Peer Review History
| Original SubmissionDecember 21, 2025 |
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Dear Dr. Zeleznikow-Johnston, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not yet 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. The reviewers were broadly supportive, and all recommend publication, recognising the study as a timely, rigorous, and an original contribution that addresses an important gap in understanding attitudes towards human preservation. The reviewers recommended shortening and refining parts of the discussion; clarifying terminology (avoiding “cryopreservation” where preservation is not established); contextualising the findings more explicitly within the broader bioethical and legal literature; providing additional detail on the survey design and population; and incorporating at least a brief synthesis of the open-ended responses. Please submit your revised manuscript by Apr 17 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.. 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.. 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.. 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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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 . 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 Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: “Research funding for this study was supported by a CryoDAO grant (2025.1).” We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “Research funding for participant payments in this study was supported by a CryoDAO grant (2025.1). https://www.cryodao.org/ One of the authors, Emil Kendziorra, is a board member of CryoDAO. CryoDAO played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. Thank you for stating the following financial disclosure: “Research funding for participant payments in this study was supported by a CryoDAO grant (2025.1). https://www.cryodao.org/ One of the authors, Emil Kendziorra, is a board member of CryoDAO. CryoDAO played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.” We note that one or more of the authors is affiliated with the funding organization, indicating the funder may have had some role in the design, data collection, analysis or preparation of your manuscript for publication; in other words, the funder played an indirect role through the participation of the co-authors. If the funding organization did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors' salaries and/or research materials, please do the following: 1. Review your statements relating to the author contributions, and ensure you have specifically and accurately indicated the role(s) that these authors had in your study. These amendments should be made in the online form. 2. Confirm in your cover letter that you agree with the following statement, and we will change the online submission form on your behalf: “The funder provided support in the form of salaries for authors [insert relevant initials], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 5. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.--> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** Reviewer #1: This article addresses questions of growing interest to the medical community. As various forms of preservation become more common, physicians and other members of the medical community will increasingly need to respond appropriately to patients who have a personal interest in the subject. As a consequence, this survey of physicians is timely and can provide a baseline for physicians who wish to understand how this new possibility is thought of by other physicians. This survey can also help to inform the views of others who interact with individuals who want to be preserved. This might include relatives, courts, solicitors, ethicists, journalists, bloggers and others. The article was well written, neutral in tone, and sought to include all perspectives. As this subject can sometimes elicit significant emotional bias, a treatment that seeks to provide a common basis of facts available to all participants is most welcome. Reviewer #2: The paper "Physician estimates of the feasibility of preserving the dying for future revival" reports on a robust and comprehensive survey of doctors in the US view on the likelihood of neural information preservation post-cardiac death, their views on their feelings towards post-'death' preservation, and practical steps that they would consider taking to facilitate this post-death revival. The study had particular strengths in soliciting views from a wide range of specialities, and limiting numbers from each speciality in order to prevent skewed-results. The study's design is also strengthened by their exclusion techniques, and the data well interpreted, presented, and potential reasons and correlations given. I would recommend this paper for publication, and suggest two minor changes. The first paragraph of the discussion is quite long and mainly a repeat of what has come before. I would remove/significantly shorten this. I would also recommend removing the word "cryopreservation" from line 55, and just say "low temperatures are used". Cryopreservation is technically only applicable if preservation is proven. Reviewer #3: Zeleznikow-Johnston et al. present a cross-sectional survey to evaluate medical perspectives on structural brain preservation and cryonics. Summary: The survey was rigorously conducted and analyzed, consisting of 13 closed-ended items (11 multiple choice and 2 rating scale combined with open-ended follow-up items in 12 items. 