Ex vivo, red cells undergo a series of changes termed the "storage lesion." Observational studies show a correlation between adverse outcomes and the storage age; however, cause and effect cannot be assumed. Prospective randomized trials are under way to determine whether "fresher" blood is better for patients. In the interim, there is an increasing demand for "fresher" blood, as clinicians become sensitized to the debate and respond to patient demands. Blood centers and transfusion services need to plan for changing demands and a paradigm shift in transfusion practice. Options include changing inventory management practices to promote the availability of the "freshest" possible blood; the use of additive solutions that better preserve blood; washing protocols that may rejuvenate red cells; and treatments to repair specific storage changes. In any case, the current focus on product quality may allow for the development of better storage conditions and clinical practices.