Background: Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. Methods: The present study compared the results of a new selective transfusion policy in which patients were not transfused unless their hemoglobin levels went below 6–6.5 g/dL versus our previous routine transfusion policy in which the hemoglobin levels were routinely maintained at 10 g/dL. The selectively transfused group consisted of 14 patiets with a mean ± SD burn size of 28% ± 11%, while the routinely transfused group consisted of 38 clinically comparable patients with a mean burn size of 26% ± 12%, Results: The patients managed by selective transfusion received fewer transfusions (2.1 ± 1.7 units) during their hospital stay than patients transfused routinely (7.4 ± 7.6 units) (p > 0.007) and were less likely to receive maintenance transfusions (4 of 29 total units versus 116 of 282 total units) (p > 0.004). No adverse hemodynamic or other adverse effects related to limiting blood transfusions in the selectively transfused group was noted. Conclusion: Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.