Faecal transplant is considered the best treatment for one of the most dangerous intestinal infections around, and it is being tested as a potential cure for many other illnesses.
But these transplants require that healthy people donate stool samples, and a new study shows that expanding the donor pool could be challenging.
People who might donate their faecal matter on a regular basis would be largely motivated by altruism, but inconvenience and the "ick factor" pose significant obstacles to regular donation, said lead researcher Breanna McSweeney, medical student at the University of Alberta.
"A lot of people would be discouraged to donate by the logistics of actually going to do all of this," McSweeney said. "That's a big barrier we have to get around if we're going to get more stool donors."
What is a faecal transplant?
Faecal microbiota transplant involves transplanting purified faecal matter from a healthy donor, to help establish colonies of healthy bacteria in the guts of sick patients.
Faecal transplant currently is used as a treatment for infection with Clostridium difficile, an opportunistic bacterium that can cause life-threatening diarrhoea if it gains a foothold in the gut. C. difficile can grow out of control if heavy use of antibiotics kills off too many "good" bacteria in the intestinal tract.
C. difficile caused almost half a million infections among patients in the United States in a single year, and an estimated 15 000 deaths are directly attributable to C. difficile infections, a 2015 study from the US Centers for Disease Control and Prevention found.
Unfortunately very little research exists on the amount of South Africans affected by C. difficile. According to the South African Medical Journal, in South Africa there's 1 gastroenterologist for every 1 000 000 people and only a handful perform faecal transplants. The stool donations for these transplants are received from the patient's family members or friends, as there are no stool donation banks in South Africa.
Altruism main consideration
Faecal transplant is also being researched as a possible treatment for diseases such as irritable bowel syndrome, McSweeney added.
To see what might motivate people to donate stool, McSweeney and her colleagues surveyed 802 people at colleges in Canada, the United States and the United Kingdom.
More than three out of four people said altruism would be their main reason to consider being a stool donor.
"Those who already were blood donors were more likely to be willing to donate stool," McSweeney said.
People also said they'd be more likely to donate if they knew how stool donations were benefiting others.
Stool pool running low
However, there are some sizable barriers to donation, the survey found.
"If they found collecting their own stool unpleasant, they'd be less willing to donate, which is a big factor," McSweeney said.
People also said they'd be discouraged by all of the hurdles one must undertake to donate stool.
Potential stool donors currently must fill out a questionnaire similar to that of blood donors, and undergo blood and stool tests prior to their donation to "make sure you aren't giving anyone stool that could harm them," McSweeney said.
For example, the first US stool bank, OpenBiome, requires that donors fill out a 200-point clinical questionnaire and take more than two dozen blood and stool screens.
Dr Colleen Kelley is an assistant professor of gastroenterology with the Warren Alpert Medical School of Brown University. "There is a very high bar to be a stool donor," she said. "OpenBiome rejects 97% of the donors who apply."
Further, donors must repeat the health assessment every two months to make sure they haven't contracted an illness that would affect the quality of their stool, according to the OpenBiome website.
Regular bowel movements
Potential donors also were discouraged by the fact that they would have to swing by a hospital to donate, McSweeney said. Unlike blood banks, stool banks currently are not in a position to hold collection drives at remote locations.
Finally, donor burnout appears to be very likely. "We found that even donating once a month, people found that quite inconvenient for them," McSweeney said.
Kelley pointed out that "some stool banks do the donation right in the centre, after a donor is approved. And they typically have the person come back in for a few days in a row since they have just been screened. So, these participants need to have regular bowel movements."
Cash can help overcome reluctance. People said they'd be more willing to donate if they were paid $15 (R198) to $25 (R330) for a donation; OpenBiome currently offers $40 (R528) per donation.
McSweeney recommends that stool banks target blood donors as potential new donors, and offer cash payments per donation to keep them coming regularly.
"As studies come back showing that faecal transplant is beneficial for more conditions, most likely we're going to need more donations," McSweeney concluded.
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