The benefit for my small hospital to have two cell savers, operated by a tech from lab has far outweighed the cost of allogeneic blood. We mostly do orthopedics/general/obgyn---not hearts/trauma/transplants where you might think that is the only place to use them. And, now with many blood management dictates, and more information about detrimental effects of banked blood....it makes even more sense. We have an in-house program, having gone from the contract situation in the past. You have more control on the education of the operators, quality control of your product, etc. We have had a program for 10 years now, and we have been AABB Periop Accredited for 6 years and will come up for it again next year. The AABB Spring Periop conference has been one of the most educational conferences, and also the SABM (Society for Advancement of Blood Management) conferences. You will see a cell saver (ours is from Sorin/Cobe) lists for about 35-40,000. , but you can get them for about 20,000, and maybe less for a used one. I am the main operator, and coordinator with two others-float pool to back me up. We do about 100 a year average--Spinal surg w. instrumentation/ Total Joints/gen.surg/OBGYN-TAHs. If I collect 300 cc with patient at normal Hgb,,,I can give back about 150cc each processing pass/batch. We can also use cell saver on Jehovah's Witnesses. We are not on-call, but could be,,,most surgeries are scheduled. If you have a surgeon who does AAA's, you might want to do an on-call,,,,even most of these are scheduled. I am also looking at making autologous platelet rich plasma. My budget for IAT (intraoperative autologous transfusion), is from BBK/lab. I also am certified by the company to do yearly maintenance, our biotech dept. only does the electrical checks. I would not start an inhouse program without budgeting for two machines---one for backup if something wrong w. the other---however, now, many times there are two ortho docs doing total hip at same time---and this can be done by one operator. Do NOT get ortho pat machines from Haemonetics----unless you plan to have an operator with that machine the whole time. Yes, they are cheaper---the company does NOT fix them--they just send you a new one---so, no machine history,etc--that should tell you something. Also, there is no way to check centrifuge speed with a tachometer (outside calibrated source), as is recommended by AABB.