There is no doubt that in order to design an effective free hemoglobin (Hb)-based oxygen carrier, a full understanding of the mechanism of Hb toxicity is required. The current knowledge of Hb's overall toxicity however, is very limited. Hb is such an intriguing molecule that even after many decades of researching its physical, biochemical, physiological and pathological profile, many aspects of its intrinsic toxicity are yet to be uncovered [1]. This is probably the main reason for not having a viable substitute of human blood on the market. In fact, no product has yet been approved in the U.S. for any indication [2]. The currently tested, Hb-based oxygen carriers trigger a complex array of reactions as a result of Hb's natural features [3]. A number of unwanted effects have been observed in human clinical trials. Regardless of the type of Hb chemical modification procedure, all the first generation Hb-based oxygen carriers are vasoactive [1][2][3][4][5][6]. Some products have also been linked with oxidative and inflammatory reactions, often described as "flu like" symptoms, gastrointestinal side effects and myocardial lesions [1,3,7,8].The products currently in various phases of clinical trials were developed before the recognition of Hb's intrinsic toxicity problems. These products seem only to address the problems of Hb purity, high oxygen affinity and short circulatory half-life; which were uncovered in the 1970s and had been resolved in various ways. There are, however, newly discovered problems that need resolution. These are vasoactivity, pro-oxidant and pro-inflammatory properties of Hb [1][2][3][4][5][6][7][8]. Therefore, it was not surprising that the commercial