Byron Buhner, CEO of the Indiana Blood Center, said the center's leadership is reviewing its business model and has started talks with centers in Illinois, Michigan and Wisconsin to join a group they formed called the Centers for Transfusion and Transplant Medicine. Contributing to the decline are fewer elective surgeries being performed and medical advances that curb bleeding in the operating room. Studies published over the past 15 years also show that too much transfused blood can be harmful, said Susann Nienhaus, director of client services and patient safety at Indianapolis-based Strategic Healthcare Group LLC, a blood management consulting firm for hospitals.