Risk as liability views system integrity and maintenance as an important goal. Management entails not only the use of knowledge about patient safety and system practice but also a cognitive and emotional commitment to the aims and goals of the organisation. The supplier agency has created that commitment and loyalty within a changing Canadian health care system (see [37] ). Yet uncertainty remains and this may be due to the centrality of precautionary principles in the blood supply system. Thus, it is not surprising that risk and precaution are seen simultaneously as two dimensions of hazard management. Good record keeping and monitoring of transfused blood (and its recipients) enables precaution to be central in risk management. Kaplan et al [50] advocate a medical event reporting system for transfusion and we concur with their suggestions. Such a system (Transfusion Error Surveillance System -TESS) is currently being developed and piloted in Canada [9] . Furthermore, the difference discourses in expert groups within the same decision-making system (but likely at different levels of decision-making) may be beneficial, if recognised as such. 'Hazard' is a safety-first approach protective of health; 'liability' ensures that the challenges of risk amplification and perceived injury may be dealt with if an unknown risk is disclosed and 'precaution' ensures due diligence and quality assurance before action is taken.