Jennifer Chapman
Executive Director
November 12, 2010

At the 2010 Strategic Meeting, the board and management discussed Alcor’s financial well-being at length.  The majority of the meeting focused on specific budget cuts, fee increases, and plans for establishing an endowment.  However, it was also necessary to discuss those policies and practices which affect Alcor’s bottom line.  This article is intended to clarify Alcor’s grandfathering practice in general, as well as the benefits and limitations of Alcor’s Comprehensive Member Standby policy, specifically.

Grandfathering

Alcor has a long-standing tradition of grandfathering its members.  This means that as cryopreservation costs increase Alcor does not require existing members to obtain more funding in order to remain an Alcor member.  Grandfathering prevents a long-time member from suddenly losing his or her membership when Alcor raises its required funding minimums.  This is especially important for members who have retired, become ill or disabled, or cannot get additional life insurance.

It is important to understand that Alcor is not contractually obligated to follow this grandfathering practice.  In fact, Alcor’s grandfathering practice allows the organization to limit its emergency response for members who are funded below the then-current minimum funding levels.  For instance, Alcor’s current membership agreements read:

Cryopreservation Agreement, Section III: Representations, Warranties, and Limits of Liability, Article 8

“Alcor does not warrant or represent that the minimum required amount of the Cryopreservation Fund will be adequate to pay for the Member’s cryopreservation and maintenance.  This amount has been suggested by Alcor with consideration to current costs and estimates of future costs.  The actual future costs remain unknown; and some portions of the current costs, especially those which may arise from the special legal, medical, and practical circumstances of the individual Member, or difficulties in transport of the Member, cannot be known or even estimated in advance.  It is the responsibility of the Member to exercise his/her best judgment as to what constitutes adequate provision of resources to achieve successful cryopreservation and storage.”

Cryopreservation Agreement, Section III: Representations, Warranties, and Limits of Liability, Article 10

“Alcor warrants and represents only that all procedures connected with cryopreservation, maintenance, and revival will be done with Alcor’s best efforts given the logistical, funding, personnel, knowledge and other constraints limiting it at any particular time.”

To reduce the financial burden of cryopreserving grandfathered members, Alcor may alter the cryopreservation process to reduce costs if the member’s payment to Alcor is below Alcor’s stated minimum in effect at the time of the cryopreservation.  Such alterations may include, but are not limited to, using fewer personnel, less sophisticated procedures, less expensive cryoprotectants, no cryoprotectants, or limiting the extent of cryoprotection of whole body patients. 

To help ensure optimal procedures will be available at time of cryopreservation, Alcor members are encouraged to plan for future increases in cryopreservation funding requirements in accordance with their life expectancy.  In short, if you are not funded at or above current cryopreservation minimums at the time of legal death, you may not receive an optimum cryopreservation.  The unsustainability of grandfathering without such cost mitigation measures was recently highlighted in a detailed analysis of Alcor finances by Rob Freitas.

Comprehensive Member Standby: Benefits

In 2005, we were pleased to announce our “Comprehensive Member Standby” (CMS) program, a major initiative in our ongoing quest to provide more effective cryopreservation procedures to Alcor members.  As the name indicates, CMS covers the “standby” phase of a cryopreservation, often referred to as “standby, stabilization, and transport.”  Standby is a critical, and often costly, phase of the cryopreservation process. 

During a standby, time is of the essence.  Teams of highly-trained personnel are available around-the-clock, waiting nearby the Alcor member in need.  Response personnel are outfitted with the necessary medications and equipment and stand ready 24 hours a day to stabilize the patient after pronouncement.  The teams respond in an expeditious manner, very similar to the response expected for a person who donates their organs for transplant.  

An expeditious response is critical because the chances of an effective cryopreservation – and thus a successful future resuscitation – increase with the promptness of the response.  The faster an Alcor patient is cooled, treated with protective medications, afforded a blood washout for additional metabolic stabilization, and transported to the Alcor operating room for cryoprotection, the better the chances that a quality cryopreservation will result.  

