There are three reasons why perfusionists and autotransfusionists around the globe still use Normal Saline with cell savers; (1) This what they were taught by their peers and/or didactic educators for decades. (2) This is what cell saver manufacturers have been stating in their Instructions For Use (IFU) for over 5 decades. (3) It is the general assumption that any solution other than what is stated in the IFU, may designate an off-label use of that device. But is the use of Normal Saline for washing salvaged blood physiologically the best solution for this autotransfusion process or is it just the way it has always been done and should not be questioned?