An Emory University medical resident has taken the notion of donation to a whole new level, agreeing to provide stool samples for multiple patients who need life-saving procedures called fecal transplants.
Dr. Hunter Johnson has aided at least four people in the past year by providing doses of his healthy feces -- yes, poop -- to help cure devastating bowel infections caused by a nasty germ known as C. difficile.
“As you can imagine, it’s not the most glamorous thing,” says Johnson, 30, of Atlanta, who was recruited by his boss, Dr. Colleen Kraft. “It’s hard enough to get people to donate blood, but it’s much harder to get people to donate feces.”
Kraft, an infectious disease specialist and clinical microbiologist at Emory, turned to Johnson and other medical residents last summer, when a gravely ill lung transplant patient came down with a C. diff infection as well.
“Basically, we had been doing it using a family member or friend to donate and this patient didn’t have anyone who could help,” she said. That's where Johnson came in.
The process worked, allowing the woman to recover from the bowel infection with the help of a stranger’s stool.
Fecal transplants are rapidly becoming a treatment of choice for recurrent C. diff infections, which strike more than 336,000 people each year and are linked to 14,000 deaths, according to the Centers for Disease Control and Treatment.
In the procedures, stool from a healthy patient is transplanted into the colon of a C. diff sufferer to restore the balance of bacteria. C. diff infections typically occur following heavy antibiotic use, when the drugs kill healthy bacteria in the gut, allowing toxic germs to flourish.
Though they sound distasteful, fecal transplants have been racking up success rates as high as 90 percent or more. Sufferers say they recover swiftly after the transplants, returning to full health within a few days.
“I’m telling you, I can’t say enough good things about this thing,” said Tom Wilson, 76, who received one of Johnson’s stool donations in March.
Wilson, who was treated for a serious bowel condition called diverticulitis in 2006, developed a life-threatening case of C. diff last December and was severely ill for months. He tried a fecal transplant using a sample from a family member, but it wasn’t completely successful.
When he fell ill again, doctors sent the real estate developer from Alpharetta, Ga., to Emory for help. He said the notion of accepting stool from a stranger didn’t faze him at all.
“When you’re as sick as I have been, you’ll do anything to feel better,” said Wilson, who figures he’s nearly fully recovered.
Johnson said he gets a sense of satisfaction from helping -- and from knowing he’s advancing knowledge about a new kind of therapy.
He figures he’s a good donor because he’s young, fairly healthy, and is at low risk for infections. People with kids, for instance, wouldn’t be good choices because children bring home so many germs.
“They don’t want you to be eating anything too crazy, not a lot of travel, no history of gastrointestinal illness,” he said. “We can’t have taken any drugs in the recent past.
“Essentially, the best donor is someone who leads a pretty boring life," he added.
In addition, a good donor has to have predictable bowel habits and be able to perform, as it were, on demand. Johnson typically donates on the morning of a patient’s transplant. “They want it to be relatively fresh,” he said.
He provides the sample and then takes it to the lab, where it’s processed to be given to the patient. At Emory, they use a colonoscope to deliver the donation, though others use enemas or tubes that run through the nose and to the stomach.
Kraft has conducted the transplants on a case-by-case basis with hospital approval. She plans to apply for a investigational new drug application that would essentially define Johnson's stool as a useful medication. Meanwhile, she and others who perform fecal transplants are waiting for the federal Food and Drug Administration to weigh in on regulation of the promising new therapy.
Both Kraft and Johnson say they’re excited by the promise of fecal transplants to cure the misery of C. diff infections. “I became a physician to help people,” Johnson said. “To these patients, it’s a big deal.”
Still, he acknowledges that not everyone finds his altruism so intriguing.
“My wife is kind of tentatively grossed out by it,” he said. “It’s a little weird for her. But she realizes it’s a good thing.”