significantly larger market out there which has not been captured. The graphs represent a customer sentiment study. This was the study with around three and a half thousand people; which we published last year with around half the dataset, which was the cleaner data set. 
  • Basically we asked a lot of people, what’s your sentiment towards cryopreservation? And there was a strong indication that some people would be interested to actually be contacted by a cryopreservation organization – 25% agree that they’d like to discuss the options. Also the internet population in the U.S goes up to around 30% who would be interested in that, while in Germany it stays around 20%.
  • In Germany it was a representative study, and again a large percentage of the population was open to these topics, noting that the interest does not mean intent. So it gives a good indication that this might indeed be something not only for a couple of thousands of people, but rather for a couple of hundreds of thousands of people – and of course this is gonna be a long path. Now we are a smaller organization, however in about a month we’ve grown half as much as other organizations in the whole year.  
  • There seems to be interest in Europe, which traditionally speaking is always a bit more conservative about these topics.
  • What we do is that we want to offer getting everything out of one hand easily, signing up for cryopreservation as easy as for any other service. Sign up in a couple of minutes, integrated signup for funding through insurance, all possible online.
  • We have a large insurance partner. We can do global insurance, with the limited exception of some countries, but in general we can sign up people from all over Europe and a good amount of others. 
  • We’re currently building out the emergency app, so if something goes wrong with one of our members, we can dispatch one of our team all integrated into one comprehensive signup and management flow.
  • Then of course, if something should happen to our members, we have medical teams – such as these ambulances in Berlin and dispatched mostly in Europe, which do the full body cryopreservation on site and the full perfusion with cryo protect agent. Through partners we also have one in Amsterdam, and soon we’ll have another in Zurich. Of course, if our members are on vacation, then we have flight kits where we just transport the equipment wherever they are – that is of course non-ideal, but it’s the best you can do. Currently we’re in Europe, but at some point of course US and the Bay Area might be a place where we will be more active.
  • About preservation procedures, the part that you always wanna do – the reason why we have quicker ambulances – you want to cool down as soon as possible. There is a saying in medicine – you’re only dead if you’re warm and dead, and that goes double for cryopreservation. So in the vehicle there is equipment with all the medical devices such as chest compressions, oxygenation medication, you can do the whole body perfusion with cryoprotective agents. Then you can cool down to dry ice temperatures at which temperature you have enough time to then drive down to Switzerland no matter where you are in Europe, and then the Swiss facility takes over for long-term care and long-term storage, well until such a time when revival of course is possible.
  • We are currently building from scratch the facility for long term cryopreservation, that will be slightly north of the Zurich airport, so quite well reachable from anywhere or at least in Europe but also internationally.
  • Owner of the storage of course is the nonprofit foundation to make sure that for this very long-term state you have a very long-term alignment of making sure that there are no financial interests or any other interests that might interfere with the goal of keeping people in cryopreservation.
  • How can you make sure cryopreservation is maintained from a monetary perspective if you don’t know how long it will take until revival is possible? We charge around EUR 120,000, which is relatively expensive – one of the goals of the organization is to bring that down – and the reason for that is that around 60% is given to this non-profit foundation and they invest it on behalf of the patient into a fund with 1-2% ROI above inflation, and then pay for the maintenance out of the interest, which maintains cryopreservation indefinitely.
  • Couple more pictures of the facility, four stories, two stories will be underground. It has a full lab, full operating theater, full imaging imaging facility for quality checks and checks, and so on and so on – everything that you might need to do that procedure with high quality.
  • The idea behind the whole organization is not just to offer this as a service, but the whole idea is that there needs to be just tremendous amounts of research money being put into that whole field. And we’re taking the following approach.
  • The fundamental understanding or hypothesis of the organization is that there are many more members or potential members out there. So we plan to run the flywheel ideally for the next couple of decades, I don’t plan to run any other company until I’m cryopreserved myself. So the idea is that you acquire customers, with that you invest in research, and the goal of research is twofold – make the procedure better, and bring the price down. And with these research results, and reduced price, and most importantly better communication of the sole sector, we increase the value of the proposition – we can now offer better service, it’s cheaper, etc., so that people who didn’t have strong interest are now able to learn about it, consider it, and become members. And then you run this flywheel until you can – technically I don’t plan to ever stop. This is not an organization I want nor will sell, it’s not primarily for making me or investors rich, it’s goal is to make this thing work.
  • We have a team of around 12 people in Berlin running the organization, and also in Basel. And I am now involved most in building the facility in Zurich.
  • If anybody is interested in some capacity, we’re raising a seed round right now – feel free to reach out if anybody is interested.
  • Then there’s still a lot of community building and partner building involved in that sector, so whoever is maybe not necessarily interested in investing, but somehow wants to be involved in that topic in some capacity, feel free to reach out as well. 
  • We’re hiring as well of course.
  • And if anybody currently lives in Europe or lives west but is Europe around once in a while, we would be happy to sign you up.
  • A reminder that you can sign up for the Foresight Vision Weekend gathering both in San Francisco and France, Tomorrow Biostasis should have a representative there. In addition to that, if you’re working in the cryonics/biopreservation area, we will be doing Foresight Focus Fellowships in the next year.

