AbstractIntraoperative autotransfusion was done only sporadically until equipment, modified from cardiac surgery, became available in the 1970's. Use has increased because of the availability of cell‐washing techniques and the increased demand for blood associated with complex operations, such as liver transplantation and resection of thoracoabdominal aneurysms. There is a lack of agreement about the use of anticoagulation with autotransfusion, and there are several factors that limit widespread applicability. More studies are needed regarding infusion of activated clotting factors, and blood contaminated with bacteria or tumor cells. Although a significant administrative commitment is required, implementation of a program of autotransfusion is useful in trauma, vascular surgery, and any procedure that involves large amounts of blood loss.