DONOR Screening and Selecting for Fecal Microbiota Transplantation Therapy

How to Screen and Select a Healthy Donor? Who can be a Donor for FMT?

Written by White Shark, 2009

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Fecal microbiota transplantation (FMT)  is the process of transplantation of healthy feces from a healthy individual (donor) into a not as healthy individual (recipient). If you have any general questions about this therapy, (why, who, really?) please click here to read all answers.

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How to select a Healthy DONOR for FMT?

Who can be a donor?

A donor is selected based on his/her health. Safety is very important, so all precautions should be taken to avoid implanting feces infected with parasites or dangerous bacteria like for example clostridium difficille.   Click here to read about basic donor requirements.

The fast and easy way forward: Family member or a child as a donor

A relatively safe way to choose a donor (in developed countries) is to choose a feces from a very healthy, breastfed young child.
It takes about 3 years for microbiota to get fully developed.
Fully developed microbiota can contain up to 1000 different strains of bacteria.
So, you are looking for a healthy child, at least 3 years old, or older.

There are very many  advantages in choosing a healthy child as a donor compared to selecting an adult donor

• does not need to be tested for sexually transmitted diseases, if mother and child are healthy. In most developed countries, mothers are repeatedly tested for blood born sexually transmitted diseases (STDs) and for many other diseases during pregnancy. Newborn babies are also routinly tested for blood born diseases. If mother have tested negative for STDs, and the baby was tested negative for STD, then once that bay is 3 years old, it can be a safe FMT donor.  Any child of pre-sexual age is considered a safe donor in regards to STDs. Most babies are also tested after birth (hospital birth), both for blood born STDs and for a long list of other diseases so  that requirement is satisfied by default.
• a healthy child may not need to be tested for intestinal bacteria or intestinal parasites, if the child is healthy, and if mother and the child have never traveled to tropical countries.
• healthy kids are never addicted to alcohol, narcotics, legal or illegal drugs, so that requirement is satisfied by default.
• healthy young kids have no dental fillings,  that requirement is satisfied by default.
• healthy kids have never suffered from any chronic disease or chronic health problem, so that requirement is satisfied by default..
• healthy kids usually eat healthy diet,  that requirement is satisfied by default.
• healthy kids have healthy digestion and healthy poop, what can be easily inspected.
• very easy to get a fresh feces, all you need to do is collect it from a potti. Far more convenient than dealing with adult poop.
• kids poop smells much better than adult poop!

The child should be very healthy, never treated with antibiotics and never treated with ANY oral or any other medications. The child  should not be underweight or overweight.  Never suffered from chronic diarrhea or chronic constipation.
To be on the safe side, the mother of the child should have never traveled to tropical countries.

Feces from the potti or from dipers::
Get fresh feces. Color of feces must be brown or brown-yellow, it must not be green, cause green color of feces almost always indicates lack of good and healthy bowel bacteria. (Unless child was drinking freshly pressed wheat grass juice, or consumed blueberries, or some other food of strong green or blue color, green color of feces always indicates lack of good bowel bacteria. Yellow (or yellow-brown, or brown if child has eaten meat) color indicates healthy feces.)

 

Here is a list of basic requirements an individual has to satisfy to be selected as a donor for FMT:
( quite many of those requirements are automatically satisfied if the donor is a young child, at least 3 years old)

