Author Affiliations: Department of Medicine (Dr Kassam), Divisions of Gastroenterology (Drs Kassam and Marshall) and Infectious Diseases (Dr Lee), Department of Medicine, Department of Pathology and Molecular Medicine (Dr Lee), and Farncombe Family Digestive Health Research Institute (Dr Marshall), McMaster University, Hamilton, Ontario, Canada; and Hamilton Regional Laboratory Medicine Program, St Joseph's Healthcare, Hamilton (Dr Lee).
Stollman and Surawicz pose important questions with regard to our fecal transplant donor process. The fecal transplant donors underwent a full medical and social history review using the American Association of Blood Banks Donor History questionnaire to ensure they were healthy and maintained an appropriate lifestyle for stool donation.1 The donors' blood and stool samples were screened and tested for potentially transmissible pathogens at baseline.2 The donors were not tested repeatedly because their lifestyle and infectious risk factors were carefully evaluated. Donors were instructed to inform the investigator whenever there was a change in their health status and to refrain from donation when experiencing fever, vomiting, and/or diarrhea. They were also requested to inform the investigator of any lifestyle change that may pose potential harm to the recipient after counseling the donors on infectious risk factors. The donors' stool was retested when they returned from a vacation destination in which there may be increased risk of acquiring enteric pathogen(s). In addition to the benefits articulated by Stollman and Surawicz, prescreened donors have advantages over a partner or family donors, in that ethical, social, and privacy complexities may arise when the transplant must be withheld because of the identification of sexually and/or recreationally acquired pathogen in the related donor.
Kassam Z, Marshall J, Lee CH. Fecal Transplant for Clostridium difficile—Reply. Arch Intern Med. 2012;172(10):825-826. doi:10.1001/archinternmed.2012.1413