Q&A

What is the biggest scientific hurdle really of getting critics off the ground? So people working in the field – what should they be focusing on? So what kind of translations and numbers would you both like to see? I heard that the preservation time between when your heart stops beating to when the first responder can come is a really interesting one. What are other potential challenges that you want to see solved here that could people make progress on?

 

  • Emil: I’m mostly interested in doing stuff that can be implemented into the clinical practice of cryopreservation tomorrow. I don’t care about cells, I care about what we need to do to preserve humans in a real world situation. This is what we’re interested in funding. Ischemic time is a big issue. And of course Aschwin probably has a longer list and there’s a long list of smaller problems that need to be solved.
  • Aschwin: It is to be expected when you’re working more on the scientific technical side of cryonics to give an answer like “if we can achieve this technological breakthrough, then will people sign up in mass.”

But one lived lesson is that if you dig really deep into why people don’t want to sign up for cryonics, you find very deep-rooted psychological objections. And a very important one is that people fear the sort of alienation of being kind of ejected alone into some kind of unknown future.

 

In terms of the scientific and technological breakthroughs, I think we are already there in terms of being able to cryopreserve in a way that we can infer the original condition of the brain. I think we are already at that station for some time, in my opinion it’s even compatible with what we call “straight freeze”, provided there’s no ischemia.

 

But there are three technologies where it would be good to put more emphasis on:

 

  • More rapid cooling in the beginning of procedures, and there are two ways of doing that. One is called liquid ventilation, in which you basically use human lungs as a heat exchanger by pumping in and out the very cold liquid, and that allows you to cool really quick.
  • Another innovation that is already kind of available is intermediate temperature storage. Right now if you store a cryopreserved patient at liquid nitrogen temperature, whether it’s whole body or neuro, you will have some degree of fracturing because the vitrification agent solidifies at around -130 and we are stored at -196 so that causes a lot of thermal stress and and fracturing. If you’re really into molecular nanotechnology, you might say that it is not really that big of an issue in the bigger scheme of problems – and you’re probably right about that – but in terms of promoting and marketing cryonics that is a big deal for people.
  • One other thing is that I think it’s really about time that we show recovery of organized brain electricity in a cryopreserved brain. That’s actually something my lab is working on, but is actually a hard model – most of the challenges are in the modelling there. But I think that would be very powerful, because you can say that if a brain is cooled down really quickly and vitrified, that brain is still capable of function, so cryonics patients should have some kind of legal standing, even if it’s not the same as normal human beings. You cannot have a person whose brain activity is potentially recoverable treated the same as someone who is dead.

So I think those would be some of the powerful things we can do in the next 10 years.

