Transfusion Transmissible Infections (TTI) in blood donors continue to be a threat to recipients, therefore, to increase accessibility to infection-free donor blood, voluntary non-remunerated donation has been recommended. This was a retrospective observational study aimed at establishing a data base for transfusion transmissible infections in family replacement and voluntary donors at the Alotau Provincial Health Authority (PHA) Blood Bank Service using donor data recorded from 2015 to 2018. Statistical significance was determined using the chi-square test with p-values of <0.05 considered significant. Ethical clearance was approved by the School of Medicine and Health Sciences Research Ethics Committee. Consent to collect data from the Alotau PHA Blood Transfusion Service and the Blood Bank Laboratory was granted on the 17/06/2019 reference #: RCO1/6/19. A total of 2852 blood donors were analyzed, of which 90% (n=2567) were males and 10% (n=285) were females. Of these, 69% (n=1959) were Family-Replacement-Donors (FRDs) and 31% (n=893) were Voluntary Donors (VDs). Donations by FRDs increased with increasing years from 2015 to 2017 and declined slightly by 1% in 2018. The complete opposite was observed in VDs. TTIs were higher in FRDs than in VDs (20.1% vs 16.8%, p=0.04), in single infections, (18.6% vs 15.2%, p=0.03), infection with HBV (9.9% vs 7.2%, p=0.02), and in those aged over 45 years (2.7% vs 0.1%, p=<0.01). The differences were statistically significant. TTI was significantly higher in male FRDs than VDs (19.1 vs 14.3, p=0.00) and in females, it was significantly higher in VDs than in FRDs (2.5% vs 1.0%, p=0.00). TTIs were significantly high in older male FRDs which seem to indicate that the primary route of transmission in this setting could be mostly sexual. This calls for establishment of effective educational awareness about risk factors in the older population, and promotion of voluntary non-remunerated donations in this setting.