Prior to the pandemic, the U.S. blood system faced sustainability issues predominantly focused on blood collection agency financial underperformance. Blood centers responded through consolidation/mergers, overhead reductions, and supply expense pruning. The November 2016 RAND Corporation report commissioned to analyze the blood system environment and identify options for ensuring its long term sustainability rendered only modest recommendations. Subsequently, and prior to the pandemic, the U.S. Congress reauthorized the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. Section 209 of this act sought recommendations for "maintaining an adequate national blood supply." Submitted to Congress in fall 2020, the recommendations reflected lessons learned and the resiliency demonstrated by the blood system during the early phase of the pandemic. Additional developments during the pandemic minimized disruptions and provide valuable outlines for future infectious disease or environmental disaster planning. As such, the blood system, under significant stress during the pandemic, demonstrated resound resiliency. Post-pandemic, long-term sustainability relies on pandemic-related lessons learned and future adaptions to blood donor engagement, changing donor demographics, big data requirements, enhanced safety processes, and innovation.