THIS IS AN EXAMPLE OF AN AGREEMENT
that people have used with FMT Donors.
Please note that the primary purpose of an agreement is to promote
understanding, not to be enforced in a court of law. This is a difficult area
legally and such agreements would be unlikely to be watertight if tested.
So the best approach is to discuss and document all the issues so that you
and your donor are on the same page and disputes do not occur
FECAL MICROBIOTA TRANSPLANT
DONOR-RECIPIENT AGREEMENT
Name of Donor:
Name of Recipient:
The Donor has agreed to supply the Recipient with fecal microbiota for medical purposes.
The Recipient confirms:
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I have sought medical advice about use of fecal microbiota transplant (FMT) for my condition
I am aware that FMT is an experimental therapy
I have discussed the risks with my doctor
I will pay for all testing required, prior to the Donor being tested
I will pay $ X per donation at the time of pickup
I will not hold the Donor responsible for any unexpected outcomes I experience from FMT
I am aware that the arrangement can be terminated by either of us without notice
I will act in good faith in my dealings with the Donor
I acknowledge that this agreement has not been drafted by a lawyer but may be used in a court of law
The Donor confirms:
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I am in good health
I have not taken anti-biotics in the last 6 months
I have answered all the questions in the Donor Questionnaire honestly
I will stop donating if I become unwell
I will practice safe or monogamous sex while donating
I will not inject, inhale or consume illicit drugs while donating
I will not take any prescription medications while donating, without discussion with the Recipient
I will comply with the following dietary requirements ______
I am aware that the arrangement can be terminated by either of us without notice
I will act in good faith in my dealings with the Recipient
I acknowledge that this agreement has not been drafted by a lawyer but may be used in a court of law
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Recipient
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Donor
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Date
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Date