http://www.evidencebasedcryonics.org/scientists-open-letter-on-cryonics/
Legal, ethical and medical issues regarding Cryonics in Spain
Lluís Estrada Garcia, MD, PhD Tarragona, Spain. February 2013
E-mail: lluis.estrada@crionica.org & lluis.estrada@iservicesmail.com
Cryonics is defined as the preservation at very low temperatures (below -120ºC) of humans and animals who cannot be sustained by contemporary medicine. In this document we refer only to such preservation of human beings who have been pronounced
legally dead, with the purpose of preserving their body and specially their brain hoping for future scientific advances that might be able to reverse the situation that has brought them to death.
Low temperatures slow down metabolism and benefit conservation. Scientific data suggest that bodies can be preserved for many centuries at temperatures below -120ºC. One of the main dangers both in the cooling and warming stage (when revival is intended) is the formation of ice crystals that might damage cells. Cryoprotectants are used to avoid this
dangerous effect in vitrification (cooling and solidification without crystal formation). Progressive improvements in this area have led to important achievements, such as the vitrification of rabbit kidneys, succeeding in reversing the process and obtaining functioning kidneys. Successful reversible vitrification of sperm, oocytes and human embryos has been achieved, as well as that of small primitive animals with digestive, muscular, sexual and nervous systems. Reversing of vitrification has not yet been accomplished in adult mammals, but it has been possible to observe adequate conservation of cell structures through electronic microscopy.
It is currently unknown whether people preserved by Cryonics will be able to be revived in the future.
People that choose or have chosen cryonic preservation have taken an ethically correct and reasonable decision, that will most likely contribute to scientific advance and that should be respected.
It is vital that laws are adapted to scientific advances. To ensure the conservation of organs (for transplants) and human bodies (for Cryonics), after death, it is necessary to be able to act with great promptness in initiating these conservation processes in order to minimize their deterioration.
The adaptation of the Spanish legislation regarding organ transplants has been very adequate. In the preamble of the Royal Decree 2070/1999, of the 30th of December it is stated: ” in order to maintain the viability of organs, it is indispensable to undertake premature preservation techniques of organs, aimed at diminishing the damages secondary to ischemia that can suffer organs in the time between death diagnosis and
extraction. Therefore, an efficient and agile procedure must be articulated to ensure immediate judicial authorization to obtain organs whenever necessary”.
Afterwards, the legislation referring to organ transplants has been improved, as shown in the first annex of the Royal Decree 1723/2012 of the 28th of December, stating: “3. Death diagnosis according to circulatory and respiratory criteria 1. Diagnosis: a) Death diagnosis according to circulatory and respiratory criteria will be based
on the unequivocal verification of the absence of spontaneous breathing and circulation, both during a period of no less than five minutes. b) Prior to death diagnosis and certification according to circulatory and respiratory criteria, it must be verified that one of the following conditions is met: 1º Cardio pulmonary resuscitation procedures have been applied during sufficient time with unsuccessful results. The period of time, as well as the procedures applied, will be adjusted according to age and circumstances that led to circulatory and respiratory arrest. The specifications of the protocols on advanced cardio pulmonary resuscitation published periodically by competent scientific societies will be followed at all times. In cases in which body temperature is 32ºC or below, the body will be warmed before establishing the irreversibility of the circulatory and respiratory arrest and therefore death diagnosis. 2º It is not deemed appropriate to apply cardio pulmonary resuscitation procedures, due to justifiable medical and ethical reasons, in accordance with the recommendations published by competent scientific societies. c) The absence of circulation will be proven by the presence of at least one of the
following: 1º Asystole in a continuous electrocardiographic rhythm strip. 2º Absence of blood flow in the invasive monitoring of blood pressure. 3º Absence of aortic flow in an ecocardiogram. Technical and scientific advances allowing, it will be possible to use any other proof that certifies absolute warranty of diagnosis. 2. Procedures for the maintenance of viability and preservation: a) In order to initiate the preservation procedures it will be necessary that the medical team responsible for the patient makes a record of the death, specifying the time of death. b) In those cases where judicial authorization is required as specified in the article 9.5 of this Royal Decree, the procedure will be as follows: 1º In the event of those cases referred to in the paragraph 1º of section 1b), techniques that maintain blood flow to organs will be resumed and appropriately communicated to Court to inform of the existence of a potential donor. After favorable judicial response or when fifteen minutes have passed and no limitation has been notified by the Court against preservation procedures, these will be initiated.”…
In this Royal Decree regarding organ transplants, immediate preservation procedures are allowed after death diagnosis in those cases in which no judicial authorization is required, and regulates how to proceed with maximum promptness in those cases in which authorization is required.
