We're all genetically programmed to die, but advances in nanomedicine are expected to allow for "radical life extension" by 2050. Meanwhile, there's cryostasis--freezing the body immediately after death with a view toward resuscitation in the future.

What About Us?

Now that the oldest of my own generation, the "baby" boomers, are on the verge of becoming "geezer" boomers, many of us are finding it ever harder to deny the disquieting intimations of our own mortality. We have been forced to admit that, so far at least, nobody has ever managed to get out of life alive. We have started to look over our shoulders, perhaps a little anxiously, to see if anything can be done. Certainly there must be some answer, some rescue, some scientific miracle that can save us from the inevitable trip down Shady Lane.

This is despite the fact that all history, literature and religion, as well as all of our personal experience, tells us that there is no way out. Death seems certain. Even by following the healthiest of diets, a lifelong commitment to exercise, the most powerful nutrients money can buy and the best positive attitude imaginable, the sad truth seems to be that eventually every last one of us will grow old and die.

Even as advances in anti-aging medicine begin to forestall the ultimate ends of our lives, the next few decades will be particularly critical. Even with the acceleration in progress, many of us will still lose out to passing illness. Until dramatic technological advances are available, the twin dangers of fatal illness and accidental death will continue to dog our heels. For the near future at least, the specter of premature death will still loom to confound and confront us.

Research into anti-aging medicine will bring about dramatic breakthroughs in the years ahead, yet the aging process will probably not yield to any single magic treatment or remedy. Several decades may pass before the combined advances in genomics and proteomics, availability of prosthetic and biological replacement organs, breakthroughs in molecular nanotechnology, and perfection of the digital-cerebral interface bring about the effective end of Death-As-We-Know-It.

A few decades from now, many of us could find ourselves hanging on for dear life in a very weakened and debilitated state. With all of the sentimentality of a bulldozer for the forest it is about to destroy, the aging process will continue to decimate and erode each of us. In the end, no matter what we do, many of us will still succumb.

Therefore, for the near-term at least, we remain condemned to follow the script of our ancestors. We will continue to deteriorate over time. Our bodies are, in fact, programmed to dry up and wear down. From the moment of our conception, a timer begins hammering out the iambic cadence of our predestined mortality. Every cell of our bodies contains genetic instructions causing normal function to deteriorate at some preordained time. Each of our cells is eventually scheduled to begin an elegantly orchestrated process of self-destruction.

Evolution has been designed for survival of the species and gives not a fiddler's damn about any individual. The bottom line is that as far as the species is concerned, each and every one of us humans is pretty much outdated and unnecessary by the time we're out of our twenties. That same cocky attitude I know I held a mere two decades ago or so ("Never trust anyone over 30") has come back to haunt me now. What goes around has come around. Mother Nature is a cruel taskmistress, and Father Time isn't much better, to tell the truth.

Be fruitful and multiply, we are told, then get lost. That's why our own bodies begin to deteriorate just as soon as we've mixed our DNA with another of our genus.[1] Once we've sown our seeds and propagated, we rapidly become obsolete in terms of the survival of our species. We are given a bit more time to help rear our young--at least to the point that they can survive without us. Yet, it doesn't seem fair.

"What about us?" we cry.

"Who cares?" booms the Immutable Reply.

Unlike all other species, we possess powers of reflection and contemplation, which ultimately lead to existential fears. We seek a way out, some manner to defeat death, to avoid oblivion. Self preservation is arguably the most fundamental drive of all living creatures, and it is especially poignant, of course, to us humans, burdened as we are with the realization that, indeed, we are destined to die. Eternal life is our "impossible dream."

The practice of medicine arose to cure illness, to repair injury, to ease suffering. But despite the nobility of the endeavor, medicine has ultimately failed in every case, and death has always won. Since the beginning of recorded history, humans have turned to the only weapon they had with which they felt able to defeat death--they looked upwards, to the heavens above. By incorporating a belief system into human consciousness that included a promise of eternal life, some of the death's sting was neutralized. Each religion has come up with a different notion of how this might happen: heaven itself for some, nirvana for others; Valhalla, the Elysian Fields, The Happy Hunting Grounds ... and countless individual variations of those themes.[2]

Never Give Up

Over the course of the past few decades, however, scientists have begun to theorize that the human life span may not be as immutably fixed at six score as once thought. There is now talk that the lives of individuals now alive may possibly be extended for hundreds or even thousands of years.

