Mullish, BH

Williams, HR

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FAECAL TRANSPLANTSObstacles to establishing an NHS faecal transplantprogrammeBenjamin H Mullish clinical research fellow, Horace R T Williams consultant gastroenterologist andhonorary senior lecturerDivision of Digestive Diseases, Faculty of Medicine, Imperial College London, St Mary’s Hospital, London W2 1NY, UKHaving recently established a faecal microbiota transplantation(FMT) programme, we raise two points about Spector andKnight’s editorial on FMT.1Firstly, despite the UK’s relatively permissive regulatoryframework on FMT, we encountered considerable obstacles toestablishing an NHS programme. Donor screening is expensive(>£500 (€703; $755)/screen/donor, repeated regularly). It isunclear whether FMT governance falls under the remit ofmicrobiology, gastroenterology, or pharmacy. There isreluctance to transfer patients with recurrentClostridium difficileinfection into an FMT centre because of infection controlimplications; conversely, clinicians from FMT centres mayencounter difficulties taking transplant material to other hospitalsowing to lengthy administrative processes—for example, issuinghonorary contracts.Similar difficulties are described elsewhere,2 and theymay resultin FMT not being available to patients who might benefitgreatly. Regional FMT networks could be one solution, with a“hub” centre to coordinate donors and transplant preparationand “spoke” centres that have agreed protocols with the hubcentre on FMT delivery.Secondly, despite the interest in the therapeutic implications ofFMT in a range of conditions, the exact mechanisms by whichit works remain unclear.3 Because FMT treats C difficileinfection so effectively in most cases, analysis of the few donorswhose stool does not induce remission of infection may beparticularly useful. To make scientific advances, researchersneed access to donors for sample analysis and robust clinicalrecords of outcomes from FMT for each donor; this should beborne in mind as “stool banks” become established.Competing interests: None declared.Full response at: www.bmj.com/content/351/bmj.h5149/rr.1 Spector T, Knight R. Faecal transplants. BMJ 2015;351:h5149. (20 October.)2 Porter RJ, Fogg C. Faecal microbiota transplantation for Clostridium difficile infection inthe United Kingdom. Clin Microbiol Infect 2015;21:578-82.3 Holmes E, Li JV, Marchesi JR, et al. Gut microbiota composition and activity in relationto host metabolic phenotype and disease risk. Cell Metab 2012;16:559-64.Cite this as: BMJ 2015;351:h6043© BMJ Publishing Group Ltd 2015b.mullish@imperial.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2015;351:h6043 doi: 10.1136/bmj.h6043 (Published 19 November 2015) Page 1 of 1LettersLETTERS

Obstacles to establishing an NHS faecal transplant programme.

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Obstacles to establishing an NHS faecal transplant programme.

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