The current system of blood banks in India is such that rural patients are deprived of timely access to an adequate volume of life-saving blood, adding to preventable mortality. On the basis of an academic framework for a blood transfusion system, we describe an alternative approach in which rural practitioners utilise unbanked blood transfusions from a voluntary pool of pre-screened donors. This system would provide safe blood – as evidenced by international experience and limited projected increase in transfusion-transmissible infection in India – at a fraction of the financial cost imposed by the current system. Given the failing status quo and the undue burden placed on rural clinicians and patients to procure blood, it is imperative that policy-makers further explore the use of unbanked, direct blood transfusion for patients facing emergent, life-threatening haemorrhage.