While the term "immortality" may sound far-fetched, from a practical standpoint, I see no reason why humans shouldn't be able to live indefinitely. Just a few decades from now, we may see the length of human existence wind upward through more and more interesting times until death simply fades into the distant future.

We have grown accustomed to the idea that medical discoveries will be able to cure all disease. It is just a matter of time. We are no longer astounded by the idea of artificial joints and limbs, or organ transplants. News of medical "miracles" that can not only keep us alive, but keep us active and in good health far longer than previously believed, is daily newspaper fare.

We've come to expect that eventually medical science will solve almost all of our health problems. There even seems to be some growing public impatience these days that modern medicine has not yet been able to find a cure for AIDS, many forms of cancer, heart disease, etc. This has become especially poignant to those of us who can no longer consider ourselves young. For as we get closer each day to what appears to be the top of the mountain, the lightning strikes seem to be occurring closer together and with greater fury--and they have even begun to hit some of us! Funding cures for these illnesses has become critical for our own continued existence and well-being.

It is becoming a widespread belief that with our exponentially increasing knowledge of the human body, the determination and dedication of our health care professionals and our vast material resources that we should be able to accomplish this task. Our own desperate need to have it be so will somehow create the ways and means to enable us to live longer, healthier lives and ultimately, not have to die.

In fact, a growing number of scientists believe that this possibility is within our grasp. Many biologists, engineers and doctors have stated that advances in molecular nanotechnology (MNT) could provide exactly the tools we will need to repair, rejuvenate and preserve our own bodies so that they might last a very long time.[3]

Nanotechnology is defined simply as engineering at the molecular or even atomic level. The idea is to create machines that can manipulate atoms one at a time, so that we can place them in the right position to create any molecule that we wish.

As Ralph C. Merkle, Ph.D., a pioneering thinker in the field, puts it, "We are nearing an era when we will be able to build virtually any structure that is specified in atomic detail and which is consistent with the laws of chemistry and physics." That means that we'll be able to create anything from a steak to a grape, a diamond to a donut, a new pair of shoes to a new pair of lungs--anything. Almost for nothing to boot!

There are a few minimal applications of MNT available today. Even so, the most optimistic believers predict the major medical applications of MNT, won't be here for at least 25 years--and possibly not for 50 years or even more.

By far the most hopeful, authoritative prediction we've been able to find comes from Dr. Richard Smalley, the 1996 Nobel Prize winner in chemistry, who has predicted that engineers will be manufacturing "cellular devices" by 2010. But, it will take at least a couple of decades after that, scientists say, before we will be capable of manufacturing nanomachines capable of performing life-giving procedures.

In Nanomedicine, the first of a three volume series on the medical applications of nanotechnology by Dr. Robert Freitas, numerous medical applications of MNT are suggested. As just one example, consider the prospects for the "respirocyte." These nanotech spheres would float alongside of red blood cells in the blood stream. Under normal circumstances, these respirocytes would store oxygen at a very high concentration. This oxygen would be available to the body under emergency circumstances.

Let's say a patient were to suffer a massive heart attack or any other potentially fatal event. As soon as the individual's cardiac arrest monitor came on (built into our wristwatch, of course), the respirocytes would immediately begin to release their stored oxygen and simultaneously begin to remove carbon dioxide from the body. Early designs indicate that these very simple circulating devices could keep an individual alive for several hours, until definite medical care could be administered. (In the case of an otherwise fatal heart attack, this might involve prosthetic heart replacement.) This example is only the barest glimmer of what nanomedicne has to offer!

All of this is astounding, to say the least, and, clearly will transform Life-As-We-Know-It. Many of the details, repercussions, proposed methodologies and so on will be discussed in the following chapter, but those of us older than 40 years of age have a more pressing concern. How can we live long enough to take advantage of these upcoming miracles?