• born by natural vaginal birth (ask donors mother)
• breast fed by mother for at least 8 months or longer (ask donors mother)
• donors mother never used any prescription medications during pregnancy, especially not antibiotics
• donor is generally very healthy person
• never tested positive for sexually transmitted diseases (STD) like: HIV, Hepatitis C, B, A, Syphilis, Gonorrhea, Herpes
• not sexually promiscuous ( sexual promiscuity increases likeliness of an STD infection)
• not practicing anal sex ( practicing anal sex increases likeliness of being infected with intestinal parasites or intestinal bacteria)
• to be on the safe side, a sexually active donor should have taken an STD test during the last few months, if possible.
• never been infected with intestinal parasites or blood parasites or dangerous intestinal bacteria
• never traveled to third world tropical countries ( traveling to  third world tropical countries increases likeliness of being infected with intestinal parasites, dangerous intestinal bacteria or dangerous virus )
• never suffered from travelers diarrhea
• perfectly healthy digestion, no chronic digestive problems
• never suffered from any chronic or serious diseases
• never suffered from any chronic pain, including but not limiting to: chronic headaches, migraine, joint pains, chronic back or neck pain, arm pain, leg pain, foot pain etc.
• never suffered from any mental illness like depression, anxiety, schizophrenia, etc.
• not addicted to alcohol, narcotics, tobacco, legal or illegal drugs
• has regular bowel movements, 1-2 per day,  healthy color of feces (brown - brown yellow), healthy smell of feces (not too strong smell), healthy shape of feces, nicely formed, rounded, not too large, not too small
• healthy body weight, not obese, not underweight
• healthy skin, healthy hair and healthy nails: never suffered from chronic acne, chronic peeling lips, hair loss, eczema, psoriasis, seborrheic dermatitis, allergies, hives, boils, warts, etc.
• never suffered from chronic unpleasant body odor, bad breath, inflamed tonsils, tonsil stones
• never suffered from chronic vision problems
• never treated with oral antibiotics or at least not treated with oral antibiotics during the last 5 years
• healthy teeth and healthy gums. At least not having large number of amalgam fillings in his/her mouth
• if it is a fertile woman, she should have a regular menstrual cycle.   Feces should not be taken during the days of  menstruation.
• if it is a woman, she should not be using hormonal birth control like Mirena IUD or any other IUD, or any other hormonal pills.
• never suffered from any chronic disease or any other diseases, including but not limiting to: inflammatory bowel diseases like ulcerative colitis and Crohn's disease, irritable bowel syndrome, any form of cancer, Fibromyalgia, any tumor, cyst, Parkinson's disease, Multiple Sclerosis, Autoimmune diseases, hypothyroidism, neurological diseases, endocrine disorders, arthritis etc.
• never treated with strong medications
• never been operated on, has all body parts on its place, working as it should
• healthy heart, lungs and cardiovascular system
• no hearing problems and no vision problems and no problems with any of the senses

When the therapy is performed in clinical setup, donor is usually tested for STDs and for blood and intestinal infections and parasites. 
When doing the therapy at home,  without possibility to test donor, you simply chose the healthiest donor available.

 

 

Teenager or adult donor:

You can also use feces from any healthy person, teenager or adult.

How to select a teenager or an adult donor?

Here are the basic requirements:

• very healthy person, never been to a doctor, never needed a doctor
• regular bowel movements, 1-2 per day
• healthy color of feces (brown - brown yellow)
• healthy smell of feces (not too strong smell, as it may indicate digestive problems)
• healthy shape of feces, nicely formed, rounded, not too large, not too small
• never treated with antibiotics,  or at least not treated with antibiotics during the last few years.
• never been diagnosed with intestinal parasites, and never exhibited symptoms of intestinal parasites
• average healthy weight, not obese, not underweight
• never been diagnosed with sexually transmitted diseases.
• physically active
• not sexually promiscuous ( to decrease likeliness of being infected with any STD since the last test)
• not practicing anal sex (to decrease chances of being infected with  intestinal parasites.)
• never suffered from chronic acne, chronic peeling lips, hair loss, eczema, psoriasis, allergies, etc.
• never suffered from chronic unpleasant body odor, bad breath
• never suffered from chronic constipation or chronic diarrhea or travelers diarrhea
• never suffered from any chronic disease or any other diseases
• never treated with strong medications
• never diagnosed with inflammatory bowel disease, irritable bowel syndrome, Crohn's disease, cancer, fibromyalgia, tumors, cysts, etc.
• not addicted to junk foods, soft drinks, alcohol, narcotics, tobacco
• not having a large number of amalgam fillings in his/her mouth
• a donor that has never been treated with antibiotics is far better than a donor that has been  treated with antibiotics
• if it is a woman, she should have a regular menstrual cycle. In that case, feces should not be taken during the days of  menstruation.
• has not traveled to tropical countries with poor sanitation (to limit chances of a donor being unknowingly infected with intestinal parasites)
• should test negative for sexually transmitted diseases like HIV, Chlamydia, syphilis, gonorrhea, herpes, hepatitis C, B, A, if possible, and if sexually active person.  Children of pre-sexual age may not need to be tested for STD.
• should test negative for intestinal parasites, if possible to get tested. (blood test or stool test.)
• should test negative for dangerous intestinal bacteria, if possible. (blood test or stool test)

