> Shipping of Cryonics Patients

Timely shipment of cryonics patients is a critical problem. It can easily happen that a standby team can respond immediately after pronouncement of death with CardioPulmonary Support, rapid cool-down, blood replacement with organ preservation solution, etc -- but if cardiac arrest has occurred on a Friday afternoon and the cryonics patient was not in Michigan (or Arizona for Alcor) the patient would likely wait on ice the entire weekend before shipping permits could be obtained.

If a cryonics patient deanimates outside North America a flight cannot be arranged before approval for shipment has been received from the American Consulate, which usually means that even in the best of circumstances approval and flight cannot occur on the same day. Weekends and holidays add to the delay.

Typically, the death certificate must be filed and a transit permit must be issued by a government agency (the health department often issues the transit permits) which is only open on business days during business hours. The offices of medical examiners are often open until noon on Saturday, so it is sometimes possible to get a coroner to issue a transit permit on a Saturday morning.

Regulations specific to states, counties and cities within the United States can vary, often creating additional problems and less often making things easier. CI's 75th patient deanimated on a weekend in a Chicago hospital. But Chicago regulations do not allow removal of a body from a hospital until the death certificate has been filed. The death certificate could only be signed by the family physician, and the family physician could not be reached on the weekend or soon enough for filing to be made before Tuesday. A similar problem happened with CI's 82nd patient who was in a jurisdiction where the family physician needed to sign the death certificate before it could be filed. In that case the family physician was on vacation. The physician was finally located, and she authorized someone else in her clinic to sign the death certificate. On the other hand, CI's 84th patient deanimated on a Saturday, but was fortunate enough to be in a jurisdiction where the funeral director could issue the transit permit -- so she was shipped from Boston on the weekend.

Alcor can often circumvent the transit permit problem by removing the head of a neuro patient and shipping the head to Alcor while the body waits for the transit permit. The head is regarded as a tissue sample, and does not require a transit permit to cross state lines. The Cryonics Institute does not offer a "neuro" option, therefore every CI patient not living in Michigan must wait for a transit permit to be shipped.

On rare occasions authorities at a local airport can impose additional problems, as happened in the case with CI's 82nd patient when an airport official refused to allow shipment if a single ice cube was found in the shipping container. The patient had to be shipped with cold gel packs.

Typically a CI patient is shipped in a Ziegler case (a water-tight metallic shipping box used by funeral directors) that contains the patient in a body bag that is stuffed with as much ice as possible. The Ziegler case is lined on the inside with foam insulation. Ice is also loaded outside the body bag. The Ziegler has a rubber gasket around the lid, and the lid is screwed tight on the ribber gasket to prevent leakage of water. The Ziegler sits on a wooden air-tray (air shipping tray) and is surrounded by a cardboard box. Pink "wool" insulation should be stuffed between the cardboard box and the Ziegler to prevent water condensation on the Ziegler from wetting the cardboard (and to further insulate the patient).

Ziegler cases	Air-tray (bottom)

The cardboard box on the air-tray should be marked "Do Not Freeze". CI's 87th patient was frozen when received, which made perfusion difficult because freezing damages blood vessels. When perfusion is not possible a patient may be shipped in dry ice, as was the case with CI's 80th patient. When shipping a cryonics patient by airline on dry ice, shipping regulations allow no more than 200 kilograms (440 pounds) of dry ice. Containers with dry ice cannot be shipped in the same cargo hold as pets or biological materials that could be suffocated.

Every effort should be made to arrange direct flights in shipping a cryonics patient. CI's 87th patient was shipped to Detroit from Melbourne, Australia, spending an hour at the Sydney airport, six hours at the Los Angeles airport and seven-and-a-half hours at the Chicago airport before arriving in Michigan.

The are three directories that list national (and some international) funeral director services. These all have color names: the Red Book, the Yellow Book, and the Blue Book

At CI we have a copy of the Yellow Book, which contains detailed listings of funeral services available in every state, where the states are listed alphabetically in the white pages. In the back of the book there is a "yellow pages" which lists specialized services. Both Alcor and CI are listed under "cryonics suspension". Another two categories are "Shipping/embalming services" and "Transportation of human remains", the only difference between the two being whether embalming is part of the package. I have never used the Yellow Book.

The two largest firms in the United States that specialize in shipment of human remains are Inman Shipping and National Mortuary Shipping (NMS). Inman is slightly larger than NMS. Inman has 450 agents in the United States, and CI's funeral director Jim Walsh is one of those agents. A funeral director need not use the services of Inman or NMS to do shipping, but those companies greatly simplify the process at competitive prices. The shipping companies file the necessary documents, make arrangements with airlines, and provide air-trays as well as other equipment.

It would seem desirable to compile a list of shipping regulations for all states and other jurisdictions of the United States so that CI and CI's Members could do better planning. Alan Lamer, who is a Director of Inman, has stated that even Inman does not keep a list. Inman relies on its agents to be familiar with the current regulations in their local areas. Mr. Lamer said that when CI has a terminal patient that we can call Inman to get up-to-date information about shipment regulations for the relevant jurisdiction.

Patient care is best for cryonics patients who do not need to cross national or interstate borders in order to be cryopreserved. But few cryonicists choose to leave their family, friends and local home, hospital or hospice when they are in a terminal condition. Cryonicists living outside the United States often think that they can move to the US if they become terminal, but the US immigration authorities create problems for visitors wanting to come to the US when in a terminal condition or afflicted with obvious health problems. CI struggled with this issue for one of our overseas patients who deanimated before we could get to the bottom of the matter.

Within the United States, although a terminally ill person could not travel on a conventional airline, such a person could use an air ambulance. The company US Air Ambulance offers not only air ambulence, but ground ambulance service. Charges are on a per-mile basis, and for long distances an air ambulance could be less expensive than a ground ambulance.

There are now plans by various overseas cryonicists to vitrify overseas and ship in dry ice or liquid nitrogen. Dry ice shipment might be adequate if there is good perfusion with CI-VM-1, but if perfusion does not achieve good saturation the prospect of devitrification (freezing) with dry ice shipment is high. Shipping in liquid nitrogen from overseas would be expensive and difficult. Shipment would have to be by boat and someone would need to accompany the shipping cryostat/dewar to ensure that the liquid nitrogen does not boil-off, or that other problems occur. The UK cryonics group is seriously considering this option, however.