 

 

So I’ve read that there are some unpleasant things happening to our proteins during the freezing process, so for instance if we use cryoprotectants, they usually pull out water outside of cells. Water molecules give stability to our proteins and thus the dehydration leads to loss of conformation of different proteins in the cells, and then they tend to aggregate and during the thawing process, cells might partially lose the information stored in this these particular proteins – so a cell can become viable again but due to synthesis of new proteins, the memory, that was encoded presumably in some proteins, has been lost. And what about other damage – during freezing there is ROS degeneration – reactive oxygen species damage the DNA, also there are some changes and alterations in methylation and epigenetics. What do you think about the influence of this process on the information content of the freezed brain? Will it significantly alter it or not?

 

  • Aschwin: A lot of that depends on how we think memory and identity are encoded – at which level, ranging from atoms to the connectome. If you see the work on the neural anatomical base of memory, you typically see electron micrographs of synapses and axons and connections.

Now if you would take these images and replace the proteins with proteins that are denatured; it would not even be able to detect that in electron micrographs. That of course doesn’t mean that we should not care about it, because clearly if you reverse the process, and a lot of proteins have been negligibly affected by these high concentration cryoprotectants, there will not be any biological viability. That’s why we often draw this distinction in cryonics and cryobiology between structure and viability.

Vitrification (solidification) without ice formation is actually really easy to do. That’s sometimes a misunderstanding that it took a long time to achieve vitrification, but if you use a high enough concentration of cryoprotectants, it is actually easy. The challenge is to use a mixture of cryoprotectants that leaves the molecular machinery of the cells – the proteins – in an intact state.

As you indicated yourself, one of the mechanisms by which you can disrupt the molecular machinery is by using “glass forming” cryoprotectants at high concentrations. They are really powerful, they basically negatively affect the hydration shell of proteins.

 

  • There is one thing that we found out in the cryobiology community, specifically Greg Fahy and Brian Wowk at 21st Century Medicine – until recently it was conventional wisdom that the higher the concentration of the cryoprotectant, the more toxicity, the more effects on proteins. But what we actually found is that a high concentration of weaker “glass formers” – that leave the biological structure of the cells intact – is actually less toxic than a lower concentration of a cryoprotectant that is more powerful.
  • The next thing I wanted to mention, which might be only for limited relevance to cryonics, because it’s generally agreed in our community that we will not re-warm the patients and then start conducting repairs, the initial repairs will be done at cryogenic temperatures via “cryorobotics”.

    However I wanted to make a little announcement. By the end of the year, at the latest early next year, there will be the first first full length – and i’m talking about more than 800 pages – protocol of how to assess the damage of a typical cryo patient at cryogenic temperatures and do some of the initial repairs at cryogenic temperatures. And if and when you’ve done that, then you can make final repairs up to the point where everything functions at normal again, and then you would initiate revival.

    So it will never be the case that you would just warm up the patient and all these processes that had been set into motion – ischemia, protein denaturation – will just continue to unfold, which would prevent any kind of meaningful revival. So a lot of the preliminary revival work will be done at cryogenic temperature.

    Even people who are cryopreserved under really good conditions will probably need some kind of molecular modifications, including further protection against ice formation – because if you warm up, there’s again a possibility that there’s ice formation because it could just be that you were just avoiding it and then when you warm up, then you have all this ice nucleation that turns into ice formation.

    So a lot will be done as we envision it now at cryogenic temperatures and then the revival process will take place.

 

Just to make it clear, I am not saying that memory should exist somewhere in the proteins, but if we’re talking about the synaptic network – the connectome – you need not to know only the information about which axon with which dendrite is in contact, but also the type of synapse, and this is determined by ion channels that exist on the membrane, and they can be affected by the cryoprotectants, by the freezing procedure, by all of these factors. It would be interesting to know whether there are studies that basically looked into what happens with the proteins that basically encode information about the synapse itself.

 

  • Aschwin: One thing I should mention is that the repair will take place at cryogenic or a high sub-zero temperature, but probably will also be done after making a very detailed scan, and how detailed that scan needs to be is probably one of the main questions about the revival of cryonics patients. You can of course simulate the brain in silico. Regardless of what you think about something like substrate independent mind, whether it is feasible or not, that actually doesn’t matter – you can at least simulate that in a model and see if it is working again. They’re all kinds of safeguards I think that you can build in to prevent scenarios where you miss something about how the brain works and then you warm up and it’s gone.

