Being a Poop Donor Isn't as Easy as It Sounds

OpenBiome lab technician Meyling Chang — An OpenBiome lab technician checks a donated stool sample. Erik Jacobs/Jacobs Photographic/OpenBiome

You've heard of donating bone marrow, sperm, blood and even breast milk. Now it's time to put poop on society's collective radar of altruistic donation opportunities. Even though it sounds too gross to be true, it's a very real practice that is credited with saving no small number of lives. Known in medical circles as fecal microbiota transplantation (FMT), poop transplants are relatively newfangled treatments for potentially deadly, recurrent Clostridium difficile infections, or C. diff. Without donors, the treatments wouldn't be possible.

C. diff is characterized by persistent diarrhea that typically pops up after a person has taken antibiotics for another unrelated infection. It's also the most common hospital-acquired infection and is extremely expensive to treat. Scarily enough, some studies have reported an uptick in community-acquired C. diff cases, not involving people previously on antibiotics. The Centers for Disease Control and Prevention (CDC) released data in 2015 that nearly half a million people in the U.S. alone were diagnosed with C. diff in the span of only one year. Of those, about 29,000 died within 30 days of diagnosis, more than 80 percent of whom were aged 65 and older.

"Many of these patients are not able to fight the infection with standard antibiotic therapies alone, so FMT can be an effective last-resort treatment. FMT has saved lives and is changing the standard of care for C. diff patients, reducing overall fatalities and, for many patients, restoring their health after months of serious illness," explains Carolyn Edelstein, executive director of OpenBiome, the first public stool bank in the U.S. "When standard treatments of antibiotics fail to work, FMT has been shown to cure infections 90 percent of the time."

The point of FMT is to introduce gut bacteria from a healthy donor into the gastrointestinal tract of a person suffering from disease thanks to diminished "good" bacteria. The procedure can be performed in a few different ways, but most commonly a solution of saline and donor stool is administered via colonoscopy. A recent clinical trial out of Canada, however, indicates that "poop pills" could be the future of FMT, as these capsules (which the patient swallows) are much easier and less invasive to administer, and could be simpler to provide to hospitals for use.

OpenBiome lab tech with FMT capsule Gina Mendolia — Another OpenBiome lab tech fills a FMT capsule.
Erik Jacobs/Jacobs Photographic/OpenBiome

Donor Details

Interest in stool donation really ramped up in 2012 thanks to growing evidence of the positive impact of FMT on C. diff patients. Edelstein notes that it was much harder for doctors to perform FMT before OpenBiome opened because the process of screening healthy donors and processing the donated material is expensive and laborious. "Stool banks alleviate those challenges by eliminating the time and cost it would take clinicians to identify, screen and process material so that clinicians can focus on treating patients instead," Edelstein says in an email.

Potential OpenBiome donors undergo rigorous testing to be sure that their samples are safe. "Our donors are exceptionally healthy individuals aged 18-50 who can donate regularly and on-site at local Boston donation spots for a minimum of 60 days," Edelstein explains, noting that the first step is to fill out an online application. Once a spot opens up, the potential donor comes in for an in-person clinical interview, as well as blood and stool screenings. Less than 3 percent of applicants qualify as suitable donors, making it a seriously elite group.

Qualified donors are paid $40 per stool contribution. They make their donations on-site as frequently as possible for a minimum of 60 days. "Every 60 days, they undergo the full screening process again. Only when they pass this second screen will we release their material for treatment," Edelstein says, adding that donors must be totally healthy at the time of each donation, so they can't be in the midst of any sort of infection or on any type of antibiotic. Stool donations also have to weigh a minimum of 2 ounces (55 grams), which is the amount necessary for one FMT treatment, and all donations undergo a technical inspection.

OpenBiome, located in Boston, is believed to be the only currently open public stool bank in the U.S., so would-be donors must be local to that area in order to participate. People in other regions interested in helping out can check with nearby hospitals and academic centers, some of which operate smaller banks for their facility's own use. And although donors are usually compensated, a new study showed that a desire to help others was a greater incentive.

"There's an urgent medical need for stool donation, but many people have trouble getting over the 'ick factor,'" Breanna McSweeney, a medical student at the University of Alberta, in Canada, and lead author of the study said in a press statement. "Unfortunately, potential donors can be very difficult to recruit and retain, so we wanted to learn more about what motivates and deters people from participating."

The need for stool donations is likely to grow as FMT is also being investigated to treat other digestive illness like irritable bowel syndrome and Crohn's disease.