In March this year, doctors in South Australia launched Australia’s first public poo donation bank, helping to ramp up efforts to cure local patients of a plethora of inflammatory bowel conditions.

The cutting-edge procedure is known as Faecal Micriobiota Transplantation, or FMT, and South Australian donors stand to make $25 per donation - simply by sitting - on the porcelain throne. The only catch, according to BiomeBank founders gastroenterologists Dr Sam Costello and Dr Rob Byrant is that potential donors possess good gut microflora, or ecosystem.

What is FMT?

Essentially, FMT is the infusion of a healthy microbiome in the form of donor faecal material. Healthy donors are screened, they donate, and their poo is mixed with a solution, strained, and placed in a patient by colonoscopy, endoscopy or enema.

The aim is to replace the recipients ‘bad’ gut bacteria with the donor’s ‘good’, after medical treatments such as long-term antibiotic use or chemotherapy has wiped them out. The idea is that this ‘good’ bacteria manufacture active anti-microbial molecules so when they are introduced into the bowel they can weed out and kill the ‘bad’ bugs which have taken over.

FMT is currently being used in Australia for treating Clostridioides difficile (C. diff) infection and for ulcerative colitis but is also being used elsewhere experimentally for conditions like IBS, MS, autism and Parkinson's disease.

More recently, in Australia, small case studies have proven that FMT has been effective in curing Crohn’s disease by using an antibiotic combination and a "crapsule" - an oral capsule of freeze-dried donor faecal microbiota for FMT.

Ethical Considerations

Commercial concerns and regulation - is this the rise of Big Poo?

Last year the FDA, the US food and drug manufacturer sought to classify human excrement for the purposes of FMT as a drug rather than a human tissue or blood product.

Critics of the decision say this could dramatically increase the cost for patients who seek FMT as the epidemic of treatment-resistant C.Diff infections are only expected to continue rising globally. It also means for those who retain the right to manufacture and sell the product, Big Poo equates to Big Business.

The procedure itself is also not without risks. Last year the FDA was prompted to issue a safety warning after one US patient died and another suffered an invasive infection, with both illnesses caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli after receiving FMTs from the same unscreened donor.

For that reason, Australia’s drug regulator has proposed moving to three classes of FMT products as ‘biologicals’ depending on the level of manufacturing the product undergoes and the expertise of the facility manufacturing the donor stool.