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While regulation would make stool donation safer, Stollman said increased testing requirements will also make the procedure more expensive, and may limit patient access if it requires the use of a more advanced lab.
Donor banks may eventually replace feces from friends and family. Stollman said both Stanford Hospital and UCSF are considering building donor banks, which would make pre-screened stools available for emergencies, and Levin said Kaiser has also considered it.
Eventually, synthetic stools could replace human donation. Eisen said researchers at the Human Microbiome Project at the National Institutes of Health are currently working on technology that would allow scientists to map our microorganisms, similar to how DNA is analyzed, which would then allow doctors to create transplant bacteria based on a patient's specific needs.
The transplant aspect may also take on a new form. During last month's IDWeek, an infectious diseases conference in San Francisco, Canadian researchers unveiled a new "poop pill" to treat C. diff. The pill does not contain actual poop, but rather the healthy bacteria from a donor's feces. Like standard fecal transplants, the stool would be donated by a family or friend and tested before its bacteria are extracted in a lab. The bacteria is then condensed into 24 to 34 triple-coated gel capsules, which a patient is required to take in one sitting. So far, 27 patients have reported being cured of C. diff after taking the pills.
As fecal transplants evolve, Stollman said his practice might not be able to keep up with the technology required to offer them. "Fecal transplants — as we know it — will not be a forever solution," he said. But until then, he's dedicated to continue offering them: "This is a very inelegant solution with elegant results," Stollman said. "It treats a population who has no other solution."