The risk of transmitting disease through blood transfusions continues to fall as additional blood donor screening and testing measures are implemented. Nevertheless, when a blood transfusion is needed during the perioperative period, autologous blood is the safest option for eligible patients. Three methods for obtaining autologous blood to use during or after a planned surgical procedure are preoperative autologous blood donation, perioperative blood salvage, and acute normovolemic hemodilution. These techniques can be used alone or in combination to decrease or eliminate a patient's exposure to homologous blood. However, because all transfusions carry some health risk and blood administration costs, autologous blood should not be collected or reinfused indiscriminately. Autologous blood services should be used for eligible patients who are likely to require a transfusion but should not be employed for minor procedures in which transfusion is unlikely.