Since 2013, OpenBiome has been processing and shipping loads of it all over the country. The frozen stool is administered to patients who are very sick with infections of a bacteria called C. difficile. The bacteria can cause extreme gastrointestinal distress, leaving some sufferers housebound. Antibiotics often help, but sometimes the bacteria rears back as soon as treatment stops. That leads to a miserable, continuous course of antibiotics.
By introducing healthy fecal matter into the gut of a patient (by way of endoscopy, nasal tubes, or swallowed capsules) doctors can abolish C. difficile for good. Finding a donor is tough business, and some patients grow so desperate that they treat themselves with fecal matter from friends and family. That's what happened to a friend of OpenBiome's founders, inspiring them to open up the first nationwide bank. So far they've shipped about 2,000 treatments to 185 hospitals around the country.
And yes, they pay for healthy poop: $40 a sample, with a $50 bonus if you come in five days a week. That's $250 for a week of donations, or $13,000 a year.
There's a catch: You don't just have to be healthy. You have to be really healthy. OpenBiome's donation procedure may be as easy as your standard bowel movement, but the selection process makes giving blood look like a walk in the park.
"It's harder to become a donor than it is to get into MIT," joked co-founder Mark Smith (who would know, as he got his PhD in microbiology there). Of the 1,000 or so potential donors who've expressed interest on his Web site over the past two years, only about 4 percent have passed the extensive medical questioning and stool testing.
The screening process can cost up to $5,000 -- so when someone makes it through, Smith and his co-founders hold on tight.
"We get most of our donors to come in three or four times a week, which is pretty awesome," Smith said. "You're usually helping three or four patients out with each sample, and we keep track of that and let you know."
Fellow co-founder Carolyn Edelstein agrees that the donors are usually in it for more than the money.
"Everyone thinks it's great that they're making money doing such an easy thing," Edelstein said, "But they also love to hear us say, 'Look, your poop just helped this lady who's been sick for nine years go to her daughter's graduation.'"
Who are these valiant donors, these chosen few? Since they have to come into the Medford, Mass. office, lots of them are Tufts University students. And plenty are recruited from the gym next door.
"It's great to have a healthy contingent of regular gym goers right there," Smith said.
For now fecal matter transplants really only have one use: treating recurring C. difficile. But OpenBiome is providing its samples to a number of trials exploring other uses.
Scientists know that the gut microbiomes of people with obesity, inflammatory bowel disease, and even autism are different from those without. But just because there are gut flora associated with these conditions doesn't mean that getting rid of them can get rid of their symptoms, and it certainly isn't a given that fecal transplants will be the miracle solution they are for C. difficile.
"There's a lot of promise in other conditions," Smith said, "But also a lot of hype. Treating C. difficile is a bit less sexy, but that's the one area where we know this works." However, he's excited to see where the "crazy frontier" of microbiome engineering will take us.
And in the meantime, Smith is always happy to find more potential donors.
"I never thought that after getting my PhD I'd start mailing poop around," he said, "But here I am."