Ensuring a Safe FMT: Donor Screening and Testing – The Donor's Perspective

Disclaimer: Openbiome is no longer taking stool donations. Learn more here.

Fecal Microbiota Transplantation (FMT) offers a revolutionary treatment for various gut-related conditions, but while recipients stand to benefit immensely, what about the donors? 

Well, you could be making a "shit ton of extra cash for your... shit," as we've previously discussed in our blog about becoming a poop donor.

In this extended piece, we'll add a unique angle—viewing the donor screening and testing process from the donor's perspective. What qualifications do you need? How is your stool used? And most importantly, is it worth it?

Why Your Poop is Gold

The Demand for Healthy Stools

FMT is mainly used for treating a dangerous bacterial infection known as C Diff, where it has a 90% effectiveness rate. Because of its promising results in C Diff and its potential for treating other chronic diseases like:

The demand for healthy stool is surging, and stool donations are increasingly becoming valuable for medical research and treatment.

Financial Incentives

While many stool banks operate strictly on a volunteer basis, some, like OpenBiome in Boston (no longer operating), do pay for your contributions. This provides a financial incentive for those who are eligible to donate. 

So, how do you qualify?

Watch how a Harvard student earns money by donating his stool to Open Biome.

Stool Donor Qualifications

Ensuring a safe FMT through rigorous donor screening and testing is non-negotiable. It's a vital process that safeguards both the donor and the recipient while maximizing the efficacy of the FMT treatment

Who is Eligible?

Only some people can be a stool donor. In fact, OpenBiome reports that only about 3% of applicants make it through their screening process. 

To ensure the safety and efficacy of the FMT treatment, donors need to be in excellent gastrointestinal health. 

Any of the following could disqualify you:

  • Unhealthy or irregular stool (ranking beyond 3-5 on the Bristol Stool Chart)
  • Inflammatory bowel disease, irritable bowel syndrome, or other gastrointestinal issues
  • History of chronic diseases or allergies
  • Recent risky behaviors, such as illicit drug use or high-risk sexual behavior
  • The use of antibiotics in the last three months

How Are Donors Screened and Tested?

Ensuring that your donor is not only healthy but also carries a diverse microbiota can significantly influence the effectiveness of the transplant. A poorly screened donor can jeopardize the treatment's success and might even introduce harmful pathogens into the recipient's system.

FMT Preliminary Questionnaire

The first step in donor screening involves completing a comprehensive questionnaire. This step captures details about the donor's medical history, lifestyle, and any potential risk factors that could compromise the quality of the fecal material.

Some facilities may also conduct an in-person or virtual interview to assess the donor's suitability for the procedure.

FMT Laboratory Tests

After passing the preliminary questionnaire, donors undergo a series of laboratory tests. These tests screen for pathogens, harmful bacteria, and parasites in blood and stool samples. The aim is to rule out any potential contaminants that could harm the recipient.

Type of Test

What it Screens For


Blood Tests

HIV, Hepatitis, and other blood-borne pathogens

Ensures donor is free from systemic infections

Stool Tests

Parasites, harmful bacteria, and other pathogens

Verifies that the stool is safe for transplantation

Microbiota Analysis

Diversity and health of gut flora

Assesses the potential effectiveness of the FMT

Continuous Monitoring For FMT Donors

Even after successful initial screening, donors are monitored continuously to track any changes in their health status. This ensures that each FMT procedure using their material will be as safe and effective as possible. The rigid screening process is one reason why FMT has a high safety profile for treating gut-related conditions.

FDA’s Stance on FMT

Due to evolving FDA guidelines, the screening process for FMT has become increasingly strict. This is to ensure that both donors and recipients can have confidence in the FMT process. 

On April 26, 2023, the U.S. Food and Drug Administration (FDA) made a groundbreaking decision by approving the first orally taken fecal microbiota product, Vowst. This development marks a significant step forward in treating recurrent Clostridioides difficile infection (CDI), among many other conditions.

So, why does the FDA care about your poop and its impact on health and the microbiome?

Why is Donor Screening Essential?

  1. Ensuring Treatment Efficacy: The FMT procedure's success largely depends on the quality of the donor material. A well-screened donor contributes to a balanced microbiome

  2. Patient Safety: Rigorous donor screening is crucial for minimizing the risk of transferring harmful pathogens or bacteria to the recipient.

  3. Building Public Trust: The thoroughness of the donor screening process builds confidence in FMT as a viable treatment option. It enhances the treatment's credibility and encourages more people to consider it an alternative to traditional methods.

Addressing Concerns About Long-Term FMT Side Effects

What Can You Tell Concerned Family and Friends?

Many potential stool donors face questions from family and friends about the long-term side effects of FMT. While it's natural to have such concerns, it's equally important to rely on credible information.

According to Luca, a Gut Health Advocate from Injoy

"While research has shown FMT to be a safe and effective treatment for inflammatory bowel disease (IBD), it's understandable to have questions about long-term effects. … Although the long-term side effects are not fully known, they are likely to be minimal or rare. Donors undergo rigorous screening to ensure the stool is safe for transplantation. The most common side effects are mild and transient, such as fever, bloating, nausea, or diarrhea. However, ongoing studies are necessary for a comprehensive understanding of long-term safety."

Practical Tips for FMT Recipients

  1. Consult Your Doctor: Always consult your healthcare provider for tailored advice. They can provide you with the most accurate and personalized information.

  2. Know the Source: Ensure your FMT provider follows FDA guidelines and conducts rigorous donor screening. This can make a significant difference in the safety and effectiveness of your FMT. Here is a list of recruiting FMT studies.

  3. Be Informed: Stay updated on where you can get a stool transplant and understand your gut health to make a more informed decision. The more you know, the better choices you can make.

Wrapping Up: The Donor's Role in the FMT Process

FMT provides a fascinating two-sided benefit. While recipients get a chance at better health, donors get to contribute to this medical revolution and potentially receive financial rewards. 

By taking these steps, you are setting the stage for a safer and potentially life-changing FMT procedure. 

So, if you're interested in becoming a donor, check out places like OpenBiome or any University with a medical research wing. Your contribution could make a significant impact.

Upcoming Designer Shit Documentary

If you found this article insightful, you won't want to miss our upcoming documentary on FMT.  

This eye-opening film will dive deeper into the science behind fecal microbiota transplantation and share real-life stories of people who have undergone the procedure.   ‍  

"In the end, our goals with this film are to give a voice to those suffering from chronic illnesses and to help alleviate some of the shame and embarrassment around something we all deal with every day."

–– Saffron Cassaday, Director

To stay current on the documentary's release and receive more valuable information on gut health, subscribe to our newsletter.  

‍Together, we can continue to learn and share knowledge about the fascinating world of the human microbiome and its impact on our health.