Like HowStuffWorks on Facebook!

How Fecal Transplants Work


Will It Blend?
Will It Blend?

Although something like it might have been practiced as far back as fourth-century China, modern fecal transplantation was pioneered in 1958 by Dr. Ben Eiseman at Denver General Hospital [sources: Allen; Brandt; Eiseman]. Fecal transplants saw only sporadic use for decades afterward, but began coming into their own around 2000 [sources: Allen; Brandt].

Here's how they work: After screening a donor for HIV, hepatitis and other disease-causing germs, the doctor dilutes a stool sample with saline or 4 percent milk, and then blends it into a milkshake-like slurry [sources: Allen; Bakken et al.; Floch; Silverman, Davis and Pillai]. The mixture is then fed into a patient's digestive tract via nasogastric or nasoduodenal tubes, through a colonoscope or via a retention enema [sources: Allen; Bakken; Hudson]. A nasogastric tube feeds matter through the nasal passage, down the throat and into the stomach; a nasoduodenal tube extends a bit farther.

The patient prepares for the procedure via the traditional take-no-prisoners, date-with-the-thunder-bucket ritual used by colonoscopy patients [sources: Allen; Stein]. Stool donations usually come from family members or spouses, but some facilities have tried unrelated, prescreened donors [source: Allen; Brandt].

If a fecal transplant sounds like a great DIY project, it isn't. First, stool is a level 2 biohazard; second, if you don't test fecal samples for communicable diseases, you could end up in a world of hurt; third, remind us to never drink frozen margaritas at your house [source: Bakken et al.; Floch; Silverman, Davis and Pillai].

As of October 2012, U.S. insurance does not cover fecal transplants, but some doctors believe billing codes for the procedure will exist by early 2013, with Medicare coverage following a similar schedule [sources: Allen; Brandt; Gewirtz]. Dr. Andrew Gewirtz of the Georgia State University Center for Inflammation, Immunity & Infection agrees.

"I would guess it might be insurable soon -- although it is possible that use of specific, defined bacterial cocktails may supplant it eventually," he says.

The procedure's legal status may pose a greater challenge. According to Dr. Lawrence Brandt of the Albert Einstein College of Medicine, the U.S. Food and Drug Administration (FDA) has declared feces for fecal microbiota transplants a drug, which makes transplants -- already a fringe therapy -- illegal until the FDA approves their use. While doctors are unlikely to do time for performing the procedure, its dodgy status could work against them should a malpractice suit arise [source: Brandt].

On the plus side, drug classification could move fecal transplants further into the mainstream. To become a widely accepted medical practice, the process must be subjected to large-scale clinical trials, but gaining funding for such trials from, say, the National Institutes of Health (NIH), hinges upon the FDA granting a substance "investigational status." Classification as a drug places feces in a category that the FDA recognizes for this purpose [sources: Brandt; Khoruts; McKenna].

Once they work the bugs out, bacteriotherapy and fecal transplantation could offer hope to a lot of sick people.