Scaling Safe Access to Fecal Microbiota Transplantation: Past, Present, and Future

  • Pratik PanchalEmail author
  • Shrish Budree
  • Alex Scheeler
  • Geraldine Medina
  • Monica Seng
  • Wing Fei Wong
  • Ryan Eliott
  • Thomas Mitchell
  • Zain Kassam
  • Jessica R. Allegretti
  • Majdi Osman
Pediatric Gastroenterology (S Orenstein, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Gastroenterology


Purpose of Review

Universal stool banks (USBs) have emerged as a potential model for scaling access to fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI). In this review, we outline the historical barriers constraining access to FMT, the evidence on methods and outcomes of USBs, and potential future directions for expanding access.

Recent Findings

Key historical barriers to FMT access include regulatory uncertainty, operational complexity of sourcing screened donor material, and logistical challenges of delivering fresh treatment preparations. USBs have demonstrated that FMT can be delivered safely at scale by centralizing donor selection, material processing, and safety monitoring. More evidence is needed to optimize USB methods, including for donor screening, material processing, and novel delivery modalities.


USBs have catalyzed broad access to FMT in North America and Europe. Future directions include developing evidence regarding oral preparations, harmonizing guidelines, disseminating best practice protocols, establishing long-term safety profiles, and expanding access to geographic areas of unmet need


Fecal microbiota transplant Microbiome Clostridium difficile infection Donor screening Geospatial Universal Stool Bank 



The authors thank Neil and Anna Rasmussen Family Foundation and the Anna Maria and Stephen Kellen Foundation, Carolyn Edelstein (OpenBiome) for assistance in designing Fig. 1.

Compliance with Ethical Standards

Conflict of Interest

Pratik Panchal, Shrish Budree, Wing Fei, Ryan Eliott, and Majdi Osman declare no conflict of interest. Monica Seng and Geraldine Medina are employed by OpenBiome, outside the submitted work. Thomas Mitchell, Zain Kassam, and Jessica Allegretti are employed by Finch Therapeutics Group, outside the submitted work. Alex Scheeler is employed by OpenBiome and Finch Therapeutics Group, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as:• Of importance ••Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Pratik Panchal
    • 1
    • 2
    Email author
  • Shrish Budree
    • 1
    • 3
  • Alex Scheeler
    • 1
  • Geraldine Medina
    • 1
  • Monica Seng
    • 1
  • Wing Fei Wong
    • 1
  • Ryan Eliott
    • 1
  • Thomas Mitchell
    • 4
  • Zain Kassam
    • 4
  • Jessica R. Allegretti
    • 5
    • 6
  • Majdi Osman
    • 1
    • 5
  1. 1.OpenBiomeSomervilleUSA
  2. 2.Harvard University T.H. Chan School of Public HealthBostonUSA
  3. 3.University of Cape TownRondeboschSouth Africa
  4. 4.Finch Therapeutics GroupSomervilleUSA
  5. 5.Harvard Medical SchoolBostonUSA
  6. 6.Brigham and Women’s HospitalBostonUSA

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