Background: The diminishing risks of allogeneic transfusion such as substan
tial reduction in transfusion-associated infections or prevention of immuno
suppression and the recognition of limited financial resources for health c
are measures cast doubt on the value of preoperative autologous blood donat
ion (PABD) for public health. Material and Methods: The epidemiological con
cept of efficacy, effectiveness, and efficiency has been applied to PABD. T
he results of hitherto published studies are summarized and commented. Meas
ures to further improve the cost-effectiveness of PABD are presented and ev
aluated. They comprise limiting of serological screening or renunciation of
component preparation of autologous units in appropriate cases. Results: W
ith regard to the reduction of allogeneic transfusions, the efficacy of PAB
D appears to be proven in colorectal cancer surgery, knee and hip arthropla
sty, and liver resect ion. PABD is possibly efficacious in most other elect
ive surgical interventions with significant, anticipated blood loss. PABD i
s effective, i.e. it extends quality-adjusted life expectancy in these case
s if there is no significant risk attributable to donation ora high statist
ical or individual risk of allogeneic transfusion. PABD is probably efficie
nt, i.e. cost-effective, in case of low patient age, low production costs o
f the autologous deposit, high transfusion probability, and low donation ri
sk. Conclusions: Published studies do not reflect the current situation. Th
e safety of allogeneic blood has improved significantly, with regard to tra
nsfusion-transmissible infections owing to intensified resting and with reg
ard to immunosuppression owing to leukocyte depletion methods. On the other
hand, not all feasible cost containment measures have been applied to PABD
. Thus, the cost-effectiveness of PABD is still at issue. Further carefully
controlled studies are needed.