 

Usually, a donor is a healthy family member, brother, sister, husband, wife, child, cousin, partner,  or a close friend.

 

You can not just ring on the door of your healthy neighbor Joe and ask him for poop.
"
- Hi Joe, how are you?  Beautiful day today!  You look really healthy!
- Hey, I need some of your poop.
- But, before you give it to me,  are you HIV negative?  Cause,  if you are positive, I don't really need it.

By the way, I have a few more questions for you:
- Are you promiscuous?  Do you practice safe sex? Do you practice anal sex by any chance?
- How long time since your last STD test?
- Have you used any antibiotics lately?
- Do you often have diarrhea? 
- Are you often constipated?  Are you often bloated ? Do you often fart?
- Do you scratch your anus often?
- Have you ever traveled to Brazil? Have you been swimming in Amazons?

- If the answer to any of those questions is Yes,  then just forget it ... I don't  need your poop, I will ask the girl next door.

"

So, it is obvious,  a donor has to be someone who will not call police after you ask him/her all of those and 100 of other similar questions ... :-)

 

 

Why are antibiotics so bad?

Antibiotics have a terrible side effect:  they alter bowel microbiota, changing it from healthy microbiota to unhealthy.

Antibiotics are the main cause or the main causative cofactor of chronic diseases like:  candidiasis, chronic diarrhea, constipation, chronic clostridium difficile infection, IBD, IBS, eczema, bad body odor, leaky gut syndrome, psoriasis, chronic acne, peeling lips, digestive problems, inflammatory bowel disease, Parkinson's disease, Multiple Sclerosis, etc.


FECES

You really need fresh feces (not older then 12 hours). You can also refrigerate fresh feces, and use it the next day, but the best is if you can get a hold of fresh feces.
You can also use a Tupperware box or any other similar plastic box to store the feces in your refrigerator.  But, fresh is the best.
So, be nice to your donor!

FMT screening questionnaries?

The gut microbiome affects the entire body, is shaped by genetics, and affects genetic expression. Happiness, intelligence, & athleticism are some of the best signs. Younger is typically better since dysbiosis increases with age, and is looking to be the cause of most diseases associated with aging (as well as most diseases in general). The ultimate donor is probably something like a 2-18 year old Michael Jordan, or a guy like this who is both physically and mentally very fit: https://i.imgur.com/JXM5asg.jpg

The following is not exhaustive. If you think of something else please include it. If there is something you don't want to disclose then please state that, instead of being untruthful about it.

For example, one person contracted their donor's sweet tooth, another person started having sleeping trouble after their FMT, others have contracted obesity from their obese donors, another contracted their donor's cramping issues, ear issues, some body odors, food intolerances, etc..

