PURPOSE: We determine whether autologous blood donation significantly decreases the need for homologous transfusions after radical prostatectomy. MATERIALS AND METHODS: The effects of estimated blood loss and autologous donation on the rate of homologous transfusions were analyzed in 3 groups of 100 consecutive patients treated between 1983 and 1992. RESULTS: Overall, donors were less likely than nondonors to receive homologous blood. As median estimated blood loss decreased from 1,200 to 800 cc from groups 1 to 3 (p < 0.05), the incidence of nondonors requiring homologous blood decreased from 62 to 11% and that of autologous units transfused decreased from 96 to 19%. CONCLUSIONS: With decreasing blood loss, safe but stringent criteria for transfusion and improved safety of the blood supply, autologous donation is an inefficient method to lower the slight risk of complications following homologous transfusion during radical prostatectomy.