How do you select a donor for Fecal Transplant

13 January 2012

I recently got a question from a reader about selecting a donor to do the Fecal Transplant for Crohn’s Disease or Ulcerative Colitis.

Q:

Can you post something about how you collected a sample from a friend? I am mortified about the social part. I would also like to make it the physical process as easy for them as possible (could get a sample kit from a medical test package, I guess). Do you have suggestions? How did you choose a donor? How much to collect to make it worth all the trouble, etc.? Any input on all these things as I and others try to figure this out would be wonderful. Thanks and good luck to you.

A:

Hi,

I asked a very good friend of mine who I knew to be pretty open-minded to become my roommate with this plan in mind. He was well aware of the toll this illness had on me and is very comfortable with his body.

You basically need to live with or very nearby the person who you are going to do this procedure with because stool needs to be used immediately or you can put it in the refrigerator for a few hours. I just got my donor to put it in a little glad ware container, basically just like someone would do if they were collecting a stool sample for testing. It was easy and painless.

Immediate family members are often picked as donors, however author Sky Curtis

explained to me that anyone with good regular bowel habits could be a good donor. I realized that even the healthiest person in my family did not always have perfectly regular bowel habits. I also did not want to have to move back to the smaller town I grew up in to use my immediate family members as donors.

So I just needed a person with regular bowel habits I also read some research that said the donor should have a similar body type as you and / or be thin (which I am). Of course you also want to make sure that your donor does not have pathogenic intestinal bacteria or STDs that can be transmitted through blood like Hepetits, AIDS or Syphillis. I got my donor to fill out a lengthy questionaire which covered which illnesses or medical conditions that had had, where they have traveled to, and lifestyle which included sexual history and behavior. Based on the answers to the questionaire there was no reason to suspect that my donor was anything but a very good donor.

This is not to say that you shouldn’t have your donor tested for the for the generally recommended tests (“Success of Self-Administered Home Fecal Transplantation for Chronic Clostridium difficile Infection,” Silverman et. al 2010) which include HIV, human T-lymphotropic virus I/II, syphilis, hepatitis A, B and C antibody, and Helicobacter pylori antibody among others. Some also advocate testing for many other parasites or bacterial infections, most of which are unlikely to occur in someone who has not traveled outside the industrialized world or has any symptoms.

However I discovered that these tests were expensive to pay out of pocket, had to be requested by a doctor for a lab to do them, and also based on the medical history of my donor and epidemiology statistics there was no reason to suspect he would have any of these diseases. So I did not have my donor’s stool tested. Later to appease one of my doctors I did have a full screen for intestinal pathogens and the tests were negative, just as they had been in the past before undergoing the fecal transplant.

However the odds of a straight, caucasian man who is not an intravenous drug user having Hepetitis, Syphillis or AIDS in the U.S. or most of the industrialized world is very low if you look at the epidemiology rates. Also most bacteria or parasites in stool would cause active diarrhea in the carrier who has it. So if they don’t have the symptoms and / or have avoided known behavior that would make them likely to be infected they probably are not.

So for about 5 weeks my donor faithfully pooped in a glad ware container and put it in the fridge if I weren’t home at the time. Ideally you would do the fecal transplant everyday at roughly the same time, however I didn’t. Also some treatment protocols say that it only takes 5 days or even once or twice. Others like Sky Curtis assured me that 4 months were necessary. My experience was this, I did it for 5 weeks and then did not do anymore. Then I added various drugs into the mix. Over time I kept getting better, minor flares still happened but each one was less severe and shorter in duration than the one before it.

I speculate that this could be because there were still some pathogenic bacteria possibly like MAP bacteria that had become active and then had to be gotten under control by the bacteria in the colon. However since I was using drugs that slowed diarrhea and strengthened the immune system (see other posts about Doxepin, Bupropion and Low Dose Nalrexone) and provided bowel rest and adequate nutrition (meal replacement shakes like Muscle Milk) I was able to keep going and I assume that the healthy bacteria and my immune system were able to fight off any possible inflammation triggering infections.

If I had it to do over again there are some things I would do differently.

1) I would do a course of anti-biotics like Vancomycin, Flagyl or Cipro to wipe out all existing bacteria. Even if this did not help treat the infection it would reduce the number of competing bacteria and help the new bacteria colonize faster. This might also reduce some of the bloating that I felt which could have been due to the new bacteria competing for dominance in the colon.

2) I would do a full bowel prep like for a colonoscopy. This could also help clear out existing bacteria to make it easier for the new bacteria to colonize.

3) I would continue on a maintenance medication like Apriso and also Mesalamine Suppositories. This could help reduce inflammation and speed up the process of the new bacteria colonizing.

4) I would start on drugs to reduce Irritable Bowel Syndrome symptoms like diarrhea and muscle spasms like anti-anxiety drugs or anti-depressants at the time of starting this procedure. It took me until after I had finished doing the transplants.

5) Low Dose Naltrexone may also be very helpful starting at about the same time as the transplants if not before since it can help strengthen the immune system.

6) Bupropion could also help for some of the same reasons and because it may reduce inflammatory response because it is a TNF-a inhibitor.

And above all else keep the faith, this takes time as you get better and it’s not a smooth uphill ride. You will still have some flares along the way, but by the end of about 4 – 6 months your symptoms will be almost completely gone.

How do you select a donor for Fecal Transplant

Q:

A:

If I had it to do over again there are some things I would do differently.

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