 

Let’s imagine we take a deceased patient many hours after death. We know that there are many blood clots inside the body. What about thrombolytic therapy? Can we use thrombolytic mechanisms as an addition to the cryoprotectants for patients that are being cryopreserved after a long amount of ischemic time?

 

  • Emil: We are already using thrombolytic agents, and we’re actually starting a research project on that with Aschwin just now to see if a larger amount of thrombolytic agents have a positive effect.

 

It seems like an age-old debate in this field – when will we see a solution to these debates? I don’t understand why it is such a controversial area in the cryogenic field.

 

  • Emil: The main problem in this whole field, unfortunately, is that there is very little research money right now. There’s significantly more research to be done to figure out all these questions, so a lot of these questions have relatively little research or indirect research backing. A lot of research needs to be done in this field. In the end that is kind of the reason why we’re building this organization – to offer more than a service – to be able to funnel money from the service to the research and conduct research experiments. This is also why there is a relatively limited amount of consensus in this whole field, there just isn’t enough research to actually know.

 

You Aschwin seem to be favoring cryo repair at cryo temperatures, but a lot of the damage would occur in tissues as you’re warming up – denaturation, fallout damage, etc. It seems like an area where a lot of progress would need to be made in the future – some sort of progressive monitoring of the process or progessive repair or protection against that damage as you warm up. But you seem to be favoring – talking about the whole field – that repair would occur at cryo temperatures rather than as the tissue is being warmed up. You don’t see that as an important step for an addressable model?

 

  • Aschwin: A lot of the cryoprotectant toxicity happens even much earlier, not even warming, but when they are introduced to the tissues. And that’s why one of the best ways to avoid cryoprotectant toxicity is to load an organ at low temperatures and limit the exposure time of the cryoprotectant. That also means that there is a tradeoff between exposure time and what we call osmotic damage. Because if you load the cryoprotectant way too fast, then you also damage the cells.

    But to get to your point about the potential for that kind of damage happening again when you warm up. The idea when I talked about doing the initial repairs at cryogenic temperatures is of course not that you fix these things and warm up and then it happens again. I think it’s pretty much agreed in our field that there won’t be any revival attempts absent any kind of very mature molecular nanotechnology. So when I say repairs at cryogenic temperatures, that would be the initial assessment and review and stabilization, and probably removing the vitrification agent, replacing it with something even more potent, accessing all the vessels and making sure it can be warmed up safely.

During that process, we would expect molecular machines to really stabilize tissues in a way that when you warm up, the normal mechanisms of cryoprotectant injury and toxicity would not happen. So it’s not like we would just warm up like we would warm up today. It would be a very controlled molecular medicine based warm-up.

Now that is a luxury we probably have in cryonics. If you talk about conventional organ preservation, those people don’t have that, so if you preserve a kidney for organ transplants today, you’re not talking about molecular nanomedicine. In that process you have to reduce cryoprotectant toxicity basically to zero and warm up fast enough that any of these mechanisms don’t kick in and prevent this kind of process from unfolding. So we aim for that ideal in cryonics, one advantage we have is that we are not required to do any kind of warm-up before we have this molecular machinery to hold things really stably into place.

The book I mentioned goes into detail on hundreds of pages into specific molecular inhibition strategies during the warm-up process that prevents the damaging mechanisms from unfolding. But again, for conventional organ preservation these things are of course not available yet and not working. That’s why perfecting normal organ preservation is very hard.

Tomorrow Biostasis Q&A

I’m signed with Alcor, but I also visit Europe. It would make some sense to me if eventually the two groups could make some kind of reciprocal arrangement at least covering the US and Europe. Is there any discussion of that or is it just too early.

