Super Donor Assessment Tool for Oral Microbiome Transplantation

Aims Oral microbiome transplantation (OMT) transfers microbiota from donor to recipient. Selecting suitable donors remains challenging due to a lack of standardised guidelines. This study developed a novel super donor assessment tool (SDAT) combining a multi-criteria decision-making (MCDM) process and an analytical hierarchical process (AHP) to identify OMT "super donors" for caries prevention. Methods This cross-sectional study used four sequential screening phases with data from 93 healthy participants, capturing socio-demographics, lifestyle, dietary and oral health behaviour. The SDAT employed MCDM and AHP, combining criteria with normalised and weighted ranks to establish the top 10 donors for three models: "Optimal donor" (Model 1), "Ideal donor" (Model 2), and "Sub-optimal donor" (Model 3). Donor plaque samples underwent 16S ribosomal RNA amplicon sequencing for microbial profiling, examining alpha and beta-diversity, differential abundance, and network analysis. Results Alpha diversity analysis showed significant differences among groups (Kruskal-Wallis p < 0.001), with Model 1 exhibiting the lowest diversity and Model 3 the highest. Beta diversity analysis using Aitchison distance and Permutational Multivariate Analysis of Variance revealed significant differences in microbial community composition (R² = 0.19, p = 0.001). Differential abundance analysis (False Discovery Rate < 0.05, controlling for age and sex) identified health-associated genera (Neisseria, Lautropia, Streptococcus, Veillonella) in Model 1, while Model 3 showed higher disease-associated taxa (Treponema, Capnocytophaga). Network analysis revealed that Model 1 was organised around Actinomyces and Prevotella, Ideal around Rothia and Haemophilus, and Model 3 was dominated by pathogenic hubs. Conclusion SDAT provides a systematic and transparent framework for super-donor selection, ensuring precision and reproducibility in donor ranks. The scoring system standardises the donor selection process, efficacy of donor screening, and reduces the risk of adverse events for oral microbiome transplantation.