A recent letter (Z Kassam et al. NEJM 2019; 381: 2070-2) describes the arduous process involved in being selected as a stool donor for fecal microbiota transplantation (FMT).
In a previous blog (2015), it appeared that 17% of donors were accepted for FMT: Rejected! Most Stool is Not Good Enough for FMT This current review of the donor program from a stool bank (OpenBiome) prospectively evaluated 15,317 donor candidates from 2014-2018.
Key finding:
- Only 3% (n=386) made it through all the steps to become donors
Reasons for exclusion:
Stage 1: common reasons for exclusion:
- geographical -living too far away to donate regularly
- BMI >30
- social history
- travel history
- not in age range
Stage 2: “failing” the 200-item clinical assessment –common reasons for exclusion:
- lost to followup
- allergic disorders/asthma
- receiving medications/supplements
- mental health concerns
- infectious disease history
- social history/sexual history/other reasons
Stage 3: “failing” the stool and nasal screening which included (in 2016) carbapenem-resistant Enterobacteriacea (CRE), extended-spectrum beta-lactamase-producing organisms (ESBL) and MRSA. –common reasons for exclusion:
- lost to followup
- infectious disorders (including C diff in 7 patients)
Stage 4: “failing” serological screening
- lost to followup
- abnormal LFTs, CBC or infection
Related blog posts:
-
- OpenBiome -Nation’s 1st Human Stool Bank | gutsandgrowth
- Clostridium difficile/Fecal Microbiota Transplantation Video …
- Consensus Guidelines on FMT
- NY Times: The Battle Over Fecal Transplantation | gutsandgrowth
- Fecal Microbiota Transplantation: How important is the BMI of the stool donor?
- FDA Warning on FMT (2019)
Island Ford, Sandy Springs, GA
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