598 validated US physicians responded to the survey invitation, of whom 334 completed the survey and met all inclusion criteria. Of these, 93 physicians rated the possibility of future revival through preservation somewhat or very plausible, 157 as somewhat or very implausible, while 84 were neutral/uncertain. Original survey items and results are available online. Assessment: This survey is an important and original research contribution, since preservation practices have evolved substantially but largely independently from medical practitioners in the four, respectively six decades since their conceptualization, see [1, 2] for SBP, and [3] for cryonics. Thus far, the academic discussion has taken mainly place in non-clinical disciplines like philosophical bioethics and medical law, see references [1-24], with [25] as a notable exception. Given the a) medical nature of preservation practices but long evolution independent of medical practitioners, b) psychological obstacles of discussing preservation practices [18] and c) survey results on acceptance of preservation practice in the general population [26, 27] and neuroscientists [28], the present survey fills a long-standing knowledge gap regarding the attitudes of physicians on preservation practices. Medical practitioners are the most proximate sources for the evaluation and provision of such practices for most patients. The survey data indicate polarized attitudes among physicians with more respondents being either optimistic or pessimistic than neutral. A polarization and emotionalization is particularly evident when looking at open-ended responses, e.g.: Responseid 9, 60-69 year old general practitioner: “I wouldn't choose it but, heck, if someone wants to try to cheat death, let them at it. God's plan will prevail eventually. The karmic implications of attempting something like this is an issue that individual will deal with eventually. As previously predicted and commented on, this cannot be offered on someone else's dime. It is NOT a right! To pretend to make it a "right", that would be available to any and all potential persons, then you are proscripting others to provide that service. THIS is immoral and unethical!” Responseid 62, 30-39 year old psychiatrist: “If this becomes a realistic outcome in the future, gating it behind wealth would be an extreme delineation from reasonable ethics.” Responseid 68, 30-39 year old neurosurgeon: “If access to this is not equal, could become a eugenics nightmare.” Zeleznikow-Johnston et al. provide a valuable research contribution in documenting this polarization and emotionalization of medical professionals concerning structural brain preservation and cryonics. The controversy around these important but rarely discussed topics requires ongoing discussion and engagement of members of the broader medical community. Therefore, I recommend publication, provided the points below are addressed. Major comments and suggestions: Please contextualize the survey with the larger bioethical [1-22], legal [22, 24], psychological [18] and related [29, 30] discussion of structural brain preservation and cryonics. Directly provide survey population profile and response data in the manuscript in tables as in [26] Describe how the survey items were designed. At least briefly analyze or summarize open ended responses in the manuscript. Analyze gender, age and geography (e.g. as a map). Discuss acquiescence and question ordering effects. Line 39-41: “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.”: Please tone down this statement, as the data only supports attitudes towards allowability of anticoagulation. Line 313 to 322: Uncertainty in CPR is of an aleatoric character while uncertainty in brain preservation and cryonics is of an additional epistemic character. This difference should be acknowledged in the texts when comparing the two. Line 384-386: "The majority of physicians surveyed support … initiating procedures prior to cardiac arrest." The data indicates only 44.3% supported initiating procedures prior to cardiac arrest. Line 387-390: "...we recommend proactive development of clinical guidelines and legal frameworks to ensure that patients seeking preservation can receive interventions..." Please tone down advocacy in your conclusion and stay more descriptive. References: 1. Drexler, E., Engines of Creation. 1986: Fourth Estate. 2. Olson, C.B., A possible cure for death. Med. Hypotheses, 1988. 26(1): p. 77-84. 3. Ettinger, R.C.W., The Prospect of Immortality. 1962. 4. Labaree, L.W. and W.J. Bells, Mr. Franklin: a selection from his personal letters. 1956, New Haven: Yale University Press. 5. Minerva, F., The Ethics of Cryonics: Is It Immoral to Be Immortal? 2018: Palgrave Pivot. 6. Shaw, D., Cryoethics: Seeking life after death. Bioethics, 2009. 23(9): p. 515-521. 7. Moen, O.M., The case for cryonics. J Med Ethics, 2015. 