| Donor selection | Screening questionnaire | People >60 years of age, those with recent antibiotic use (within six weeks), significant risk factors for blood-borne viruses, recent constitutional illness, and/or recent travel to countries with high rates of infectious diarrhoea are typically excluded from further assessment |
| Medical questionnaire | People with a personal or family history of disorders associated with perturbation of the gut microbiota (including inflammatory bowel disease, irritable bowel syndrome, metabolic syndrome, autoimmune disorders and/or gastrointestinal malignancy) are typically excluded from further assessment |
| Laboratory testing, repeated at regular intervals, typically includes: | Blood screening | Hepatitis A serology Hepatitis B serology and hepatitis B DNA Hepatitis C serology and hepatitis C RNA HIV-1 and -2 and HTLV-1 and -2 serology Syphilis serology Cytomegalovirus and Epstein-Barr virus serology Entamoeba histolytica serology Strongyloides stercoralis serology
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| | Stool screening | Microscopy, culture and sensitivity for enteric bacteria (at least three samples over three separate days) Analysis for ova, cysts and parasites (at least three samples over three separate days) Acid-fast staining for Cyclospora, Isospora and Cryptosporidium Screening for carriage of antibiotic-resistant organisms, carbapenemase-producing Enterobacteriaceae Clostridium difficile toxin and polymerase chain reaction (PCR) Analysis for rotavirus and adenovirus Helicobacter pylori faecal antigen
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| Choice of recipients | Indications | |
| Contraindications | There are only a small number of absolute contraindications, eg a life-threatening food allergy FMT seems to have similar efficacy (and no additional infective complications) when given to immunocompromised individuals, including solid organ transplant recipients, recipients of recent chemotherapy, people with HIV infection and people with inflammatory bowel disease (IBD) taking B/T cell immunomodulatory therapy20
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| Transplant preparation | Typically >50–60 g of stool is mixed with 250–300 mL of diluent (most often saline), before filtering of the slurry. The exact protocols used vary between different centres Transplants are either prepared from fresh stool on the day of delivery, or prepared in advance and frozen (using glycerol as a bacterial cryopreservative) before thawing on the day21
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| Transplant delivery | The transplant may be delivered either via the upper gastrointestinal route (gastroscopy, or nasogastric or nasoenteric tube) or by the lower gastrointestinal route (enema or colonoscopy). FMT capsules are an emerging delivery modality Anti-CDI antibiotics are typically stopped 12–72 hours prior to transplant; a polyethylene glycol preparation may be given on the day prior to administration A proton-pump inhibitor (PPI) and/or a prokinetic (ie metoclopramide) are often administered prior to upper gastrointestinal administration. Loperamide is often administered after lower gastrointestinal administration to facilitate retention within colon
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