Frequently Asked Questions about Fecal Transplantation
What is fecal transplant?
Your body has a lot of necessary (good) bacteria in its gastrointestinal (GI) tract. Fecal transplant involves taking stool from a healthy person and transferring it into a person suffering from a disease caused by reduced amounts of the necessary (good) bacteria. Fecal transplant is most commonly used as a treatment for a disease caused by overgrowth of a (bad) bacteria called Clostridium difficile (or C diff) when standard therapies have failed.
How does fecal transplant work?
Our GI tract contains thousands of different bacteria and other microorganisms which are essential to maintaining health. Antibiotics can disrupt these bacteria and allow disease-causing bacteria such as C diff to flourish. Fecal transplant involves transferring the necessary (good) microorganisms from a healthy donor into a patient with C diff infection. These bacteria then begin to grow in the patient’s colon and prevent C diff from overgrowing again.
How is the transplant performed?
Colleen Kelly, MD, gastroenterologist at the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative, introduces a solution of donor stool and saline into your GI tract during a colonoscopy. Other methods which have been successfully used elsewhere (and which may be considered in select patient cases) include fecal enemas and infusion through a nasogastric (nasal) tube into the upper part of your GI tract.
What is the success rate?
Controlled clinical research studies looking at fecal transplant success rates have yet to be completed, so we do not have that type of data. However, there are over 200 case reports in the world’s medical literature to date, reporting an overall success rate of 90 - 95%. Links to these publications are available for physicians or patients to review upon request. Kelly has treated more than 80 patients with relapsing C diff over the past four years and has had a similar success rate in her experience.
Is fecal transplant safe?
Proper donor screening and testing is essential. Donors complete a screening questionnaire similar to that which is done at blood banks and for organ or tissue transplants. Prospective donors with risk factors for HIV and viral hepatitis are excluded from donating. Persons with significant gastrointestinal or autoimmune disease or a history of malignancy are not acceptable donors. Donors who meet the criteria undergo blood work testing for HIV, hepatitis A, B and C, and syphilis. They are also asked to submit stool to be tested for bad bacteria (such as salmonella), parasites, and clostridium difficile. Patients are asked to sign a consent form acknowledging the risks of undergoing a colonoscopy as well as theoretical risks related to the fecal transplant itself (infection, allergic or immune reaction, or other disease transmissions).
Am I a candidate for the fecal transplant procedure?
Kelly performs fecal transplant for patients who are suffering from recurring C diff. In general, her patients have had at least three recurrences of C diff and have failed at least one tapering course of the antibiotic Vancomycin. Patients who have experienced two more severe episodes of C diff infection (admitted to an intensive care unit) are also possible candidates. At this time Kelly is not performing fecal transplant on patients for irritable bowel syndrome (IBS), inflammatory bowel disease (ulcerative colitis or Crohn’s) or other conditions outside of C diff.
Who should be my donor?
The best donor is somebody in good health who has not taken any antibiotics for at least 90 days. Most patients chose an immediate family member, although the donor does not necessarily have to be related to the recipient.
We have stool from a healthy volunteer available if you do not have a donor.
What kind of screening tests are needed? Are these tests covered by the donor’s health insurance?
Feces are a "bodily fluid" and proper donor screening and testing is essential. Donors complete a screening questionnaire similar to that which is done at blood banks and for organ or tissue transplants. Prospective donors with risk factors for HIV and viral hepatitis are excluded from donating. Persons with significant gastrointestinal or autoimmune disease or a history of malignancy are not acceptable donors. Donors who meet donor criteria undergo blood work testing for HIV, hepatitis A, B and C, and syphilis. They are also asked to submit stool to be tested for parasites and clostridium difficile.
Donors are cautioned that their health insurance may not cover the costs of these screening tests, which may amount to several hundred dollars.
How much does a fecal transplant cost? Is it covered by my health insurance?
There is no "fee" for the fecal transplant itself. The procedure is performed during a colonoscopy or sigmoidoscopy which is usually indicated for patients suffering from chronic diarrhea and recurring C diff infection. Most insurance plans cover the costs of the patient’s laboratory testing and the colonoscopy. However, to be sure, patients are urged to check with their insurance company to get detailed information about co-pays, deductibles and requirements for referrals, especially regarding out-of-network or out-of-state providers.
My family member is very sick in the hospital with C difficile. Can Kelly help?
Within Rhode Island, Kelly provides consultative service at The Miriam Hospital, Rhode Island Hospital and Women & Infants Hospital. Unfortunately, she is not able to see patients at other hospitals nor can she accept patients or arrange to transfer the care of a patient from an outside hospital.
I can't find a doctor in my area who performs fecal transplant. My doctor may be willing to perform fecal transplant, but isn't sure how. Can you help?
Colleen Kelly, MD, is happy to speak with other physicians interested in performing the procedure and share her protocol. She can also make arrangements to perform fecal transplant on patients from out of state who come to Rhode Island for the procedure.