The use of bone marrow transplantation for hemoglobinopathies was first proposed in thalassemia major and is now the therapy of choice for young patients affected by this disorder and having a suitable donor. Even though bone marrow transplantation is very effective in treating sickle cell anemia, enthusiasm for it is restrained by the unpredictable course of the disease. Selection criteria are difficult to establish and vary among medical teams and their patients' characteristics. Some of the factors playing a role in the decision are summarized in this article. They include genetic and environmental factors, features of the patient such as age or the presence of organ damage, and the possibility of using new alternative therapeutic approaches.