Everything You Need To Know About Faecal Transplants

Photographed by Ruby Woodhouse.
It's tough to have a conversation about faecal transplants without having some very vibrant imagery pop into your head. It sounds like something the Goop crowd would be into, along with coffee enemas and vaginal steams. Indeed, Goop has written about whether or not "transpoosions could save us all," which could definitely give some skeptics pause. But faecal transplants are way more than a wellness trend, and they're seen as a promising treatment for certain gut infections.
Faecal microbiota transplantation (FMT) is the transfer of faeces from a healthy donor into the colon of someone who's sick, explains Scott Olesen, PhD, scientific director at OpenBiome, a nonprofit stool bank that conducts research and works with clinicians to facilitate FMT. Specifically, we know that FMT can be helpful in treating C.Diff, a serious and sometimes fatal gut infection caused by bacteria. The belief is that FMT can help "re-shape the environment of the gut," he says. In clinical trials, FMT has been shown to resolve 80-90% of recurrent C.Diff, and that's major.
To be clear, faecal transplants are not just another unconventional wellness measure to add to your gut health routine, such as taking probiotics, eating fibre, or drinking kombucha, Dr. Olesen says. "FMT is in a different category, because it’s a serious medical procedure," he says. "It shouldn’t be thought of as a wellness treatment, because it has very few known applications, and they're for serious conditions." As FMT becomes buzzier, you may have even more questions. Here, Dr. Olesen gives us the tea on FMT:

What is a faecal transplant?

A faecal transplant is a procedure in which a healthy person’s stool is transplanted into the colon of someone who’s sick, in order to repopulate it with a diverse array of microorganisms, Dr. Olesen says.

How does FMT work?

Essentially, it starts with a pre-screened donor who delivers a healthy stool. Then, that material is sent to a manufacturing facility, where it's processed and put into containers that allow it to be shipped, Dr. Olesen says. "We provide it to one of our clinical partners, and depending on the formulation, the material can be delivered in a few different ways to the patient," he says.
The main formulations that microbiota can be prepared and packaged in are via a colonoscopy, a feeding tube, or oral capsules. "A common one is through colonoscopy," Dr. Olesen says. "So, the FMT material is loaded into an endoscope, and delivered into the patients' colons."

Can you make money selling your poop?

Becoming a stool donor is much more time-intensive than, you know, making your standard at-home faecal donation into the toilet, or even donating blood. First, donors have to apply and go through a rigorous screening process to make sure that their stool doesn't contain anything that could be potentially dangerous, such as bacteria, funguses, or viruses, Dr. Olesen says. Anyone with a family history of microbiome-related diseases would be ruled out, too. "We set them aside, because there's some possibility that stool could transfer that disease," he says. Only about 3% of people will make it through the program and become donors. Once accepted, donors have to make deposits a couple times a week, which they get paid $40 (£32) for. "We’re very thankful for our donors and we provide them some compensation for their time," he says.

Does insurance cover FMT?

Insurance companies haven't caught up to FMT quite yet. Technically, FMT is considered an "investigational new drug," meaning it hasn't been through the typical FDA approval pipeline, Dr. Olesen says. "Sometimes insurance isn’t familiar with it, and it’s harder to know if they should provide coverage," he says. OpenBiome aims to provide materials in the most affordable way possible, so that patients have access to high-quality treatments that are safe. To give you a sense of the cost, the prepared formulations can cost between $1,595 (£1,227) and $1,950 (£1,500) per dose.

Are faecal transplant procedures safe?

When FMT is performed by a physician, according to medical guidelines and standard medical procedures, then it appears to be very safe, Dr. Olesen says. "There are ways FMT can be really dangerous, for example, if you perform it yourself, or if you use a donor who hasn’t been well screened," he says. While a DIY faeces transplant might make you giggle, it shows the extreme measures people will go to when they're desperate to find relief from gut infections, he adds.

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