Continuing advances in medical and surgical treatment have resulted in increasing demands for blood and blood derivatives. In most developed countries and in many developing ones, the blood transfusion services are organised centrally either as National Blood Transfusion Services or under the auspices of organisations such as the League of Red Cross or Red Crescent Societies. Centrally organised services have been shown clearly to be superior to hospital based transfusion services. Although hospital based services may be a convenient alternative under certain circumstances, in most cases there is inefficient use of resources and difficulties in setting, achieving and enforcing quality standards. This is so particularly in developing countries. The need to change from a remunerated or replacement donor system is emphasised, with the ultimate goal being national self-sufficiency in blood and blood derivatives. Attention is also drawn to the importance of education and motivation of staff working in the blood transfusion services if these objectives are to be met.