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Doctors' estimates of the feasibility of preserving the dying for future revival

Importance: Terminally ill patients sometimes inquire about preservation procedures (e.g. cryopreservation, aldehyde-based fixation) as end-of-life treatment options, yet physician perspectives on feasibility and ethical acceptability remain uncharacterized. Objective: To assess US physicians' estimates of preservation feasibility, views on interventions to improve outcomes, and positions on ethical and legal frameworks. Design: Cross-sectional survey conducted October 2025. Setting: Sermo, an online platform for verified US healthcare professionals. Participants: Convenience sample of 334 physicians comprising 150 primary care physicians (general practice, internal medicine, family medicine) and 184 other specialists. Main Outcomes and Measures: Estimated probability that preservation retains neurally-encoded information sufficient for future revival; support for pre-mortem anticoagulation and pre-cardiac arrest procedure initiation; views on compatibility with patient-centered care. Results: Among 334 physicians, the median estimated probability that preservation under ideal conditions could retain sufficient neural information for future revival was 25.5%. Overall, 27.9% found preservation somewhat or very plausible for enabling future revival; 47.0% found it somewhat or very implausible. Most physicians (70.7%) supported prescribing anticoagulants to terminal patients to improve preservation quality; 11.7% opposed. For patients choosing preservation in combination with medical assistance in dying, 44.3% supported initiating preservation prior to cardiac arrest; 28.8% opposed. Most (58.1%) agreed preservation could be consistent with compassionate care (20.1% disagreed), and 49.1% reported comfort with patients choosing preservation (30.0% uncomfortable). Familiarity with preservation correlated with higher probability estimates (ρ = 0.26; p < 10-3), while end-of-life discussion frequency correlated with support for pre-cardiac arrest procedures (ρ = 0.18; p = 0.003). Conclusions and Relevance: US physicians assigned a median 25.5% probability to preservation retaining neural information under ideal conditions in a manner potentially compatible with future patient revival. The majority support for pre-mortem anticoagulation and substantial support for pre-cardiac arrest initiation indicate that many physicians would consider accommodating patient requests for preservation-enhancing interventions. These findings may inform development of clinical guidelines, though the speculative nature of the estimates warrants consideration. ### Competing Interest Statement Andrew McKenzie is an employee of Sparks Brain Preservation, a non-profit brain preservation organization, and a director of Apex Neuroscience, a non-profit research organization. Emil Kendziorra is a shareholder and CEO of Tomorrow Bio, a biostasis provider, President of the Board of the European Biostasis Foundation, a non-profit research foundation, a shareholder and director at Oxford Cryotechnology, Inc., a cryopreservation research organization, and a board member at CryoDAO, a Swiss research association. ### Funding Statement Research funding for this study was supported by a CryoDAO grant (2025.1). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Pearl Institutional Review Board of Pearl IRB waived ethical approval for this work (#2025-0579). Specifically, the survey and its implementation were reviewed by the Pearl Institutional Review Board and received an exemption determination (#2025-0579) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes A list of the survey questions is available here: https://osf.io/awgk7/files/jn27a The full set of participant response data is available here: https://osf.io/awgk7/files/hrm76 <https://osf.io/awgk7/files/jn27a>

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