Informed Consent - This is Important!

This document is written to be understandable independent of prior knowledge, nevertheless some technical terms might be used. If there is any doubt, please reach out at any time we are happy to support. 

If you would like to understand the procedures and risk in more detail incl. the biological andbiochemical basis, we are happy to provide a comprehensive write up to you, please contact us.

Informed consent is highly important in the field of human cryopreservation. This means that people who sign up for cryopreservation should have a good understanding about what they are (and aren't) signing up for. Since the successful reanimation of cryopreserved humans depends on significant scientific advancements, no guarantees can be made whether and in what state patients would be reanimated.

Tomorrow Bio has the policy to always cryopreserve patients with the best possible cryopreservation technique available, unless physically impossible (e.g. body lost in the ocean during a plane crash). This policy exists because it can't be known how far future technology might advance and what damage may or may not be repairable. Because of this, Tomorrow Bio will not make an arbitrary determination about which patient conditions are good enough for future reanimation to be possible. However, patients should still be aware of the potential damage that can occur before or during their cryopreservation, and how that could affect their potential reanimation.

Please note: 

Currently it is not possible to warm up and reanimate humans who have been cryopreserved. It is furthermore not known, IF and WHEN the required technology will exist, it might take many decades, centuries or even longer. It is entirely possible that reanimation will never be possible! No one, including us, can predict what will be possible in the (far) future and what will not be possible. Unfortunately, we can also not give any probabilities about the chances of reanimation, as they are unknown.

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How does the procedure work?

Cryopreservation involves multiple steps. During each step several procedures are required including surgical procedures. 

1. Take over of the patient after legal death, but as fast as possible after the heart has stopped beating.
2. Start of cooling with ice water. 
3. Start of cardiopulmonary support as soon as possible thereafter, to reduce the time the body and most importantly the brain is not supplied with oxygen.  
4. Removal of blood and replacement of all fluids in the body against cryoprotectant solutions. 
5. After arrival at a cryopreservation facility, the body is cooled down with specifically designed cooling curves until the final storage temperature is reached.
6. Long-term storage in maintained.

It is possible that the cryopreservation organization or one of it’s partnership decides to adapt the procedures or uses a fundamentally different procedure if it is believed that this would increase the chances of potential reanimation in the future. This can be done based on the individual situation and/or new research finding. The preamble of the cryopreservation contract should be considered the shared understanding of why cryopreservation is done.

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Potential Damage Before Cryopreservation

Pre Mortem Injury: Conditions outside of the control of the patient and Tomorrow Bio could lead to damage of the patient's body before they are cryopreserved. Damage to the patient's brain could occur as the result of neurodegenerative disease (e.g. Alzheimer's disease), cancers (e.g. brain tumor), or accidents. Injuries incurred before a patient's cryopreservation may be irreversible.

Ischemic Injury: Cryopreservations procedures can only and exclusively begin AFTER a patient has been legally pronounced dead. In practice this means that many patients will go through a period of where the body may not be sufficiently supplied with oxygen (so called ischemia) which will damage most of the body's organs, including the brain. This period can lead to a range of different changes in the function of the cells, tissues and organs. After a patient's heart stops there will be a period of minutes or hours (or longer, depending on the individual circumstances) during which blood circulation will be absent and the body will be sufficiently supplied with oxygen. If these changes occur to a relevant degree, they will make it impossible for the cryoprotective agent to reach all parts of the tissue leading to a low quality preservation. Please note: It is not known if these damages can be repaired in the future. 

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Potential Damage During Cryopreservation

Cryoprotectant Perfusion: Cryoprotectants (practically an antifreeze solution) need to be delivered to the brain and other organs in high concentrations to limit or prevent ice formation during cryopreservation as much as possible. This process requires considerable time and imposes stresses on the organs, tissues and the brain. During perfusion a range of damages can occur, for example toxicity, vessel damage to high pressure, and damage due to high osmolarity (high solute concentration) Nevertheless, the cryoprotectant perfusion is absolutely necessary as ice crystal formation damages the cellular structure considerably. Furthermore additional damage types can occur during this step of the cryopreservation procedures. As of now, it is unknown if these damage types can be repaired in the future.

Biochemical/Biophysical Freezing: The goal of Cryoprotective Perfusion is to reach high enough concentrations to reduce or eliminate ice crystal formation. Nevertheless, depending on how much water is removed or replaced by cryoprotectants, some or all body tissues may freeze during cooling. The resulting combination of elevated concentrations of cryoprotective agents, cellular shrinkage, and low temperature may cause damage to the cellular structure, tissues and organs (including the brain).  Furthermore additional damage types can occur during this step of the cryopreservation procedures. As of now, it is unknown if these damage types can be repaired in the future.

Mechanical Cryopreservation Injury: Several kinds of mechanical injury to tissues as a result of cryopreservation could occur. The tissues including the brain dehydrate during the cryopreservation proceeding, which leads to shrinking due the lower water content. This shrinking can cause twisting and deformation of the tissue causing damage to cells, axons, blood vessels, and other structures. During cooling thermal stress can occur if different parts of the body or brain cool at different speeds, this thermal stress can lead to tissue fractures. Furthermore additional damage types can occur during this step of the cryopreservation procedures. As of now, it is unknown if these damage types can be repaired in the future.

Unknown Types of Damages / Incomplete Preservation Technique: As it is currently not completely known how memories, personality or consciousness works or arises it is possible that the preservation technique is not sufficient to preserve vital parts that are needed to reanimate the person. Furthermore unknown damage types may occur during any step of the cryopreservation procedures.

Potential Damage During Revival

Patients that are reanimated after cryopreservation could experience a range of issues as a result of the condition that killed them prior to their cryopreservation, the dying process, the reanimation procedure, and/or reintegration into society. Physical issues that a reanimated patient could experience include but are not limited to: complete or partial memory loss, loss of skills, and loss of part or all of the patient's original biological body. Emotional issues that a reanimated patient could experience include but are not limited to: loneliness and grief as a result of the permanent loss of friends and family who were not cryopreserved and reanimated, emotional distress at the loss of work or social status, and an inability to properly adjust to new cultural and social circumstances. Additional problems could arise for reanimated patients, and it is unknown whether these problems will be resolved in the future.

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External Risks

Independent of the condition of a cryopreserved patient, a patient's chances of being reanimated could be threatened by external forces.

We do everything possible to mitigate these risks but it is possible that they are out of our control.

Economic & Institutional: Large financial crises (e.g. hyperinflation) could cause the costs associated with maintaining patients in cryopreservation to rise beyond what the patient care trust is capable of paying. This could come if the specific materials needed for maintenance increase in price significantly (e.g. liquid nitrogen cost) or inflation could effectively wipe out all of the value of the patient care trust. Additionally, the organization responsible for the cryopreserved patients could cease operations without the possibility to transfer the patients to another organization or location. 

Legal: Local or international bans on the maintenance of cryopreserved patients could force cryopreserved patients to be removed from their dewars. Additionally, relatives of cryopreserved patients with significant resources could attempt (and potentially succeed) to have their loved one taken out of cryopreservation (despite the wish of the patient to be cryopreserved).

Geopolitical: Changes in the geopolitics of the location where cryopreserved patients are stored could threaten the existence of the patients. Country borders could shift in such a way that legal protections that used to exist for patients are erased. War could make the storage location unsafe for patients and the individuals maintaining the patients. 

Existential threats: Existential threats pose the chance to wipe out cryopreserved patients and/or all the individuals who could take care of cryopreserved patients. These existential threats include but are not limited to: asteroids, nuclear war, climate/natural disasters, and epidemics.