This perspective on blood- materials interactions is intended to introduce the set of papers stemming from the symposium, "Devices and Diagnostics in Contact with Blood: Issues in Blood Compatibility at the Close of the 20th Century," organized on August 4-6, 1999 at the University of Washington by the University of Washington Engineered Biomaterials (UWEB) Engineering Research Center. This article outlines some of the history of blood contacting materials, overviews the work that has originated at the University of Washington over the past 28 years, speculates on the origins of the controversies on blood compatibility and considers the issues that should be addressed in future studies.