41(8): p. 677-81. 8. Thau, T., Cryonics for all? Bioethics, 2020. 34(7): p. 638-644. 9. Minerva, F. and A. Sandberg, Euthanasia and cryothanasia. Bioethics, 2017. 31(7): p. 526-533. 10. Merkle, R.C., The technical feasibility of cryonics. Med Hypotheses, 1992. 39(1): p. 6-16. 11. Fuhr, G., et al., Unterbrochenes Leben? 2013, Stuttgart, Germany: Fraunhofer Verlag. 142. 12. Cerullo, M.A., The Ethics of Exponential Life Extension through Brain Preservation. Journal of Evolution and Technology, 2016. 26(1): p. 94-105. 13. Cerullo, M.A., Uploading and Branching Identity. Minds and Machines, 2015. 25(1): p. 17-36. 14. Buben, A., Dying to Live: Transhumanism, Cryonics, and Euthanasia, in New Directions in the Ethics of Assisted Suicide and Euthanasia, M. Cholbi and J. Varelius, Editors. 2023, Springer. p. 299-313. 15. Andrade, G. and M.C. Redondo, Cryonics, euthanasia, and the doctrine of double effect. Philosophy, Ethics, and Humanities in Medicine, 2023. 18(1): p. 7. 16. Hayworth, K. Killed by Bad Philosophy. 2010 20 March 2024]; Available from: https://www.brainpreservation.org/content-2/killed-bad-philosophy/. 17. Freitas, R.A. and G.M. Fahy, Cryostasis Revival: The Recovery of Cryonics Patients Through Nanomedicine. 2022: Alcor Life Extension Foundation. 18. German, A. and M. Tretter, Brain Preservation and Cryonics Through the Lens of Moral Psychology. Neuroethics, 2025. 18(1): p. 12. 19. McKenzie, A.T., et al., Structural brain preservation: a potential bridge to future medical technologies. Front Med Technol, 2024. 6: p. 1400615. 20. Shao, J., Cryonics Wager: An Analysis. International Journal of Philosophical Studies, 2025. 33(1): p. 36-49. 21. Stodolsky, D.S., The growth and decline of cryonics. Cogent Soc. Sci., 2016. 2(1): p. 1167576. 22. Mullock, A. and E.C. Romanis, Cryopreservation and current legal problems: seeking and selling immortality. J Law Biosci, 2023. 10(2): p. lsad028. 23. Huxtable, R., Cryonics in the Courtroom: Which Interests? Whose Interests? Medical Law Review, 2018. 26(3): p. 476-499. 24. Spector, D.R., Legal Implications of Cryonics. Cleveland-Marshall Law Review, 1969. 18: p. 341. 25. Whetstine, L., et al., Pro/con ethics debate: when is dead really dead? Crit Care, 2005. 9(6): p. 538-42. 26. Kaiser, S., et al., ATTITUDES AND ACCEPTANCE TOWARD THE TECHNOLOGY OF CRYONICS IN GERMANY. Int J Technol Assess Health Care, 2014: p. 1-7. 27. Rodrigues dos Santos, J.P., et al., Swiss public attitudes to human cryopreservation. medRxiv, 2026: p. 2026.02.16.26346390. 28. Zeleznikow-Johnston, A., E.F. Kendziorra, and A.T. McKenzie, What are memories made of? A survey of neuroscientists on the structural basis of long-term memory. PLOS ONE, 2025. 20(6): p. e0326920. 29. Laakasuo, M., et al., What makes people approve or condemn mind upload technology? Untangling the effects of sexual disgust, purity and science fiction familiarity. Palgrave Communications, 2018. 4(1): p. 84. 30. Laakasuo, M., et al., The dark path to eternal life: Machiavellianism predicts approval of mind upload technology. Personality and Individual Differences, 2021. 177: p. 110731. ********** what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? 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If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. |
| Revision 1 |
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Dear Dr. Zeleznikow-Johnston, Thank you for submitting your manuscript to PLOS ONE and addressing the reviewer comments. After careful consideration, we feel that it has merit but requires minor edits to 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. As the reviewers requested a geographical analysis, please incorporate the geographical analysis into the main text by explicitly referring to the new supplementary data and include a brief statement outlining the associated limitations. As a minor aside, the updated text contains an interesting historical reference to Franklin's comments; however, you may wish to note that Robert Boyle already wrote about the effects of cold to preserve bodies over a century before, and conducted experiments freezing and reviving fish [Boyle (1665) New Experiments and Observations Touching Cold. John Crook, London.] Please submit your revised manuscript by May 20 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.. 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.. 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.. 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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| Revision 2 |
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Physician estimates of the feasibility of preserving the dying for future revival PONE-D-25-67370R2 Dear Dr. Zeleznikow-Johnston, 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support.... If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Barry L. Bentley, Ph.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: |
| Formally Accepted |
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PONE-D-25-67370R2 PLOS One Dear Dr. Zeleznikow-Johnston, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Barry L. Bentley Academic Editor PLOS One |
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