The requisite technology needed for "radical life extension" should be available sometime between 2025 and 2050--if all goes according to plan. But for those of us born in the mid-1950's or earlier, that's cutting the edge of oblivion a little bit too close to the bone. Many of us are going to find ourselves right on the cusp. The main focus of this book has been, in fact, teaching us what we can do to help buy a few more of these potentially critical years.

How existentially frustrating and galling to die just a few years before science comes up with the technology to keep everyone else going forever--so close and yet so far.

We have mentioned leapfrogging--the notion that if one can live to 80, one might reap the benefits that will extend life to 90; from 90, we might live to 110, from 110 to 150, and then who knows. The bottom line is this: Sometime during the 21st century the day should come at last, arguably the most wondrous day since creation, when Death gets a taste of its own medicine. But until this day of near infinite joy, The Grim Reaper will still come for us, tap us on the shoulder and take us away. What then?

All is still not lost. Not by a long shot! We can be like the frog in the cartoon and "Never give up." There is one last chance at continued survival even for people who have "died." I have mentioned that the line separating life and death has begun to fade, and that, in many cases, death comes simply because it seems inevitable and that there seems to be little merit in continuing the resuscitation efforts.

In addition, we recall an adage from the Emergency Room: "There is no such thing as a patient being cold and dead." By ensuring that a patient is cold right when they die, by definition, they are not really dead. This is the essence of "human cryostasis" (also historically termed "cryonics"), and, as defined by the Alcor Life Extension Foundation, is "the practice of maintaining patients currently classed as legally 'dead' at extremely low temperatures for treatment by future medicine."[4]

Under usual circumstances, our current definition of death simply means that the parties concerned with the patient's welfare (family, physicians, clergy, patient) have agreed that resuscitation efforts are no longer likely to be successful. Therefore, these measures are terminated and the patient is allowed to die.

In the event of cyostasis, the thinking is that the resuscitation efforts are simply not likely to be successful with present day technologies. Therefore, resuscitation with a view toward full restoration of normal function is just interrupted temporarily. The focus of the resuscitation effort is directed instead toward stabilizing the patient so that the present disease process is not allowed to cause any further damage. It is planned that full resuscitation with a view toward definitive cure will be resumed at some future time. This will be at a future date when medical science has advanced to the point of being able to cure the presently fatal disease process, as well as to reverse the added damage from the stabilization procedure itself. Patients in cryostasis are "legally dead," however, from a fundamental scientific standpoint they remain "potentially alive."

The Fundamental Theorem of Immortality Medicine

Ralph Merkle, PhD, a nanotechnology and cryostasis pioneer as well as a Director of the Alcor Life Extension Foundation, looks at it this way: "Cryonic suspension is a method of stabilizing the condition of someone who is terminally ill, so that they can be transported to the medical care facilities that will be available in the late 21st or 22nd century."

Notice that Dr. Merkle regards persons declared legally dead today to be merely "terminally ill" in the larger scheme of things. What we regard as "dead" today will merely be "seriously ill" tomorrow. In the words of Jerry Lemler, M.D., medical director of Alcor, "Death should not be equated with a lack of heartbeat or absence of breathing, even though, unfortunately, the term is still used in this archaic fashion. 'Death' is a state that should be reserved to apply to those individuals whose biological functions cannot ever be reversed to restore life. Period!" Consider what I have named The Fundamental Theorem of Immortality Medicine (FTIM): what we now call "death" is (or will soon turn out to be) just another disease.--in many cases, anyway.

History is filled with numerous, encouraging examples of how other diseases had once been uniformly fatal to earlier generations, but turned out to be completely curable later on. Tens of thousands of plague victims in the Middle Ages would have easily survived with antibiotics that are readily available today. Patients declared "dead" as recently as a few decades ago could have been "brought back" today with the equipment and knowledge readily available in almost every emergency room in the modern world. Currently, people are saved every day even without equipment of any kind whatsoever, simply through proper application of CPR (cardiopulmonary resuscitation). A few years ago these people would have died, because no one knew what to do. The same thing will happen again in the future.

