Red cell collections and transfusions peaked in 2008 at approximately 17,286,000 units collected, 17,159,000 units distributed, and 15,014,000 units transfused. By 2015, collections, distributions, and transfusions declined dramatically, by 12,591,000, 12,028,000, and 11,349,000 units, respectively. Note the narrowing of the distribution and transfusion curves, possibly representing diminished resiliency and surge capacity. Reprinted by permission from John Wiley & Sons, Ltd: Transfusion doi: 10.1111/trf.14165, copyright 2017.