Based on current knowledge, kids are ideal donors for 3 reasons:

1) Dysbiosis increases with age, often including an onset at puberty.
2) Less likely to have taken antibiotics.
3) They're unlikely to have picked up an STD

Babies/toddlers might work but are a bit more risky since it's harder to judge their health & development till they get closer to adolescence. For these cases the health & diet of the mother becomes more important: https://www.reddit.com/r/HumanMicrobiome/wiki/maternity

FMT screening questionnary for an Adult Donor

Please see this stool chart and note your stool type: https://upload.wikimedia.org/wikipedia/commons/9/9e/BristolStoolChart.png

How consistently are your stools each type?
Are there foods that cause changes in the type of stool you have? If so, which foods cause what changes?

Have you had past/recent blood tests? Any abnormal results?

History of, or known exposure to, HIV, HBV or HCV, syphilis, human T-lymphotropic virus I and II, malaria, trypanosomiasis, tuberculosis?
Tattoo or body piercing within previous 12 months?

Incarceration or history of incarceration?

Known systemic infection or current communicable disease?

Previous reception of blood products?

Recent (<12 months) needle stick accident?

Recent medical treatment in poorly hygienic conditions?

Risk of transmission of diseases caused by prions?

Recent parasitosis or infection from rotavirus, Giardia lamblia and other microbes with GI involvement?

Recent (<12 months) travel in tropical countries, countries at high risk of communicable diseases or traveler's diarrhea?

Surgeries or hospitalizations?

Breast fed? For how long?

Vaginal birth or c-section?

Health status/fitness of self? Including physical fitness, body fat percentage, etc..

Health status/fitness of parents and siblings?

Any diseases or illnesses that run in the family (Alzheimer's, cancers, depression/suicide, heart failure, etc.)? If parents have health problems, at what ages did they develop?

Any congenital/birth defect/disease of self or immediate family members?

What's your current diet like, and your dietary history (especially as a child)?

Any food cravings? Any food intolerances?

Allergies?

Please list all instances of antibiotic, antiviral, or antifungal usage, and at what ages and duration taken.

Any drug use?

Probiotics, medications, supplements?

Risky sexual behavior (anonymous sexual contacts; sexual contacts with prostitutes, drug addicts, individuals with HIV, viral hepatitis, syphilis; work as prostitute; history of sexually transmittable disease, unprotected sex with untested partners)? If so, how frequent/recent?

Smoked or lived with smokers?

Issues with sleep such as insomnia, frequent waking during night, nightmares, sleep paralysis, etc.? Do you dream every night and remember them when you wake?

Skin (dryness, excess sweating, rashes, eczema, dandruff, dermatitis, etc.)?

Any problems with hair, eye sight, teeth/mouth, ears/hearing, body odors including bad breath, weight/fitness issues, sex drive, heart, lungs/breathing, bladder, hormonal, any kind of sensitivities.

Mental/emotional health, happiness, mood, anxiety, depression, or any other neurological or psychiatric conditions?

Have A's in class always came easy?

Joint/muscle pain/stiffness?

Digestion: issues with constipation/diarrhea, gas, overly foul BMs, acid reflux, ulcers, heartburn, etc.?

Any addictions or addictive behavior?

Do you get sick often? When under stress?



FMT screening questionnary for a Child Donor

A child should be at least 3 years old, to be a perfect donor. It takes up to 3 years for microbiom to fully develop.

This summary & list of studies give a good idea of the kind of things that affect a child's health: https://redd.it/4ilwfb

Please see this stool chart and note your stool type: https://upload.wikimedia.org/wikipedia/commons/9/9e/BristolStoolChart.png

How consistently are your stools each type?
Are there foods that cause changes in the type of stool you have? If so, which foods cause what changes?

Have you had past and/or recent blood/medical tests? Any abnormal results?

History of, or known exposure to, HIV, HBV or HCV, syphilis, human T-lymphotropic virus I and II, malaria, trypanosomiasis, tuberculosis?

Known systemic infection?

Previous reception of blood products?

Recent (<6 months) needle stick accident?

Recent medical treatment in poorly hygienic conditions?

Risk of transmission of diseases caused by prions?

Recent parasitosis or infection from rotavirus, Giardia lamblia and other microbes with GI involvement?

