Strengthening Blood Supply Resilience Through Group O Stewardship: A Year of Empower Group O Care

Group O blood types—particularly O negative—are among the most vital and most constrained resources in the U.S. blood supply. As demand for these products continues to rise amid a changing donor landscape, responsible stewardship has become essential to maintaining a resilient and reliable blood supply.

To address this challenge, the American Red Cross launched the Empower Group O Care Initiative, an education-driven effort that partners with contracted hospitals to strengthen Group O blood supply resilience through sustainable stewardship education and evidence-based practices. Since its launch in February 2025, the initiative has delivered meaningful progress:

• O negative distribution declined from 13.1% to 12.8%
• In 10 of the past 12 months, O negative distributions remained below the previous baseline of 13.1%
• These improvements conserved approximately 13,000 units of O negative blood, stabilizing O negative inventory 

Importantly, progress has been seen across hospitals of all sizes. While smaller hospitals (fewer than 200 beds) have historically had the highest O-negative distribution rates, reductions have occurred across the board. Medium-sized hospitals (200–500 beds) have shown the most significant improvement. 

Lowering O-negative distribution rates has also improved inventory resilience. Since the launch of Empower Group O, the Red Cross has reduced the number of days per month when O negative inventory falls at or below critical levels. This added stability helps ensure that O negative blood is available when emergencies arise, protecting patient outcomes and supporting hospital readiness. 

Empower Group O Care in Practice 

Hospitals participating in Empower Group O Care are translating stewardship awareness into measurable practice changes by: 

• Reserving O-negative units for patients who clinically require them, including O negative recipients and specific high-risk populations
• Developing and refining emergency transfusion protocols for patients with unknown blood type
• Implementing policies that support timely switching to O positive or type-specific blood when clinically appropriate
• Auditing utilization patterns to identify opportunities to reduce the number of O negative units transfused to non-O negative patients
• Providing type-specific red blood cells, including antigen-negative units whenever possible
• Educating clinical staff on the safety of O positive red blood cells and the risks of alloimmunization

By uncovering patterns of overuse and aligning transfusion practices with the latest research, Empower Group O Care helps hospitals maintain reliable access to essential blood products.

The Systemic Challenge Behind O-Negative Shortages

O negative blood is uniquely valuable because it is universally compatible and often used in trauma situations when a patient’s blood type is unknown. For more than a decade, the Red Cross has distributed O negative blood at rates higher than the industry average, and while our current distribution rate has stabilized to support long‑term sustainability, it remains above industry norms to continue meeting urgent, life‑threatening needs.

At the same time, demand for O negative blood continues to outpace supply. Fewer than 7% of the U.S. population has O negative blood, and that percentage continues to decline as donor demographics shift. Industry data show that O negative red blood cells have remained in chronic short supply . 

While emergency use remains essential, long-standing transfusion practices, including the use of O negative blood when clinically appropriate alternatives exist, contribute to ongoing shortages. Multiple peer-reviewed studies have found that a significant share of O negative transfusions could safely be supported with O positive blood in appropriate clinical circumstances.

Together, these realities highlight a shared opportunity across hospitals and blood providers to strengthen stewardship practices and preserve O negative blood for patients who need it most.

Looking Ahead

Through continued education, hospital partnership, and data-driven utilization insights, Empower Group O Care will continue helping preserve vital blood resources and strengthen blood supply resilience in the years ahead. In parallel, the American Red Cross is expanding efforts to increase Group O blood collections through targeted donor engagement strategies designed to support the long-term sustainability of the blood supply. 

Together, stewardship and donor engagement represent a coordinated approach to protecting access to these essential blood products for patients who depend on them. 

Learn More

For more information on responsible Group O blood use, visit the Empower Group O Care resource library. 

To learn about the American Red Cross Medical Office, visit the Medical Office webpage.