 

  • Emil: We are super open to collaborating with anybody. Sometimes the more established organizations have more difficult decision-making processes than we do. We’re talking to all of them, but it might take a good amount of time until any of that comes about.
  • Aschwin: I can briefly comment as a quasi Alcor official. It certainly is the case that it has been formally recognized that it would be a good thing if Alcor and Tomorrow Biostasis could put something in place, but that usually doesn’t tend to be easy. This is the first time, I think I can say, from Alcor’s perspective, where there is an initiative in Europe, that we really respect and that we think could be fruitful. There might be some time where Tomorrow Biostasis has members in the US, and then it will be also in his interest of course for Alcor to assist in their cases one way or another. Or there might be so many cases that we need each other regardless of the location. I’m pretty optimistic that these talks will continue moving forward and something will come out of that.
  • I wanted to note that it is often a misunderstood that most people die in a sort of really rapid way – actually most people die in a pretty prolonged agonal phase, and then wherever you are (unless it is a country with a very poor medical infrastructure), Alcor will deploy Alcor’s international organization and now with the technology of field cryoprotection, there doesn’t necessarily have to be a difference in quality if you are far away or close.

 

After a person dies, especially for more or less non-old people like 30 or 40 or 50 years old, it sometimes happens very rapidly and there is a short window. And I witnessed in Ukraine when I signed up with KrioRus, that they called up the local H+ community to help even before the representative of KrioRus arrives. And this actually saved some time. So my question is whether you are planning to establish connections with the local communities in different European cities so that the reaction time is shorter?

 

  • Emil: So our model in that regard is that there are parts that need to be done fast, and there are parts that are complex and need to be done professionally. So it’s not realistic at least currently that local teams can do the whole procedure. But as I said before, cooling is the most important part – cooling initially can be relatively simple, you just need ice and a chest thumper, it’s relatively doable with a local team. So the idea definitely is that if there are local teams with some level of organizational structure, we can then collaborate with them especially for regions that are further away from where we are – you know like the north of Nordics and south of Italy, Spain, Portugal, and so on. In these regions we’re in contact and talking to organizations and supporting local organizations, so that is always part of the story. And then of course later on we plan to have local teams there – once they become well logistically viable – when you have a certain number of members in these regions.

 

It’s impressive that the signup on your website is such a smooth process. There are a few forms and it guides you along pretty well, which is really appreciated. Could you talk a little bit more about the practicalities of signing up? You know, the timelines, details about life insurance? Is there an app?

 

  • Emil: So from my previous anecdotal experience, I knew that signing up with the existing organizations is a tedious thing to do. Cryopreservation is a best example of a thing that is important but not urgent, so you might as well do it a month or a year later. So we wanted to make the sign up process as simple and streamlined as possible – it only takes 20 to 25 min and there are three main steps. You give us your contact details – your email address, telephone number, address, age and your credit card, paypal, or direct debit number. After that you become a member and we send you documents for digital signing. We send you a buyer’s license contract that you can sign – this includes a body donation contract and a body donation agreement – all of the parts that make your cryopreservation contract. And if you choose our insurance partner, which is optional, then we send you an insurance questionnaire to fill, which is the typical medical questions for term life insurance. After you sign that, then the insurance approves you after a couple of days. The only thing we require afterwards is that you put everything in your last will and we advise you to add a patient advanced directive. People usually finish in 20 minutes or so.

Soon you will also be able to do it via an app, but the app will be primarily there initially for fast emergency detection – so that we know faster when something is wrong with you.

With our insurance, we’re the policy holder. The reason for that is because historically there have been a couple of cases, where the next of kin tried to get the money off the insurance. In our case, there would be no way to do that since we hold the insurance and they are the insured person. So you don’t have this problem that anybody has any incentive to not have a person cryopreserved, but rather have the insurance paid out as part of the inheritance.

 

 

So how is it that there are so few people signed up for cryonics, even from the longevity community? Why do you think that is and if someone is now skeptical and inherently feels opposed to this whole process still? How can you kind of take them by the hand and within just give them a little bit more security and that this may actually be a good thing to consider.