Recent (<6 months) travel in tropical countries, countries at high risk of communicable diseases or traveler's diarrhea?

Surgeries or hospitalizations?

Breast fed? For how long?

Vaginal birth or c-section?

Health status/fitness of self? Including physical fitness, body fat percentage, etc..

Health status of siblings?

Any congenital/birth defect/disease of self or immediate family members?

Current diet & dietary history?

Any food cravings? Any food intolerances?

Allergies?

Please list all instances of antibiotic, antiviral, or antifungal usage, and at what ages and duration taken.

Prescription or OTC drugs or supplements?

Issues with sleep such as insomnia, frequent waking during night, nightmares, sleep paralysis, etc.? Do you dream every night and remember them when you wake?

Skin (dryness, excess sweating, rashes, eczema, dandruff, etc.)?

Any problems with hair, eye sight, teeth/mouth, ears/hearing, body odors including bad breath, weight/fitness issues, heart, lungs/breathing, bladder, hormonal, any kind of sensitivities.

Mental/emotional health, happiness, mood, anxiety, depression, or any other neurological or psychiatric conditions?

Have A's in class always came easy?

Joint/muscle pain/stiffness?

Digestion: issues with constipation/diarrhea, gas, overly foul BMs, acid reflux, ulcers, heartburn, etc.?

Any addictions or addictive behavior?

Do you get sick often? When under stress?


FMT screening questionnary for a father as a donor

 (microbiomes run in families, are passed down from both parents (see zika for recent & popular example), and are shaped by genetics):

Health status/fitness?

Have you had past and/or recent blood/medical tests? Any abnormal results?

Surgeries or hospitalizations?

Any diseases or illnesses that run in the family (Alzheimer's, cancers, depression/suicide, etc.)?

Any congenital/birth defect/disease of self or immediate family members?

Food intolerances?

Chronic digestion issues?

Allergies?

Chronic sleep issues?

History of antibiotic, antiviral, or antifungal usage? How near to time of conception of child?

Drug use around time of conception?

Skin (dryness, excess sweating, oily, rashes, eczema, acne, dandruff, etc.)?

Mental/emotional health, happiness, mood, anxiety, depression, or any other neurological or psychiatric conditions?

Joint/muscle pain/stiffness?

Addictions or addictive behavior?

Hormonal issues?



 

FMT screening questionnary for a mother as a donor

Health status/fitness?

Have you had past and/or recent blood/medical tests? Any abnormal results?

Surgeries or hospitalizations?

Any diseases or illnesses that run in the family (Alzheimer's, cancers, depression/suicide, etc.)?

Any congenital/birth defect/disease of self or immediate family members?

What's your current diet like, and your dietary history (especially around conception, birth, & breast feeding)?

Any food intolerances?

Allergies?

History of antibiotic, antiviral, or antifungal usage? If so, at what ages and before/after which kids?

Any drug use? While pregnant/breast feeding?

Issues with sleep such as insomnia, frequent waking during night, nightmares, sleep paralysis, etc.?

Skin (dryness, excess sweating, rashes, eczema, dandruff, etc.)?

Weight/fitness issues, heart, lungs, bladder, etc., hormonal, any kind of sensitivities.

Mental/emotional health, happiness, mood, anxiety, depression, or any other neurological or psychiatric conditions?

Joint/muscle pain/stiffness?

Chronic digestion issues?

Addictions or addictive behavior?

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Related links

• Bacteriotherapy - Development and Delivery of a Treatment for Clostridium difficile
• Video: ABC TV Catalyst, 14 July 2011 - Fecal Bacteriotherapy for Clostridium difficile infection
• Fecal Microbiota Transplant and It's Emerging Medical Applications
• Microbiome talk by Jonathan Eisen on TEDMED 2012
• The Power of Poop: Patient FMT Information & Advocacy Site
• The Fecal Transplant Foundation