Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Psychology, University of Guelph, Guelph, ON, Canada.
Lancet Infect Dis. 2020 Mar;20(3):e44-e49. doi: 10.1016/S1473-3099(19)30569-9. Epub 2019 Nov 26.
Faecal microbiota transplantation is an effective therapy for recurrent Clostridioides difficile infection, with potential therapeutic applications in other health conditions. As research uncovers potential associations between the intestinal microbiome and various disease states, stool donor screening has become increasingly stringent, leading to low donor acceptance. Many stool banks have opted to recruit universal stool donors, who are encouraged to donate frequently over a prolonged period and whose stool is used to treat multiple patients. However, various ethical concerns arise when recruiting universal stool donors, which need to be addressed to mitigate harm to donors. In this Personal View, we describe the major ethical issues with universal stool banks across six domains: informed consent, privacy, the imposing of restrictions on autonomy, stewardship of microbiome information, financial incentives, and preventing a sense of obligation. We also suggest several priorities for future research that should be pursued to address these crucial issues and develop more donor-centric stool banks.
粪便微生物群移植是治疗复发性艰难梭菌感染的有效方法，在其他健康状况下具有潜在的治疗应用。随着研究揭示肠道微生物组与各种疾病状态之间的潜在关联，粪便供体筛查变得越来越严格，导致供体接受率低。许多粪便库选择招募通用粪便供体，他们被鼓励在较长时间内频繁捐赠，并且他们的粪便用于治疗多个患者。然而，在招募通用粪便供体时会出现各种伦理问题，需要加以解决以减轻对供体的伤害。在这篇个人观点中，我们描述了通用粪便库在六个领域的主要伦理问题：知情同意、隐私、对自主权的限制、微生物组信息的管理、经济激励以及防止义务感。我们还提出了未来研究的几个优先事项，以解决这些关键问题并开发更以捐赠者为中心的粪便库。
