Building a poop bank for human fecal transplants

The TV series Transplant (now streaming on Peacock!) is a clever play on words referring to its central character, Dr. Bashir “Bash” Hamed’s status as both a refugee and an emergency medical doctor, a practice which often involves transplantation of organs and other tissues.

Most people are familiar with the practice of transplanting organs, bone, ligaments, skin, and other tissues. Something you may be less familiar with, however, is the less-discussed practice of transplanting feces. While it’s not something most of us would like to think about, the procedure can be incredibly therapeutic for those individuals who have had their gut microbiome wiped out. It also might help you stave off aging, but that’s another story altogether.

The complex relationship between the gut microbiome and an individual’s overall health is increasingly being understood. In animals, it has been found at least partly responsible for increased memory and aggressive swarming behaviors, among other things. It seems clear, at this point, that maintaining robust gut health is critical to the overall health of the individual, whether you’re an insect or a person.

Changes in how a person eats or other environmental factors throughout their lives can have a significant impact in their gut microbiome, and those changes can then cascade throughout the rest of the body. If something goes wrong, that often means relying on borrowing a microbiome jump start from a stranger by way of a fecal transplant. Not to put too fine a point on it, but that process involves mixing a donated stool sample with water to make a slurry and then transplanting that into the digestive system of the recipient. The results can be phenomenal, but it’s not the most pleasant thought.

Scientists from the Brigham and Women’s Hospital and Harvard Medical School think they might have a better solution. They suggest collecting stool samples from individuals when they are young and disease free and storing those samples for later use. The details of their plan were published in the journal Trends in Molecular Medicine.

Stool culture Photo: WLADIMIR BULGAR/SCIENCE PHOTO LIBRARY/Getty Images

The major benefit with this process over existing ones is that a transplant recipient would be receiving material from their own body. That sidesteps any considerations about compatibility between donor and recipient while still accomplishing the goal of resetting the gut microbiome.

One such stool bank already exists in Somerville, Massachusetts and offers the option of banking your own samples for later use. Scientists wondered if this process could be scaled up and made available to a wider population. They liken the process to that of cord blood banking — when parents freeze the blood from the umbilical cord of their babies. Umbilical cord blood carries an excess of stem cells and immune cells which could have therapeutic uses later in life. Likewise, scientists cite the potential benefits of stool banking for treating a whole host of ailments including asthma, multiple sclerosis, inflammatory bowel disease, and more.

One major hurdle to enacting widespread stool banking is the associated cost. Once a sample is taken, it would have to be preserved long-term, mostly likely by using liquid nitrogen to cryo-preserve it. Using cord blood banking as a comparison, the service isn’t cheap. Parents can pay thousands of dollars for the initial collection and storage of the sample, followed by an annual storage fee which is typically several hundred dollars.

If stool banking became available along similar economic lines, that could result in an additional health disparity wherein wealthy individuals would have access to potentially life-saving treatments that the rest of the population is priced out of. The scientists who published this opinion paper acknowledge those challenges and note that solutions will have to come through a partnership between scientists, business, and governments.

Here's hoping that such a solution can be found. At the end of the day, a fecal transplant is one of those times when homemade is preferable to store bought.