The First Corollary to the Fundamental Theorem of Immortality Medicine states that the disease we now call death will soon be amenable to "treatment" in many cases by soon-to-be available therapies. Thanks to the Human Genome Project, genetic engineering, therapeutic cloning and other advances, many scientists predict the eradication of cancer and many other currently incurable diseases within the next 20 years or so. This is our hope for the medicine of the future. One of tools we may need to employ to enable us to take advantage of these future developments is cryopreservation.

Cryopreservation--Is--Cool

This is also the view of Robert C.W. Ettinger, the man regarded as the founder of the early cryonics movement. From this starting point, our current, more sophisticated methods of cryopreservation (or biostasis as it is called) have developed. The early cryonics movement began in 1962 with the private publication of the first version of Ettinger's book, The Prospect of Immortality.[5] "In all probability, you'd close your eyes, sick and old, in a present-day hospital bed, and you'll wake up, young and healthy, to a new and very long life in an amazing near-future world."

That was Ettinger's initial ideal, but there were a few rather substantial technical glitches that needed to be overcome. The most pressing problems involved the freezing process itself, which typically causes major and, often, irreparable damage to human tissue at the temperatures used for cryopreservation. Frozen tissues have a tendency to form cracks and split. The use of "cryoprotectants" to prevent major fissures of this sort became a major pursuit.

An even more difficult problem to solve was that of freezing damage to the individual cells. When the body undergoes the freezing process, water is drawn from each cell. This causes the cell to shrink, and unfrozen particles surrounding the cell can puncture the membrane of the cell wall.

These harmful effects are diminished by the process of replacing blood with cryoprotectant fluids, which inhibit or reduce the formation of the harmful ice crystals. The cryoprotectant used most successfully to date has been glycerol, a colorless, syrupy liquid made from fats and oils. It has numerous industrial applications, including everything from skin lotions to explosives.

Research involving the search for better cryoprotectants is ongoing at the present time. In fact, the largest human cryostasis organization in the world, Alcor, suspended their first patient by a newer process called "vitrification" rather than freezing just a few months ago. Vitrification is a process similar to freezing, but it involves cooling living tissue in such a way that it enters a glass-like rather than ice-like state. By doing so, almost all of the freezing damage described above is avoided. It is the feeling of most experts in the field that the long-term damage resulting from vitrification will be dramatically less than that from freezing.

Some recent experiments have shown that organs from small mammals have shown some preservation of function after cryovitrification and subsequent thawing. Cryovitrification of human organs and other medical applications is on the horizon.

Even so, there are many who still feel that because harmful effects from the freezing or even vitrification processes are unavoidable with current technology that human cryostasis is a waste of time and money at the present time. Such thinking causes the baby to be thrown out with the bath water. These critics are losing site of the fact that the entire foundation of human cryostasis depends upon future medical technologies. We don't need to repair the damage inherent in the freezing process today. Our present responsibility is simply to place the patient into cryostasis with as little damage as possible. The medical technologies of the future will be likely to have cures for the fatal diseases of today, as well as effective repair processes for the damage done by the freezing or cryovitrification process.[6]

Whether present methods of human cryostasis will ultimately be successful or not has to do with probabilities and statistics. Some experts predict that patients in cryostasis awaiting the repair and resuscitation technologies of future medical science have only a 1 in 1000 chance. I don't look at it this way. It's either 100% or zero. Another way to look at it is as follows: if you don't undergo cryostasis, you will most assuredly never become repairable at a later time, since further decay and deterioration have taken place. On the other hand, if you try it and it works, you will have the chance to be returned to a functioning condition. What have you got to lose? By funding one's cryostasis with life insurance, I figure, depending on your age, about $10-75 a month.

The Human Cryostasis Entry Procedure

Right now there are really only two organizations that have the personnel, technology and facilities to initiate and maintain human cryostasis: Alcor Life Extension Institute (Alcor) and The Cryonics Institute (CI). There are major differences between these two organizations in the way that patients are readied for entry into cryostasis. Alcor utilizes licensed health professionals to take charge of the patient every step of the way from clinical death to suspension, while CI outsources this work to funeral parlor operators. As a result, prices differ from $28,000 at CI to $50,000-150,00 at Alcor.

