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POTENTIAL MOTIVATORS AND DETERENTS FOR STOOL DONORS: A MULTICENTER STUDY

Presentation Number: Tu1894

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AuthorBlock: Breanna McSweeney1, Jessica R. Allegretti4, Monika Fischer6, Tanya Monaghan5, Benjamin H. Mullish3, Elaine O. Petrof2, Emmalee Lynn Phelps6, Karen Wong1, Huiping Xu6, Roxana Chis2, Dina H. Kao1
1 University of Alberta, Edmonton, Alberta, Canada; 2Queen's University, Kingston, Ontario, Canada; 3Imperial College London, London, United Kingdom; 4Brigham and Women's Hospital, Boston, Massachusetts, United States; 5University of Nottingham, Nottingham, United Kingdom; 6Indiana University, Bloomington, Indiana, United States;

Background: FMT is a highly-effective therapy for recurrent Clostridium difficile infections. To develop an effective FMT program, stool donors are required and essential for FMT; however, they are difficult to recruit and retain. We aimed to identify factors which could optimize donor program and imrpove donor retention.
Methods: A 32-item questionnaire was disseminated via several social media platforms as well university electronic mailing lists in Edmonton and Kingston, Canada; London and Nottingham, England; Indianapolis, and Boston, USA. Items included questions regarding motivation for becoming a stool donor, knowledge and perception of FMT, and history of being a blood donor or considered being an organ donor. Questions regarding economic compensation, screening process, and time commitment were also posted. Four logistic regression models incorporating these variables were built to predict willingness to donate stool.
Results: A total of 802 respondents (387 [48.3%] from 21-30 years old; 573 [71.4%] women; 323 [40%] healthcare professionals) completed the questionnaire between June 22 and September 28, 2017 (table 1). 334 (41.7%) participants indicated altruism as the main reason for being a stool donor, while 282 (35.2%) indicated economic compensation was an additional motivator. Younger participants, students, and US residents were more likely to be motivated by economic compensation than those older, non-students and living in the UK and Canadian residents. Those who had a positive attitude towards FMT were more willing to receive and donate for FMT. Those more willing to donate for FMT were more knowledgeable about FMT, and did not find donating or the screening process invasive or time consuming. However, the willingness to donate decreased with required frequency of donation. Although economic compensation appeared to motivate donors, knowing how FMT helps individuals was more influential. One recurrent theme impeding stool donation was the logistics of collecting and transporting feces. Based upon the logistic regression model the impact of each variable (odds ratio; 95% confidence interval) on willingness to donate was shown in table 2. The model (#4) which incorporated all these variables predicted the willingness to donate stool with the highest accuracy (ROC= 0.86).
Conclusion: Although a significant proportion of participants identified altruism as the main reason for becoming a stool donor, economic compensation, and positive feedback from their stool donation are additional motivators. The screening process, high frequency of stool donation, and logistics of collecting/ transporting stools were potential deterrents. These variables should be taken into consideration recruiting and retaining stool donors.

Table 2. Logistic regression model results for predicting willingness to donate stool.

 Model 1Model 2Model 3Model 4
OR (95% CI)P ValueOR (95% CI)P ValueOR (95% CI)P ValueOR (95% CI)P Value
Baseline Characteristics
Considered being blood donors1.55 (1.17 to 2.05)0.003----1.61 (1.12 to 2.32)0.01
Attitudes and Potential Barriers
Positive attitude toward fecal
microbiota transplantation
--1.52 (1.37 to 1.7)<0.001--1.39 (1.24 to 1.55)<0.001
Collecting one’s own stool--0.88 (0.82 to 0.94)<0.001--0.91 (0.85 to 0.98)0.016
Having to see a doctor to be a donor--0.92 (0.86 to 0.997)0.043--0.93 (0.85 to 1.01)0.087
Time commitment to donate every month--0.79 (0.74 to 0.85)<0.001--0.84 (0.78 to 0.91)<0.001
Potential motivators
Economic compensation is offered----1.4 (1.29 to 1.52)<0.0011.33 (1.22 to 1.45)<0.001
Compensation of $20.01-30 per donation----1.22 (1.15 to 1.3)<0.0011.16 (1.09 to 1.25)<0.001
Helping others----1.36 (1.25 to 1.49)<0.0011.31 (1.19 to 1.44)<0.001
C Statistics0.550.800.820.86

Models 1, 2, and 3 include covariates in each category separately with variables selected using the stepwise variable selection.

Table 1. Participant demographics

  N (%) / Mean (SD; 95% CI)
CountryCanada313 (39.0%)
USA306 (38.2%)
UK166 (20.7%)
Other17 (2.1%)
GenderFemale573 (71.4%)
Male222 (27.7%)
Other7 (0.9%)
Age<2134 (4.2%)
21-30387 (48.3%)
31-40154 (19.2%)
41-5088 (11.0%)
>50139 (17.3%)
OccupationHealthcare Professional323 (40.3%)
Student249 (31.0%)
University Faculty or Staff80 (10.0%)
Business/Sales21 (2.6%)
Manager8 (1.0%)
Non-Healthcare Professional30 (3.7%)
Office Job22 (2.7%)
Research20 (2.5%)
Retired13 (1.6%)
Unemployed11 (1.4%)
Other25 (3.1%)
Blood DonationHave not previously donated363 (45.3%)
Have previously donated439 (54.7%)
<11 donations299 (37.3%)
11-20 donations91 (11.3%)
>20 donations49 (6.1%)
Considered being an organ donor724 (90.3%)