The current need for family and replacement donation in sub-Saharan Africa should not hide the difficulties of its management.

Dear Sir, Family replacement donation was initially described as a type of donation which is more risky than the voluntary not remunerated (VNR) donation and even during the last decade (Cunha et al., 2007; Mbanya & Tayou, 2005). For many years, this has consolidated WHO in the promotion of VNR donation (WHO, 2001, 2004). Currently, the majority of the countries having chosen exclusively the strategy of supply from VNR donation still do not have sufficient blood supply, in spite of the considerable assistance of international partners (Tagny et al., 2011). Family replacement donation still constitutes for several countries, an essential source of blood, notably when VNR blood donors are not available during school or university holidays. Blood supply from family replacement donation reduces the significant needs caused particularly by infectious diseases, anaemia from traumatic or obstetrical origins. Moreover, the cost of the exclusive supply from VNR donation remains hard to bear by the limited budget of the countries which adopted it. Indeed, the cost of a blood bag from a VNR donation is two to four times higher than that of a unit from a family replacement donation because of a high cost of the activities of promotion, mobile collection and quality system (Allain, 2011; Bates et al., 2007). Recently, some studies also asserted a weighty argument in favour of the family replacement donation: contrary to preceding information, it would be as much at risk as the VNR donation in first time donors (Allain, 2011). Only regular donation, family replacement as well as voluntary non-remunerated, are more capable to provide a supply at low risk. The combined use of the two types of donation is necessary but must gradually leave the place to a pool of regular donors capable to provide sustainable supply at lower risk. So, currently the family replacement donation remains useful; however, its daily management is problematic.