An Innovative Trial Assessing Donor Sex on Recipient Mortality

The investigators have designed an innovative pragmatic randomized trial that will allocate transfusion recipients to receive either only male or only female donor transfusions. Primary objective: To confirm that a transfusion strategy of receiving male donor RBC (Red Blood Cell) units only will improve survival compared to a transfusion strategy of female donor RBC units in all hospital patients requiring a transfusion. Secondary objectives: 1. To assess effects of male RBC units on major morbidities (cancer, infection, end-organ damage) 2. To assess effects across major patient subgroups (major surgery, intensive care, oncology) 3. To assess the effect of female donor pregnancy history on recipient transfusion outcome 4. To build capacity to conduct large innovative prospective pragmatic clinical trials in transfusion medicine using routinely collected clinical and administrative information.