Benefit: No out-of-pocket expense for standby services at the time of need

Prior to initiation of the CMS program, Alcor members paid out-of-pocket for their standby needs with a credit card or prepayment.  Standby expenses could range from $15,000 to $40,000, depending on the location and duration of the standby.  It was often very difficult for members to incur these expenses at a time of great emotional stress and competing financial needs.  Further, not every member had the financial means to make such arrangements. 

The core concept of CMS is to provide standby coverage to eligible members for no additional charge at the time of need.  (Eligible members are those residing in the continental U.S. and Canada.  Standby response to Canada may be delayed by customs and immigration delays.)  In exchange, members pay an out-of-pocket cost of $10 per month, which is waived for minors and eligible students.   For this modest fee, Alcor members receive standby coverage that would otherwise cost tens of thousands of dollars at the time of need.

Benefit: CMS includes up to $5000 for relocation assistance

Further, the CMS program has a built-in benefit for terminal members.  Alcor is a staunch advocate of encouraging its members to relocate to the Scottsdale area, especially in the event of a terminal illness.  The benefits of relocation include greatly reducing ischemic injury to the patient through expeditious application of Alcor’s post-pronouncement response protocol (known as bedside care), reducing the potential for unexpected logistical challenges, and minimizing cost. 

Our members are warmly welcomed at a variety of highly cooperative hospice facilities in the Phoenix and Scottsdale areas.  These hospices will immediately pronounce our members upon clinical death and provide a supportive atmosphere before and during the critical first moments of our stabilization process.  If it is not yet time for hospice care, we can help our members find local resources to meet their living space needs. 

We believe so strongly that a successful standby sets the stage for a successful overall cryopreservation that our CMS policy provides up to $5000 of relocation assistance to any terminal member (with a prognosis of 90 days or less) who relocates to the greater Phoenix area.  We realize relocation at the end of life can be a difficult decision.  We offer this relocation benefit to increase the quality of the cryopreservation, while reducing the burden on families. 

Comprehensive Member Standby: Limitations

The level of standby care that can be provided beyond basic CMS may depend upon how much funding the individual member has provided.  Basic CMS coverage, for instance, does not include transport to Alcor after legal death by a charter jet and may not include field blood washout before transport. 

Limitation:  CMS does not include expedited transport to Alcor by charter jet

The need for cryopreservation is often unpredictable.  Legal death may occur as the last commercial flight of the day is departing.  Even if Alcor is present at a patient’s bedside and immediately begins the stabilization process following pronouncement, the patient may ultimately suffer several hours of ischemic injury before transport to Alcor if no commercial flights are available.  If the delay is significant, cryoprotective perfusion, i.e., the vitrification process, may not even be possible. 

Depending on the circumstances, an overnight delay may be enough to significantly impair the cryopreservation or result in a straight freeze.  A straight freeze does not provide any of the protective qualities of the vitrification solutions and is believed to require more advanced technologies to attempt future resuscitation.  In fact, any delay in the onset of perfusion is undesirable and best avoided.

To receive the best cryopreservation possible, transport to Alcor for cryoprotective perfusion needs to happen as expeditiously as possible.   How can that be achieved for those who do not live in the immediate Phoenix area?  There are a few ways to increase your chances of receiving expeditious transport to Alcor: (1) Relocate nearby the Alcor facility or (2) fund a charter flight.

As previously indicated, we actively encourage our members to relocate nearby the Alcor facility when the time of need can be foreseen.   Although relocation nearby Alcor is the ideal outcome, it is not always possible.  For remotely-located members in danger of suffering a considerable delay while awaiting a commercial flight, we recommend providing funding for a charter flight after legal death. 

Charter flights within the continental U.S. can cost as much as $40,000, depending on the distance to be traveled.  Alcor can arrange for a charter flight at the time of need, but only if the member has provided adequate funding.  It is important to realize that funding for a charter jet must be provided above and beyond the required cryopreservation minimum. 

