Transfusion practice, like medical practice in its entirety, has evolved rapidly over the past few decades. Recent research on clinical outcomes has examined the impact of blood transfusion on critically ill patients, patients with trauma, those undergoing cardiac surgery, those experiencing acute coronary syndromes, oncology patients and others. Evidence is mounting of adverse outcomes associated with blood transfusion in a wide variety of clinical contexts. Here, we highlight the deficit in the current literature guiding transfusion practice, and call for an Australasian study to fill this deficit.