In addition, one needs to bear in mind that to effectively place a patient into cryostasis requires sophisticated procedures, pharmaceuticals, and equipment. This is not something that can be easily arranged at the last minute. Before any organization will consider allowing an individual admission to their facilities, prior arrangements are required. Consent forms need to be signed and financial arrangements made. This is why, at least at the present time, nothing can be done in cases where people die suddenly or unexpectedly without having made prior arrangements.

But, let's assume for now that a patient has made the appropriate arrangements and is prepared to enter cryostasis. To obtain the best results from the rescue and eventual cryopreservation operations, it is desirable to have a few days' notice of the patient's impending demise. This enables technicians to be on "stand by" at the bedside and ready to start the cooling procedure at a moment's notice.

Damage to the body after legal death occurs quickly under normal above-freezing conditions. The time before irreparable harm occurs is measured in hours, however, not minutes. Then again, we don't have days either. This means that if someone dies in the wilderness, or anywhere that would prevent technicians from getting to them within a half-day or so, the options for cryostasis are drastically reduced. Accidental deaths, such as those associated with fires or explosions, where the body or the brain, in particular, is irretrievably damaged or destroyed, are relative contraindications to suspension.

As the popularity of human cryostasis increases, which should occur as more people become aware of this possibility and the technology improves, options for cryostasis will no doubt extend to more remote areas. For now, however, the urban hospital or hospice is the optimum location for access to cryosuspension technology.

The first criteria that must be met before the cryotransport team can go to work is that the patient must be pronounced legally dead. According to the book published by the Alcor Foundation, Cryonics--Reaching for Tomorrow: "In actual medical practice, legal death seldom means that the final basis of life has yet been lost, only that a qualified authority sees no value in continuing to support life with present technology."

In most jurisdictions, the difference between clinical death and legal death isn't much. In the first case, absence of respiration and heartbeat, in the other, a piece of paper signed by a physician or mortician. That's it. Once the patient is declared legally dead, then the cryotransport team can get to work.

At the time of death, the patient should have something on their person, such as a medical-alert style bracelet on the wrist, which identifies them as a member of such-and-such cryostasis organization and which also advises health care personnel as to how the organization can be reached. In the case of the Alcor Life Extension Foundation, the ID bracelet also provides advice about beginning the initial suspension protocol, and gives phone numbers to alert Alcor's central laboratories. These numbers are manned 24 hours per day with personnel who can initiate rescue communications including physicians to advise the hospital personnel on initial protocols and procedures. In the case of CI, instructions are to make contact with a local mortician to begin the cooling procedure.

As soon as the heart stops beating, blood stops flowing and ischemic damage, which is tissue injury caused by lack of oxygen, begins to set in. This is why cryonicists would like to be able to begin the suspension just before a patient is declared legally dead. That way the last few beats of the patient's heart could be used to circulate anticoagulants and other important medications. Current laws do not permit that such measures be taken prior to death, however. Performing any interventions vis-à-vis freezing on even a "barely-living" person is still regarded as murder.

Therefore, as soon as possible after legal death has been declared, the cryotransport team begins the suspension protocol. At Alcor, the following procedures are implemented as soon as possible:

1) Anticoagulants are injected into the blood stream to minimize clotting. Other protective pharmaceuticals are utilized to combat cell membrane breakdown, stabilize blood pH, prevent the formation of bacterial colonies, minimize capillary leakage, block calcium and other unwanted ions from entering the cells, halt shivering reflexes which can speed up metabolism, prevent free radical damage, and in other ways prevent much of the catastrophic damage to tissues which will otherwise take place.

2) CPR (cardiopulmonary resuscitation) is instituted as a mechanism of circulating the medications administered. If the time since cardiac arrest is short, respiratory support with pure oxygen is utilized as well. Ideally, a bi-directional, hi-impulse "Thumper" is used to closely approach the circulatory efficiency of the human heart.

3) Initial cooling of the patient is begun, with the application of cold packs, ice water or a cooling blanket. Partial immersion of the patient in a mixture of crushed ice and water is best, particularly where the ice water is recirculated and either sprayed or otherwise delivered to surface areas of the body, so that the core temperature of the patient drops rapidly. Every 10 degree C drop of temperature reduces metabolism by 50% (75% in the brain), dramatically increasing the time before the damage caused by oxygen lack causes irreversible biological death.