A charter flight can often be available in as little as 2-4 hours.  When moments count, and the next commercial flight is several hours away, a charter flight is your best bet.  At this time, only members who have provided $40,000 in additional cryopreservation funding have secured charter jet services within the continental U.S., should the need arise. 

Limitation:  CMS may not include field blood washout

Blood replacement with an organ preservation solution is known as blood washout, or simply washout.   The main immediate benefit of washout is rapid cooling.  As previously indicated, the faster an Alcor patient is cooled, the better the chances that a quality cryopreservation will result.  Placing ice around the body is not nearly as effective as circulating cooled solutions throughout the body using the vascular system, as occurs during a washout. 

Washout is the single most logistically challenging aspect of a standby.  It requires personnel trained to access the vascular system and operate the necessary perfusion equipment.  It often requires securing an appropriate facility where the procedure can be performed on short notice.  In deciding whether to proceed with a washout, Alcor must balance the benefit of expedited cooling against the potential detriment of delaying transport of the patient to Alcor for full cryoprotection.  Alcor must also consider the cost.  Retaining the necessary personnel and facilities can be expensive, particularly if the standby lasts longer than expected. 

In some circumstances, a patient who would have benefited from a washout will not receive one, simply due to financial constraints.  At this time, those who have provided less than $80,000 for a neuropreservation or less than $200,000 for a whole body cryopreservation may not receive a field washout.  As Alcor raises its rates, members who want to have the best chances of receiving an optimum cryopreservation will need to increase their funding to match Alcor’s new rates.

Limitation: CMS may include limited standby personnel or technologies

CMS can provide limited standby personnel for limited periods of time and may not include improved technologies.  It is anticipated that new technologies will become available in the future that will cost more.  For instance, it may one day be possible to expeditiously cool a cryonics patient internally much faster than even a washout can achieve, such as using lung lavage technology.  Thus, Alcor will use its best judgment, considering the amount of funding provided by the member, to determine the level of care that can be provided. 

Recommendations for Securing Your Optimum Cryopreservation

The above explanations are only examples of ways in which your cryopreservation may be impacted due to funding limitations.  All aspects of Alcor’s cryopreservation protocol, including standby and operating room procedures, are eligible for modification in accordance with your available funding.  In general, Alcor will make best efforts consistent with funding available.  It remains each member’s responsibility to ensure the accuracy of Alcor’s records regarding available funding. 

This article is not meant to be an exhaustive list but to give you a sense of the importance of contacting Alcor today regarding increasing your cryopreservation funding.  In some cases, it may be as simple as changing the beneficiary on your existing insurance coverage to allocate a greater percentage to Alcor.  In other cases, you may need to seek additional coverage through your life insurance agent.  Cash prepayment and credit card authorization are also options.

Recommendation #1:  Provide Alcor with funding well in excess of current cryopreservation minimums at all times

If you already have a life insurance policy with a death benefit that exceeds the existing cryopreservation minimum, you may be okay. However, make sure that your funding is consistent with your remaining life expectancy.  The longer you expect to live, the more funding you should provide, or expect to provide, for your cryopreservation in the future.  The following tables show historical price increases for Alcor’s neuropreservation and whole body cryopreservation procedures.

Neuropreservation Funding Minimums

1970s – $25,000
1982 – $35,000
1991 – $41,000
1994 – $50,000
2005 – $80,000

Whole Body Funding Minimums

1970s – $60,000
1982 – $100,000
1991 – $120,000
2005 – $150,000
2011 – $200,000

Similar price increases driven by inflation and improving technology are inevitable in the future, and must be planned for. We encourage you to contact Alcor to confirm the status of your funding and make any necessary changes without delay.

Recommendation #2:  Even if you plan to relocate to the greater Phoenix area at your time of need, fund a charter flight

Funding a charter flight can be achieved by ensuring Alcor has access to at least $40,000 above the current cryopreservation minimum.  Charter flights can be funded by life insurance, cash prepayment, or credit card authorization.  (Contact Diane for the necessary credit card authorization form.) 

