Donor Selection for Fecal Microbiota Transplantation: Current Criteria, Safety and Future Perspectives - A Narrative Review

Abstract

Purpose of research:
The aim of this review was to summarize current knowledge on donor selection for fecal microbiota transplantation (FMT) and to identify donor-related factors that may influence the efficacy and safety of this therapy. Particular attention was paid to donor screening procedures, microbiological characteristics of donors, the concept of the “super-donor,” and emerging approaches to personalized donor–recipient matching.

Research materials and methods:
A narrative literature review was conducted based on recent clinical studies, systematic reviews, consensus statements and guidelines. Publications addressing donor qualification, laboratory screening, donor microbiome composition, and safety aspects of FMT were analyzed.

Basic results:
FMT is currently an established treatment for recurrent Clostridioides difficile infection, where clinical success rates often exceed 90%. The review showed that donor selection is one of the key determinants of treatment outcomes. Current protocols rely on extensive medical history assessment and laboratory testing to minimize the risk of pathogen transmission. Studies suggest that donors with greater microbial diversity and richness may achieve better outcomes, particularly in inflammatory bowel diseases. Several bacterial taxa have been proposed as markers of favorable donor profiles, although most findings still require validation. 

Conclusions:
Donor selection is a critical component of successful and safe FMT. Future developments are likely to focus on microbiome-based donor characterization, personalized donor and recipient matching, and precision medicine approaches that may improve the effectiveness of microbiota-based therapies.