Major liver surgery is increasingly performed for cancer and benign indications. Such surgery can be associated with significant hemorrhage. As a consequence, blood transfusion may be required in approximately one quarter of patients. Blood transfusion is a key determinant of poor short- and long-term outcome following liver surgery. It is also associated with immediate transfusion risks and it is a limited resource. For this reason, programs to decrease the use of blood transfusions in liver surgery are necessary and important. Our research program seeks to decrease the use of blood transfusion in liver surgery. To do so, a novel intervention aiming at decreasing the odds of requiring a transfusion will be tested within two clinical trials. This intervention, hypovolemic phlebotomy, seeks to decrease blood loss in the operating room and consequently to decrease blood transfusions. Secondly, our program seeks to determine the incidence of inappropriate transfusions in liver surgery, as well as to define their context. This information will be used to generate tailored knowledge translation and behavior modification interventions to minimize inappropriate transfusions in the future.