Diane Cremeens, Membership Services Coordinator

Toll-free: 877-462-5267 x 132

Local: 480-905-1906 x 132

Fax: 480-922-9027

Email:

_________________________________________________

Jennifer Chapman

Executive Director

ALCOR FOUNDATION

The next Alcor Board of Directors meeting is scheduled for Saturday, November 6, 2010, at the Alcor facility (7895 East Acoma Drive in Scottsdale, AZ) at 11:00 A.M. (MT). Members and the public are encouraged to attend.

Jennifer Chapman
Executive Director
Board Report
September 11, 2010

In April of 2009, we learned that Alcor member Orville Richardson had been buried in February of that year by his siblings. After a protracted legal dispute over the past 15 months, which was ultimately concluded in Alcor’s favor by the Iowa Court of Appeals, Orville was finally transported to Alcor. This case exemplifies the extreme importance of our members establishing relationships with individuals who support their cryopreservation arrangements. It was a tremendously difficult situation, and one that we hope is never repeated. Orville is now Alcor’s 99th patient.

We received two last-minute, non-member emergency calls last month, both post-mortem situations. These are always challenging calls and neither resulted in a cryopreservation. First, in early August, we were contacted by a woman whose brother had passed away suddenly about 24 hours prior in Massachusetts from heart failure. She had never discussed cryonics with him, but she said he was “into science.” She wanted to know more about cryonics. After coming to understand the cost and biological challenges of the case, the family decided not to proceed.

The second emergency call was about ten days later, on August 16th. We were contacted about an elderly man who had died twenty minutes prior of sepsis in Wisconsin. His son was a Ph.D. and educated about cryonics, more so than the average person. He decided to take a proactive role in pursuing cryonics for his father. He even attempted to convince the hospital to administer the medications in Alcor’s emergency response protocol, a request that was ultimately denied. Although Alcor strongly discourages last-minute cases and carefully weighs several factors when determining whether to accept a given case, this situation looked more promising than most for several reasons. Alcor had been timely notified post-mortem, the son was informed about cryonics, the father had apparently expressed a desire for cryopreservation, and the family expressed no reservations about the financial burden of paying for the cryopreservation and last-minute surcharge. Given all the favorable signs, we collected a down payment and deployed Aaron Drake to aid with expediting transport to take place following membership approval. In the end, certain family members who were authorized to make the decision whether to proceed wavered in the decision-making process. This lack of clear support contributed to the decision not to proceed with the case.

Alcor is a staunch advocate of encouraging its members to relocate to the Scottsdale area, especially in the event of a terminal illness. The benefits of relocation include greatly reducing ischemic injury to the patient through expeditious application of Alcor’s response protocol following pronouncement (known as bedside care), reducing the potential for unexpected logistical challenges, and minimizing cost. We have established positive relationships with local hospices and have access to multiple Phoenix/Scottsdale locations. Relocation at the end of life can be a difficult decision, we realize. To reduce the burden on families, our Comprehensive Member Standby program offers reimbursement of relocation expenses up to $5,000 for eligible members.

The percentage of cases Alcor has been at the patient’s bedside (whether locally or remotely), and initiated its stabilization procedure immediately following pronouncement, increased by 20 percent over the past 19 months when compared to the previous eight years. Our standard of offering bedside care whenever possible is significantly preferable to the team arriving even hours (or sometimes days) after pronouncement, as can occur if Alcor is not notified in a timely manner of an impending health concern. Alcor’s “watch list” program initiated by Aaron Drake monitors the health conditions of our members and has greatly contributed to our ability to anticipate their emergency response needs. We will continue to place strong emphasis on maintaining member communication and offering bedside care into the future.

The percentage of cases involving terminal perfusion has also improved by 16 percent over the same date range. This means that more members are receiving full cryoprotection according to pre-determined standards. The Alcor team has done a commendable job over the past 12 months, achieving these improvements while simultaneously handling the highest caseload in Alcor history.