Throughout this process, which takes anywhere from eight to twelve hours, technicians monitor body temperature, the rate of assimilation of the cryoprotective solution and other dynamics.

When these are complete, the technicians move the patient to a facility where further stabilization can be carried out. By means of extracorporeal circulation, blood is replaced by an "organ preservation solution," essentially identical to that used by organ transplant teams. This stabilizes the integrity of the patient's circulatory system. By now the temperature of the patient has been reduced to about 10 degrees C.

Following this initial stabilization, the patient is air-shipped to a central station. There, the final stages of preparation for cryogenic temperatures are completed. Additional cryoprotective agents are gradually added to the organ preservation fluids over a period of several hours, while technicians monitor body temperature, the rate of assimilation of the cryoprotective solution and other dynamics.

In cases where vitrification is to be carried out, specific proprietary, licensed compounds are used, including synthetic protein "freeze blockers" which inhibit crystal formation between --50 to --100 degrees C, the range where much of the freeze damage typically occurs. The difference between the best conventional cryoprotectants and the new compounds is dramatic. In one demonstration, conducted by the cryobiologists who developed these new compounds, two flasks, one with and one without these new "freeze blockers" were cooled through the zone of danger. Without the freeze blockers, the formerly clear fluid turned to a milky solid, indicating countless trillions of ice crystals. With the freeze blockers, it was like looking into a transparent solid of glass.

At the end of this second stage of cryoprotection, again describing the new procedure of vitrification, the patient will be at about --10 degrees C. Circulation through the vascular system at this temperature will still continue, but very slowly. As the ideal, target concentrations of the protective compounds are achieved, it is necessary that further "cooldown" with subsequent vitrification be brought about very rapidly.

Beginning at a temperature of about --10 degrees C, the temperature of the gas surrounding the patient (almost pure nitrogen) is dropped suddenly to -130 degrees C. The gas is circulated rapidly, as if the patient were in a strong wind. The core temperature of the patient's body drops at the rate of nearly one degree per minute, and is much, much faster at the surface. This is one of the keys to succesful vitrification--very rapid cooling. If the procedure is done properly, no ice crystals will form. It will take only a few hours for the procedure to be essentially complete, and the patient will then gradually settle to a temperature at which there are no more changes of a biochemical kind, even over very long periods time. Protection is complete.

In the final stage of cooling, the patient is transferred into other containers and placed in contact with liquid nitrogen vapors for the "final descent" to -196 degrees Centigrade. This takes an additional five to seven days. One technical problem that remains is that on the way to these colder temperatures, thermal stress cracks can form. This occurs whether vitrification is used or not. Hopefully, future technologies will soon make it possible to maintain patients at higher, safer temperatures or a mechanism developed to avoid these thermal fissures. Much remains to be done before even the best procedures of today are declared to be the early headwaters of true suspended animation, but rapid progress is being made.

At this point the patient, wrapped in super-strong shrink wrap, is immersed in liquid nitrogen--sometimes in the company of as many as three other colleagues--inside a tank that resembles a very large thermos bottle, with two layers and a vacuum in between.

And there the patients remain--suspended in liquid nitrogen, kept as intact as possible until such time as medical science has some certainty that they can be repaired and revived.

...Continued in Part II...

References

[1] For further information on why death and sex ("the little death" in French) go hand in hand, see Sex and The Origins of Death by William R. Clark, New York: Oxford Press, 1996.

[2] This covers heaven, but how about "the other place"? Largely to encourage the masses of people into providing adequate financial support for the infrastructure of most religions, in my opinion, the concept of hell was widely and extensively disseminated.

[3] Drexler, K. Eric. Engines of Creation. New York: Doubleday, 1986.

[4] Alcor Life Extension Foundation. Cryonics: Reaching for Tomorrow. Scottsdale AZ: Alcor Foundation, 1993.

[5] This book is available in its entirety online at extropy.org.

[6] A plausible explanation as to how this might be possible is presented by Drexler in Engines of Creation, pp. 136-138.