 

  • Emil: I think the biggest problem is unfortunately that most humans do care about the urgent things and delay things that they might do in 10 years. This is a thing that you might put out for years if you feel healthy. That’s why my ideal cryopreservation organization is like this Amazon one-click-buy. You just click and then you’re signed up. Of course that’s not really possible, so we can at least take as much pain out of the process and try to get people to jump over this last hurdle and just take the next Saturday morning to sign up with our streamlined 20-min process.
  • Emil: Regarding some security or assurement, anything we say about whether this will work is speculation. But if fundamentally the proposition of living longer or living in the future is interesting to you, then the only consideration you have is whether the bit of money now and potentially more money in the future is worth it. Hopefully at that time we’ll already bring down the cost significantly.
  • Aschwin: One remarkable thing I’ve seen in our community is that you would think you want people to get to a point where there is interest. But the gap between people being interested and actually doing it is formidable often. You can find online some very strong pro-cryonics articles by people saying that this is the most sensible thing to do – but if you ask them whether they did their cryonics arrangement, they always have some excuses. So that gap between interest and execution of the arrangement is enigmatic. Max Moore even introduced a word “cryocrastination” for this phenomenon.

 

I had this idea about bundling – what if you bundle cryopreservation with a type of insurance that could cover longevity therapeutics that may come out in somebody’s lifetime. One of the concerns that is frequently brought up is “this could be for billionaires only, and most people won’t be able to afford these”. So what if you framed this as an insurance that actually pays for the therapeutics that may come out so you can definitely afford them no matter what, oh and by the way, you can also cryopreserve yourself, if the former course fails.

 

  • Emil: Currently unfortunately you can’t do that – we use standard term or whole life life insurance. So it’s not a specific cryopreservation insurance. But later on, it is on our long term roadmap, to find reinsurance and build our own insurance when we have 5 to 6 figures of members. At that point we can build these potentially more complex products, if of course you can convince the reinsurance with some risk model of how expensive these longevity treatments will be in the future.

 

Do you do any kind of bundling with different services for example when people do their will or something like that?

 

  • Emil: Not yet, but this is the idea long term, that some stuff you can add-on.

 

How do you guys put organ vitrification in with your strategy? At all does that fit in with what you guys are trying to do?

 

  • Emil: Yes, something might come out later on, but our focus is always on the brain. So all the other organs if you need a slightly different cryoprotective agent, or you don’t have the blood brain barrier to take care of, we will always focus on the brain. But if something comes about from research that can be done for organ preservation, with regards to biobanking for example, that might be a subsidiary or a spinoff or something like that. But the focus is not on organs.

 

I think you guys have come a long long way in terms of how to do cryopreservation and the marketing side here is very effective. But I wouldn’t downplay the gap in understanding where memories are stored, how they are encoded, where our cognitive functions are stored and encoded, emotions, personality, etc. I think it would help the marketing story to have this state-of-the-art discussion, because those questions are still unanswered.

 

  • Emil: You’re not wrong, there’s a tremendous amount of research that still needs to be done. We decided that the path forward is to fund this research. You can either rely on some very wealthy people to donate money for the research or you sell a product being well aware you cannot say with what probability or how likely it is it will work. But as long as you can ensure informed consent – and we have a personal call with everybody to make sure they fully understand that they are buying a chance – we can then use that money to fund the research that you need to do to increase the understanding better how memory, etc. is encoded and how to preserve it better.

 

As I’ve talked with people about why they have been cryoprocrastinating, one of the thing that has come up – with people who have family – is the fact that they now have to get insurance policies on three four five six people – and since they can’t insure everybody, they will insure noone. The odds that you’re going to lose a family of four or five at once are relatively low. Are you doing anything both from the insurance perspective but also the marketing and business perspective of taking some kind of a family or group orientation? The Chinese cryonics organization is basically saying “this is a family doer”, which also alleviates the anxiety about the future you are potentially stepping into, since you already have a group, you are reuniting with your family. And it also helps with the question of whether you want to spend dollars on yourself today for my insurance policy, or whether to insure my other family members because I need to be looking after them? Do you think about any of these personal and family insurance?