As we work to issue reports for our cases over the past year, members of the R&D committee offered the below recommendations for additional technical data to be included:

• Time of cardiac arrest/when breathing was first observed to stop
• Time at which the nurse could no longer detect a pulse
• Time of pronouncement
• Time between cardiac arrest and pronouncement
• Medications, dosages, and times administered (including in the O.R.)
• Time CPS started (including time of any interruptions)
• Temperature measurements throughout
• Name of the cryoprotectant and the carrier solution
• Data graphs showing temperatures during stabilization/transport
• Data graphs showing temperatures during cryoprotective perfusion
• Data graphs showing temperatures during cool down
• Data graphs showing pressure, flow, and concentration graphs during cryoprotectant perfusion
• More detailed discussion of cryoprotectant perfusion

We appreciate their recommendations and plan to incorporate this data in future reports, if it is available. Last month, our dewar manufacturer declined to bid on manufacturing additional dewars for Alcor. Steve Graber expeditiously developed detailed digital schematics to aid with seeking bids from competing manufacturers. We subsequently contacted eight dewar manufacturing firms and received a few bids. One of the companies operates overseas and would have to invest in the required manufacturing equipment. As a result, we opted to order three dewars from a US-based firm. The estimated manufacturing time is about four months. We also purchased a used dewar from Cryonics Institute (CI). This dewar is immediately available for shipment to Alcor after CI receives our payment. It was in working order when last in use, and we will commence testing shortly.

In early August, Eric Vogt worked on readiness-related projects at Alcor in support of our ongoing efforts to improve inventory control and vastly expand Alcor’s documentation library. He reorganized suite 105 earlier this year and took a detailed inventory. During his recent visit, Eric confirmed the inventory count and identified items to be reordered. He established a temporary system of monitoring inventory levels using a spreadsheet format, which will be useful until Steve Graber develops a functional database. Indicators or “flags” on the physical bins will be used as visual reminders when inventory levels are low. Aaron recently modified our medication kit to include partitions, which keep the contents neat, organized, and easily accessible. Eric diagrammed the contents of the redesigned medication kit for easy reference during kit construction. He also updated the inventory sheets for our remote response kits, eliminating duplicative items, and prepared shipments of medications and field equipment for our field teams.

Alcor has long faced the imperative challenge of overcoming financial instability. Over the past decade, it has sustained largely as the result of membership dues from its loyal membership base, donations from its generous benefactors, and a handful of large bequests. Membership dues remain a fairly stable source of income for the organization. However, donations and bequests are difficult to predict and, therefore, relying on them results in a precarious situation.

In June 2011, the LEF/Miller/Thorp grant will expire and we must plan accordingly. The three-year grant, begun in 2008, contributes to salaries, training events, and a host of readiness-related projects, equipment, and activities. Needless to say, the grant has benefitted Alcor’s general operating budget tremendously and we are appreciative to the donors for their generosity.

My recent efforts have largely focused on developing a budget and budget balancing strategies to address the nearly $400,000 deficit Alcor will face in 2011 and 2012, should it receive no income from cases. Although it is unlikely that there will be no cases in a given year, it is Alcor’s tradition to prepare for the worst case scenario. Due to the unpredictable nature of cryonics caseloads, we start with a baseline assumption that no cases will occur. The deficit we face is only partially due to expiration of the grant. Even in 2010, Alcor would have experienced a deficit were it not for case income.

Although the challenges we face are significant, they are not insurmountable. After submitting a detailed analysis of our budgetary situation to the Alcor board and proposing a budget balancing strategy, I am confident Alcor can finally resolve its budget deficit without relying on unpredictable donations or bequests. I look forward to meeting with the Alcor board this weekend during our annual Strategic Meeting to discuss this and other challenges facing the organization.

Respectfully Submitted,
Jennifer Chapman
Executive Director
ALCOR FOUNDATION

To review previous Executive Director’s board reports, visit the alcor staff page.

