-->PONE-D-25-45890-->-->Cryopreservation sentiment in Switzerland-->-->PLOS ONE

Dear Dr. Kendziorra,

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Barry L. Bentley, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

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Reviewer #1: Yes

Reviewer #2: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This is a well-done survey on an important topic. It is useful data and overall written in a reasonable way. It is interesting to see the correlations and overall it is consistent with previous data.

My one main concern is regarding the conclusion here: "Survey results show that most participants were against making cryopreservation illegal (Fig 2). A total of 83.5% of respondents either opposed or remained neutral toward a ban, with 38.9% explicitly disagreeing or strongly disagreeing and 44.6% expressing neutrality. Only 16.4% agreed

or strongly agreed with making it illegal."

I don't think it is accurate to say on the basis of these results that 83.5% of people are *against* making it illegal, if they have responded that they are neutral to that question. I think it is more accurate to say that 38.9% disagree with this, while 44.6% are neutral. It also would be accurate to say that only a minority (16.4%) think that it should be made illegal. So I think it would be fair to conclude that there is no expressed widespread interest in making it illegal, or making a change from its current status. This is an important conclusion of the survey and I think that the language describing this result should be precise throughout the manuscript in order to be accurate.

Also, some of the citations could be formatted better. For example, some of them seem to have authors, but the authors are not listed in the citation. It might also be useful to have a few citations in the beginning to the general topic of cryopreservation/biostasis/cryonics, so that readers know specifically what you are referring to.

One minor point regarding: "This suggests that some individuals may view cryopreservation as a way of coping with death anxiety". I would specifically describe this as a "problem-solving way of coping", rather than just a way of coping. Because theoretically, it's not just about feeling better, which is sometimes the connotation of the word "coping", but rather attempting to solve the problem of death.

Reviewer #2: dos Santos, Montazeri and Kendziorra report an exploratory online-survey of swiss residents on attitudes towards cryonics. By showing support for legality of cryonics in Switzerland and replicating results from the German population by Kaiser at al. 2014, the present study is of general interest for capturing temporal, geographical and cultural determinants of medical and end-of-life preferences. It therefore constitutes a valuable contribution to the cryonics literature. I support publication provided the issues below are addressed:

1. Line 1: The title “Cryopreservation sentiment in Switzerland” is too broad. “Cryopreservation” covers embryos, gametes, organs, etc. The survey is specifically about human cryopreservation/cryonics. “Stated attitudes” would be more precise than “Sentiment”. My suggestion for an alternative title is “Swiss public attitudes to cryonics”.

2. Line 8 and 34: The authors describe the 2022 EBF cryonics facility as the first in Europe. The authors should modify this claim, due to the KrioRus facility established in 2005 in geographical Europe. For instance, the authors might replace “Europe” with “Schengen Area”.

3. Line 26: The authors should discuss and include references to at least some landmark publications on cryonics in bioethical journals, including Shaw Bioethics 2009, Moen JME 2015, Thau Bioethics 2020, as well as more recent article like Sauchelli Sci Eng Ethics 2024, Shao Int J Phil Stud 2025, German and Tretter Neuroethics 2025

4. Figure 1: The authors might consider representing this data as a pie chart or a diverging stacked horizontal bar chart.

5. Line 128: The authors may also relate their findings regarding family wishes to Hillenbrink R, Wareham CS. Mourning the frozen: considering the relational implications of cryonics. J Med Ethics. 2024

6. Line 254 and Line 277: If successful, cryonics could have pronounced benefits. It is therefore of general interest to elucidate the underlying psychological and sociological causes for its appeal to the general population in different framings. The manuscript provides some engagement with this topic by pointing to Bandura's reciprocal determinism, but the authors should extend their discussion of potential causal effects. This includes the framing as a medical treatment in the utilized vignette, potential framing effects of an anonymous online survey vs., e.g., person-to-person and public conversations. The authors should relate their results to Laakasuo et al. 2018 https://doi.org/10.1057/s41599-018-0124-6 and 2021 https://doi.org/10.1016/j.paid.2021.110731 and German and Tretter 2025 https://doi.org/10.1007/s12152-025-09584-7

7. Please clarify competing interests, including affiliations and equity stakes related to Tomorrow Biostasis, the European Biostasis Foundation, and other pertinent entities discussed in the manuscript.

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-->6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes: Alexander German

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-->PONE-D-25-45890R1-->-->Swiss public attitudes to human cryopreservation-->-->PLOS One-->

Dear Dr. Kendziorra,

-->Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Specifically, could you please address the following:

(1) On the previous request concerning identifying data, please remove the fields in the supporting data containing exact ages and retain only the age bins.

(2) Provide further detail in the main text on the consent process to demonstrate that informed consent was appropriately obtained from participants.

(3) Consistent with best practice and the WMA’s Declaration of Helsinki, I would reiterate the request for the study to be reviewed by an independent ethics panel, or provide clarification if such independent oversight has already taken place, in order to confirm that relevant ethical and legal requirements were followed (e.g. GDPR). Please feel free to contact me if you require advice on what is required for this.

(4) Ln 18 & 45-46: first dedicated cryopreservation facility: Thank you for clarifying the geographical scope. Along with Russia, Alcor operated a UK facility in the 1980s, so the change to clarify Schengen is appropriate. However, in line with Reviewer 2’s comment, the wording remains imprecise. The term “cryopreservation facility” is very broad and encompass a wide range of facilities (e.g. tissue banks, seed storage, brain banks, reproductive facilities, etc.). Please clarify in the text that the facility being discussed is specifically intended for whole-body human cryopreservation, as this is the important distinction.

(5) Unaddressed reviewer comment: Reviewer 2 suggested that the authors relate their findings regarding family wishes to the discussion in Hillenbrink & Wareham. This comment was not addressed in the response to reviewers. Please respond to this point and, if appropriate, incorporate relevant discussion into the manuscript.

Please submit your revised manuscript by Apr 25 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Barry L. Bentley, Ph.D.

Academic Editor

PLOS One

-->-->

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Swiss public attitudes to human cryopreservation

PONE-D-25-45890R2

Dear Dr. Kendziorra,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Barry L. Bentley, Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

Minor corrects:

(1) Please use the definite article with "Schengen Area", i.e. "the Schengen Area".

(2) Please remove contractions (i.e. change "it's" to "it is").

Reviewers' comments: