Here\'s Why People Are Donating to Science

 Anna Medaris Miller

STUDENTS AT PRESTIGIOUS Boston-area schools aren't typically used to rejection. But that's exactly what most experience if they apply to become donors at OpenBiome, the only public (and largest) stool bank in the U.S., which advertises near its Somerville, Massachusetts, location. The bank accepts less than 3 percent of applicants.

"It's harder to be a stool donor at OpenBiome than it is to be accepted into Harvard or MIT – that's the level of rigor it takes," says Dr. Majdi Osman, an internal medicine physician and the nonprofit's clinical program director. That's because most of the chosen stool will eventually end up in someone else's colon; if it's not carefully screened, the recipient could wind up with any number of medical conditions with potential links to the microbiome.

"We take a very cautious approach," Osman says. Specifically, donors first answer a simple questionnaire; if they've recently taken antibiotics or traveled somewhere deemed risky, for example, they're out. If their body mass index or alcohol intake is too high, or if they're older than 50, they can stop right there.

If they make the initial cut, they meet with a clinician who asks them 200 questions getting at other topics like if they have a history of depression. The condition, as well as anxiety, allergies, asthma and eczema are among the most common reasons applicants are ruled out, Osman says. After all, plenty of research has found strong links between mood disorders and gut bacteria, although it's not clear what causes what.

Folks who make it past both sets of questionnaires then give a blood and stool sample for final evaluation. Those deemed all clear become stool donors – at least three times a week over a period of 60 days, they'll stop by OpenBiome, pop a squat and go about their days. Their samples, which earn them $40 each, get turned into medical treatments for patients or tested in labs.

"Our donors love it," Osman says, because they can make a difference in science and people's health simply by doing something they do every day. "Many donors," he adds, "end up being donors for many months."

A Brief FMT History

Why would someone else want your? Most likely because he or she has a Clostridium difficile infection, a common but severe bacterial infection that most often strikes older people or others with long hospital or health care stays. The condition, which can cause debilitating diarrhea and other potentially life-threatening complications, is highly treatable with a fecal microbiota transplant, or FMT.

The procedure is typically done via colonoscopy and results in the patient hosting someone else's fecal matter – and thus healthy gut bacteria – in his or her colon, explains says Dr. John DiBaise, a gastroenterologist at the Mayo Clinic in Phoenix. While invasive, it's a very safe procedure when administered in health care facilities with appropriately-screened donors, he says.

Before banks like OpenBiome, though, donor stool was tougher to come by – leaving patients who didn't respond to antibiotics miserable and even putting their lives at risk in the most severe cases. Some would turn to their family and friends for stool. Today, people are increasingly relying on anonymous donors, DiBaise says, and they're not just getting donations from stool banks, either.

At the Mayo Clinic and some other health care facilities, for example, most FMT donor material comes from staff members who've been cleared of conditions like chronic gastrointestinal illnesses and even behaviors like getting tattoos or engaging in risky sexual activity that could put them at risk for communicable diseases. "It's people we're familiar with, and they see this as an opportunity to help someone," DiBaise says. "They gotta go – they might as well give it to somebody."

Even people who don't have stool donation opportunities nearby, or who don't qualify to donate stool for FMT can use their bowel movements for a greater good. American Gut, for example, is a crowd-sourced project located at the University of California-San Diego that collects stool samples and survey information from anyone who wants to send it via a kit the project provides. After de-identifying the samples (so donors remain anonymous), the team sequences the microbial data and health and lifestyle information, and makes it available to anyone who wants to study or analyze it. The goal? "To characterize the human microbiome," according to the website.

Small Steps Forward

Eventually, all this, um, crap, may turn into something revolutionary. Researchers are using samples to study FMT's effectiveness in treating everything from irritable bowel syndrome and ulcerative colitis to depression and autism to diabetes and obesity. For example, research has shown that germ-free mice that receive fecal transplants from obese mice end up gaining much more weight than ones that receive fecal transplants from lean mice. One case study of a woman who received a fecal microbial transplant from her daughter to treat C-diff recorded a rapid 34-pound weight gain post-transplantation that mirrored her daughters'.

Still, it's too early to draw conclusions, says Dr. Amir Zarrinpar, an assistant professor in the University of California-San Diego's division of gastroenterology, who studies how microbiome fluctuations affect metabolism, obesity and diabetes. "Could FMT be used to treat obesity? Not now, but maybe," he says. There's more promise, he believes, in using research like his for something like creating "engineered probiotics," or safe bacteria that could be altered to, say, release a hormone that makes you feel full. "Instead of a patient taking a fecal transplant where they're getting a whole bunch of stuff – some beneficial and some not – with engineered bacteria, we can be more precise about what we want to create," he says.

No matter how exciting, the important thing, experts emphasize, is to let the pros decide when and how to turn the research on FMT's effectiveness into treatments. "With the cost of health care and the fact that [FMT] has been so safe, it's very tempting for people to do this at home," Zarrinpar says. "But it’s safe because we do such a good job of screening the donor."

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