(Names and identifying details have been edited or removed to protect patient privacy and out of sensitivity for the nature of the described events. All times are expressed in Mountain Standard Time (MST) unless otherwise indicated.

Alcor member A-1175 was a 68-year-old man who suffered a terminal, self-inflicted intentional brain injury on approximately August 18, 2016. The member had sent letters to his brother, his best friend (Forrest Bennett,FB), and the police department detailing what he had planned to do. On the morning of August 19, 2016, local police received a letter from the member advising of his planned suicide. Police officers subsequently performed a welfare check at the member's residence where they found the member had sustained a gunshot wound to the head which they determined to be self-inflicted.

The member was transported to the Medical Examiner's Office (ME). A full autopsy was ultimately avoided. The member remained at the ME's Office until August 24, 2016. The bullet was removed and the member was received by the cooperating funeral home. The member was placed on dry ice immediately, and neuroseparation was performed the next day. The member's cephalon was put in an Alcor dry ice shipper and sent by courier to Alcor. The cephalon was then placed in the neuro cooldown system on arrival and cooled in liquid nitrogen (LN2). No audio or video recordings were made throughout any part of this case, and no CT scan was performed.

Alcor received a TeleMed alert for member A-1175, who had sustained a self-inflicted, terminal gunshot wound to the head. Contact was made from FB, the member's close friend who had initiated the call to Alcor. Police had notified him earlier in the day of the member's status. Contact was made with the member's brother, who was in Hawai'i, and also an Alcor member. He stated that he did not know that his brother was experiencing suicidal ideation. Assurances were made that Alcor would do their best to preserve the member in the best way possible under such challenging circumstances.

The member was being held by the ME's Office awaiting an autopsy. Josh Lado(JL) was able to speak with an investigator who stated that all of the medical examiners had left for the weekend and that a note would be attached to the member's ME file for a call to be made to Alcor before any autopsy was planned on the following Monday. Documentation was sent to add to the patient's file including the member's advance directives and his Last Will and Testament for the ME to review.

A call to FB and other Alcor members in the area was made to discuss plans and procedures for the coming days. Concerns were voiced, due mainly to previous experiences with medical examiners. It was decided that an Alcor representative would be at the office when they were to re-open on Monday, August 22, 2016. The decision was made to have FB be at the ME's office and have MM call in to the same on the morning of Monday, August 22, 2016. Alcor's legal counsel was made aware of the case, including possible complications such as the chance of a full autopsy.

Max More(MM) contacted FB to update and plan for the following days. MM sent all available paperwork to FB regarding the member. MM asked FB if he would act as a representative for Alcor at the ME's office Monday morning. MM contacted legal counsel to discuss if FB could serve as a representative for Alcor. Legal counsel advised MM to write a letter authorizing FB to be a Patient Advocate and Representative. MM faxed a letter to both FB and the ME's office.

FB went to the ME's office. Alcor wanted to do everything possible to stop a full autopsy from occurring. MM also called just after regular business hours began. The ME had received the notes sent over the weekend and was aware of the position Alcor had on an autopsy, but no decision had been made. The ME had other cases ahead of the member's and would look at the member's case later in the day or the following day.

Alcor made arrangements to send the neuro shipper to FB in anticipation of the ME or the funeral home helping with the neuroseparation. JL made arrangements with the funeral home to ensure that Alcor had someone to perform the neuroseparation in place.

The ME advised FB that a full autopsy was not required and they would only be recovering the bullet from under the member's scalp. The ME also stated that the member would be released the same afternoon. FB relayed this to Alcor. He was then advised to do his best to collect approximately 100 to 200 lb of dry ice to begin cooling the member as soon as the funeral home came to receive him.

JL spoke with the funeral home to discuss the procedures Alcor would need to be performed, as well as with FB. These duties were ultimately all carried out as follows: The funeral home was asked to be responsible for getting a Ziegler Transfer Case, which they succeeded in doing. FB then lined the bottom of the case with dry ice and placed the member on top of it. A towel roll was placed behind the member's shoulders to elevate his neck to an angle that would facilitate his neuroseparation. Then, more dry ice was placed on and around the member's head, torso, and all around his body using the remaining dry ice. At this point, the member began the cooling process for 24-hours before the neuroseparation took place. After the neuroseparation, the member's cephalon was put into the neuro shipper with dry ice filling the rest of the box. The member was shipped back to Alcor as soon as possible after packing into the neuro shipper. The funeral home agreed and stated they could not get a Ziegler case until the following day due to limitations from their supplier.

SOURCE: Preventing Autopsy for Alcor Member A-1175 (Suicide)