 

  • Emil: We do family packages for our membership fee – so for the part that goes to us, not the insurance. For the insurance since we’re using these standard providers, at least with the insurers we are working with, family deals just do not exist. You can’t sign up multiple people at the same time and get a discount deal. Of course with term life insurance, which most people at least in Europe use, that indeed is also quite difficult. With whole life, which is basically a savings plan, that’s significantly easier. You can just say that we’re all saving money and whoever dies first will get a certain amount of money out of that pocket.
  • Emil: The core of this whole endeavor is to get the cost down significantly by scale and with that solve it so it is easier for a family of five for example to sign up even without going to seven figure amounts. So it makes sense to bring the cost down and on the other hand try to later on have products that you design to be tailor-made life insurances for the topic of cryopreservation.

 

One more question, which goes back to your earlier mention of the survey that you ran – what were the demographics? What were the selected communities? Was it the general public or were you looking at people who are already reading about cryonics or life extension?

 

  • Emil: There are two parts – a US part and a Germany part of the survey. The Germany part is representative – we used a market research organization, the survey size was a couple of hundred people. Whereas in the US we have 3500 people and that is an internet population we’ve recruited online. It’s not a purely representative sample – we have an over-representation of urban cities, age is relatively representative as is income, but also over-representation of people who have high internet affinity. Here is the link to the study with all information on the demographics.

 

What’s the one thing that you want people to take away from this? What’s the one myth about cryonics that’s unhelpful and you want to bust?

 

  • Aschwin: It’s much easier to put life insurance in place if you’re younger and you’re healthy. So if you’re reading this, and even if you have concerns and don’t know which organization, at least put life insurance in place. Or craft a document that says that you want to be cryopreserved if you’re critically ill. Because if the moment arises, then you can make that decision, don’t delay these things – we’ve seen this happening over and over again at Alcor. If you want to do this, no matter your reservations, at least put a sort of structure in place in advance that allows you to take advantage when the time comes.
  • Emil: One of the biggest myths is that it’s unaffordable for a lot of people. People think you need to wire $200,000 tomorrow and you would not be able to afford that, or don’t want to afford that. We don’t want anybody to pass us $10,000 because we need to hold it in trusted accounts, everything is just annoying. Doing it through life insurance I think is whether it is worth it to themselves to pay $50 a month. It is not unaffordable, of course being well aware this is the term life insurance, but then again most people when they are older, they have significantly more net worth at that point and hopefully we will also make it cheaper. So it’s not something that only the millionaires and billionaires can afford, it is indeed to a degree accessible to almost everyone.
  • Aschwin: One big myth actually is that people who really want to be preserved in the end don’t have money for it. What we’ve seen in our field – and I’ve studied this issue quite carefully actually – is that if someone really wants to be cryopreserved and there is no funding, the community usually organizes a public fundraiser and from what I’ve seen these are almost invariably favorable. You may not end up with the organization that you want or it might be a brain only cryopreservation, but there are options. Which of course doesn’t mean you shouldn’t make any arrangements, this is more of a last resort. The community usually steps up in these cases, some anti-aging researchers were even offered a cryopreservation, some of them turned the offer down, but this happens quite often.

 

What can this group do to help your current efforts along? So what’s next for both of your individual efforts and the next months to years? And also what could this group possibly do to help out?

 

  • Aschwin: A year ago I would have put this really strong emphasis on the development acceleration of molecular medicine and nanomedicine, because I think we need some kind of molecular technologies to revive people. As I said earlier the good news is we will have a very comprehensive work coming out later this year about molecular repair of cryonic patients. But one thing that is going to be important and is this kind of sneak peek of that work, is that there will be like 250 pages of specific research questions that will need to be addressed to make this happen. It would be really interesting to focus on some of these research questions. And then we can see if small funds can be raised for these specific investigation areas that need to be resolved to make this thing really happen.
  • Emil: For Tomorrow Biosciences it’s mostly about getting up to speed so we can start with the research, so if you are or you know anybody who is interested in the space and would like to collaborate, do not hesitate to contact. Also if anybody is interested to either donate to research in that field, or signup to the organization itself for future cryopreservation, keep in contact with Tomorrow Biostasis.

Seminar summary by Bolek Kerous.