From 1976 through 1985, the United States Food and Drug Administration received reports of 355 fatalities associated with transfusion, 99 of which were excluded from further review because they were unrelated to transfusion or involved hepatitis or acquired immune deficiency syndrome. Of the remaining 256 reported deaths, 51 percent resulted from acute hemolysis following the transfusion of ABO-incompatible products. These deaths were due primarily to managerial, not clerical, errors. Other causes of death (in order of frequency of report) included acute pulmonary injury (15%), bacterial contamination of product (10%), delayed hemolysis (10%), damaged product (3%), and graft-versus-host disease (0.4%). Management systems for transfusion facilities should be created or revised to include the specific identification of personnel eligible to administer transfusions to provide written guidance and appropriate training (including recognition and management of errors), and to implement measures that target safe transfusion practices. Continued research into acute pulmonary injury, the immunologic hazards of transfusion, and the prevention of bacterial contamination of blood components is necessary.