Jennifer Chapman
Executive Director
Board Report
June 5, 2010
In mid-May, we cryopreserved 92-year-old Paul Garfield, a neuropreservation patient. Paul was a dedicated member of Alcor for 20 years and a long-time volunteer at the organization. Even in his 90’s Paul maintained an active lifestyle, often going dancing and visiting Alcor weekly. After being hospitalized in early 2009, he moved out of state to live with relatives. Alcor developed a cordial relationship with his son, who expressed a desire to honor his father’s wish for cryopreservation, despite personal reservations. The son informed Alcor in March that Paul had suffered a stroke and was undergoing physical therapy. On May 11, Paul was admitted to hospice care after his condition deteriorated, possibly due to another stroke. Alcor immediately deployed Aaron Drake and Suspended Animation to perform a standby that ultimately lasted about a day. Several Alcor Texas team members also offered assistance gathering supplies, providing transportation, and participating in the standby. Following pronouncement, Suspended Animation immediately began stabilization procedures and performed a successful field washout. He arrived in Alcor’s operating room approximately 20 hours post-pronouncement, and we achieved terminal perfusion. Paul became Alcor’s 95th patient.

Earlier in the month, we had received an emergency call regarding a member with lymphoma who had been hospitalized in Ohio. We had been tracking this member’s health condition as part of our watch list program. We were receiving mixed signals regarding his condition and decided to deploy Aaron Drake on May 4 to perform a wellness check. During the five-day deployment, Aaron met the member, his family and health care providers. The deployment was ended when the member showed sufficient signs of recovery, but the visit afforded us the opportunity to lay the groundwork with his health care providers, who would largely become our source of information thereafter. We continued to closely monitor his condition and were contacted by his nurse when his health further deteriorated. On June 3, Aaron was again deployed to do a wellness check.

Late this month, we were visited by an 85-year-old member who was moved to the Phoenix area by his supportive daughter. He was unable to communicate, which is particularly disconcerting for those of us who have known him for years. Although we did not enjoy seeing him in that condition, we are glad he is now living only a few miles from Alcor central. We also received a last-minute case inquiry on our emergency line from a gentleman who was seeking to cryopreserve his hospitalized mother. He has not yet provided the information necessary for Alcor to further assess his request.

Following our back-to-back cryopreservation of hospice patients last month, we had the pleasure of hosting a visit from several representatives of one of our local hospice providers. It was a valuable opportunity to give and receive feedback about our mutual experience. Several logistical details were discussed to ensure an optimal process in the future, such as where to park the Alcor vehicle and how to minimize the disruptiveness of our thumper. (We have now upgraded to the quieter Lucas 2). We explained the aspects of their service that are critical to our objectives, such as timely pronouncement. We have also been assigned our own private room near the exit, for the most expeditious transport to Alcor. It was a positive meeting and we look forward to continuing our mutually beneficial association.

Our dewar provider has finished its testing of Bigfoot #10, and the boiloff rate is higher than desired at 17 liters per day. (Apparently the initial result of about 10 liters per day was not reliable, as suspected.) We are at least two to three years away from running out of dewar space, considering our current caseload. Therefore, we have requested the patient care trust board’s approval of funding for additional dewars. We plan to offer a financial incentive if our dewar provider is able to further improve its boiloff rate.

Randal’s redesign of the whole body enclosure is now complete and the table is ready for testing. Hugh Hixon will work with Joel Andersen and Randal to conduct the necessary tests. Randal also built the back plates and shelving for six ATPs. Steve Graber will assemble the remaining components with assistance from Hugh.

We hired a new professional employer organization this month, following a significant increase in the cost of doing business with ADP TotalSource. D’Bora and Bonnie devoted significant time to this project, interviewing several firms, providing them with information, and managing all the necessary setup with the new firm. Their efforts are appreciated.

On the financial side, the A/R report indicates collection efforts are warranted for delinquent membership dues and CMS payments. The total outstanding balance for those 61-90 days past due is ~$13k and those over 90 days past due total ~$72k. This represents a 5% increase over the past two months. Bonnie plans to send duplicate invoices and/or collection notices to the members who are behind on their dues.

Respectfully Submitted,
Jennifer Chapman
Executive Director
ALCOR FOUNDATION
To review previous Executive Director’s board reports, visit the Alcor staff page.