In the early 1990s, unsafe transfusions were estimated to be responsible for up to 10% of all HIV infections, many of them in high income countries. HIV-contaminated blood now accounts for approximately 5% of HIV infections in Africa today. In many countries more and more testing is being done to make blood safe, but the majority of developing nations still do not carry out even the most basic mandatory tests for diseases such as HIV or hepatitis B and C. Annually, some six million tests that should be done to check for infections are not done. Most countries still lack a nationally coordinated Blood Transfusion Service. Despite some recent improvements in this important area, fewer than 30% of countries have a well-organized service in place.

Too many countries still rely on family replacement (a member of the patient's family donating his/her blood) or paid donors. Argentina, for instance, relies heavily on replacement donors, who make up 92% of its blood supply. Although Pakistan has increased its voluntary unpaid blood donation in the last five years to 20% of its blood supply, replacement donors made up 70% and paid donors 10% of blood supplies in 2004.

Family replacement donors may feel under pressure to donate and may therefore hide aspects of their health and lifestyle, which could mean that their blood is more likely to contain infection. In the case of paid donors, governments may think that the financial incentive will motivate more donation and boost supplies, but paid donors are often pushed by need and are therefore also more likely to avoid mentioning important details about their health status.

Many blood transfusions are unnecessary. Patients around the world risk being infected during blood transfusions when alternatives — such as intravenous replacement fluids — would be equally effective.