Fecal microbiota transplantation (FMT), often called “poop donation,” involves transferring healthy gut bacteria from a donor to a recipient. This procedure aims to restore a balanced gut microbiome, primarily used to treat recurrent Clostridioides difficile infection. Rigorous donor screening is essential to ensure patient safety and prevent the transmission of infectious diseases or other health conditions.
General Health and Lifestyle Criteria
Potential fecal donors must meet general health and lifestyle criteria. Donors are typically between 18 and 60 years old, with some programs specifying 18-48 years. Maintaining a normal weight, often a Body Mass Index (BMI) between 18 and 25 kg/m², is required. Donors should exhibit good general health, free from chronic fatigue or unexplained weight loss, and report regular bowel movements.
Lifestyle factors are also evaluated. Individuals with a history of high-risk sexual behavior, intravenous drug use, or recent incarceration are disqualified due to the potential for carrying transmissible pathogens. A history of alcohol or drug abuse is another disqualifier. These criteria serve as an initial filter to identify healthy individuals.
Infectious Disease Disqualifiers
Infectious agents are a primary category for disqualification. Donors are screened for current or past infections with pathogens such as Human Immunodeficiency Virus (HIV), Hepatitis A, B, or C viruses, and syphilis. Blood and stool testing is performed to detect these and other infectious diseases.
Screening also includes enteric pathogens, such as Clostridioides difficile, Salmonella, Shigella, and specific strains of E. coli like O157:H7. Parasites, including Giardia and Cryptosporidium, are also part of the stool analysis. Donors are tested for multidrug-resistant organisms (MDROs), such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Recent travel to areas where certain infectious diseases are endemic can also lead to temporary or permanent disqualification.
Gastrointestinal and Autoimmune Conditions
Specific conditions affecting the gut and immune system can disqualify potential donors, even if non-infectious. Chronic gastrointestinal conditions, such as Inflammatory Bowel Disease (IBD) including Crohn’s disease and ulcerative colitis, are disqualifying factors. Irritable Bowel Syndrome (IBS) with significant symptoms and Celiac Disease also exclude a donor. A history of gastrointestinal surgery that affects nutrient absorption can also be a reason for disqualification.
Systemic autoimmune diseases, such as lupus, rheumatoid arthritis, or multiple sclerosis, also disqualify donors. These conditions can alter the donor’s gut microbiome in ways that may not be beneficial or could even be harmful to a recipient.
Medication and Recent Health Events
Current or recent medication use and significant recent health events serve as disqualifying factors for fecal donation. Recent use of antibiotics is a common reason for temporary disqualification, as these medications can significantly alter the gut microbiome. Immunosuppressants and some psychiatric medications can also disqualify a donor due to their potential impact on the microbiome or the possibility of drug residues being transferred to the recipient.
Major surgeries, organ transplantation, or a recent cancer diagnosis or treatment also lead to disqualification. These events can indicate an underlying health issue or a compromised state that makes donation unsafe.