In Cryonic preservation, which aims at the conservation of all organs, the same promptness is required in the initiation of preservation procedures, in order to diminish damage to organs due to ischemia in the time between death diagnosis and the start of preservation procedures.
Unfortunately, in mortuary sanitary police legislation Cryonic preservation has not been foreseen and there are regulations that hinder prompt initiation of cryopreservation procedures and transfer in adequate conditions.
For instance, in the Decree 2263/1974 of the 20th of July, in which Mortuary Sanitary Police Regulations are approved, it states: “Article 5. Until burial license has been authorized it will not be allowed to perform non-judicial autopsy, sanitary procedures for the conservation of corpses, coffin closing, cremation, transfer authorizations or any other similar procedures. Article 6. Notwithstanding what current special legislation establishes for the extraction of anatomical pieces for transplant and use of corpses for scientific and teaching purposes, the final destination of all corpses will be one of the following three: 1) burial at an authorized location, 2) cremation, 3) offshore immersion.”
In the Decree of the 14th of November of 1958, BOE of the 11th of December, Civil Registry Regulations, it is established: “Art. 276 Verifications and other procedures for the registration and issue of the burial license will be conducted within twenty-four hours
following decease.”
Jurisdiction of mortuary services is transferred to the autonomous communities but their regulations, as well as the ones just described, are not adapted to the preservation needs of Cryonics. Promptness is sought in conservation procedures for organ transplants, which are considered an exception, but Cryonic preservation is not allowed. Both are conservation processes of organs that require the same promptness but they receive radically different treatment. Regulations regarding means for transportation should also
be updated, in order to allow, as in organ transplants, the use of adequate containers for transfers at low temperatures.
The adaptation for Cryonics of the Spanish legislation is imperative. This would allow Spanish citizens or foreigners residing in Spain and that are interested in human cryopreservation, access to such procedures, and therefore not relegate them to a very disadvantageous position as compared to those citizens that live in countries with updated legislations.
References:
1. Benjamin P. Best. Scientific Justification of Cryonics Practice. Rejuvenation Research 11, 2; 2008 http://www.cryonics.org/reports/Scientific_Justification.pdf
http://crionica.org/modules.php?name=Content&pa=showpage&pid=99 (In spanish)
2. Gregory M. Fahy, Brian Wowk, Roberto Pagotan, Alice Chang, John Phan, Bruce Thomson, Laura Phan. Physical and biological aspects of renal vitrification. Organogenesis 5:3, 167-175; 2009 http://www.21cm.com/pdfs/12FahyORG5-3[1].pdf
3. Yuri Pichugin, Gregory M. Fahy, Robert Morin. Cryopreservation of rat hippocampal slices by vitrification. Cryobiology 52, 228–240; 2006 http://www.21cm.com/pdfs/hippo_published.pdf
4. Benjamin P. Best. Small animals surviving cryogenic temperature. http://www.benbest.com/cryonics/Crypto.html#cryogenic
5. Suspended Animation Inc. Rapid intervention. http://www.suspendedinc.com/rapid_intervention2.html
6. Suspended Animation Inc. Procedures. http://www.suspendedinc.com/procedures.html
7. Suspended Animation Inc. Vitrification. http://www.suspendedinc.com/vitrification.html
8. Benjamin P. Best. Cryonics Protocol — A Summary. http://www.benbest.com/cryonics/summary.html