The Silent Hill: Townfall blood transfusion puzzle in the Otherworld Medical Center can feel like two puzzles mashed together—and, honestly, that is basically what is happening.
During The Patient, you’ll return to the distorted Medical Center and eventually reach the central transfusion area. First, you need to put three specific blood bags into the correct wall stations. Then, just when you think you’re done, the game throws a much larger circular blood-routing mechanism at you.
The trick is that these two stages use different information. The first section is about placing Sarah Watson, Matthew Clark, and George McEwan’s blood bags correctly. The second asks you to identify which patients have blood compatible with Simon Ordell’s A+ blood and route those sources into the center of the machine.
Here’s the full Silent Hill: Townfall blood transfusion puzzle solution, including the blood bag placement, the ORDELL dial, the compatible blood types, and what to do after the puzzle is complete.
Where to start the blood transfusion puzzle
The sequence takes place in the distorted Medical Center during The Patient. After the hospital changes, you’ll eventually return to the central transfusion area with the blood bags you collected throughout the surrounding wards.
There are two objectives to complete:
- Place three specific blood bags into the wall stations.
- Rotate the circular mechanism and route the compatible blood types into ORDELL.
That distinction is important because solving the first section does not automatically solve the circular mechanism.
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Which blood bags do you need?
For the first part, you need these three blood bags:
- Sarah Watson
- Matthew Clark
- George McEwan
Place them in the following physical arrangement:
| Position | Blood bag |
| First position on the left | Sarah Watson |
| Next position on the left | Matthew Clark |
| Position on the right | George McEwan |
Some walkthroughs use different numbering systems when describing the stations, so don’t get too hung up on whether another guide calls a position the second, third, or fourth slot. The reliable detail is the physical left-to-right arrangement: Sarah first on the left, Matthew next to her, and George on the right.
Sarah Watson’s blood bag
Return to the central transfusion area and find the blood-bag stations along the wall.
Place Sarah Watson’s Blood Bag in the first position on the left.
Sarah matters beyond this first placement because her A+ blood also becomes one of the three compatible blood sources needed for the final ORDELL mechanism.
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Matthew Clark’s blood bag
Place Matthew Clark’s Blood Bag in the next position on the left, directly beside Sarah’s position.
Your left side should now read:
Sarah Watson → Matthew Clark
George McEwan’s blood bag
Take George McEwan’s Blood Bag and place it at the station on the right side of the central arrangement.
The completed setup is:
Left: Sarah Watson → Matthew Clark
Right: George McEwan
Once all three are installed, you’re ready to activate the transfusion mechanism.
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Activate the transfusion machine
With the three blood bags in their correct positions, head back toward the area beside the large double doors.
Look for the switch next to the doors and interact with it.
This activates the transfusion mechanism and opens the way toward the next section of the puzzle.
And this is where the puzzle gets much more interesting.
The next mechanism is a huge circular blood-routing device with several rotating sections and pathways leading toward a central panel marked ORDELL.
Don’t try to connect everything you see. The game wants you to figure out which blood sources are actually compatible with Simon.
Simon Ordell’s blood type is A+
The name ORDELL in the center of the mechanism is Simon Ordell’s surname.
To work out the correct routes, check Simon’s medical wristband. It identifies his blood type as:
A+
The compatibility information around the puzzle then tells you which blood types can connect with A+.
For this puzzle, Simon’s A+ blood is compatible with:
- O−
- O+
- A−
- A+
That gives you the key information needed to identify the correct patients.
The important part is that you’re not supposed to connect every patient shown around the circular mechanism. Only the compatible blood sources need to reach ORDELL.
Which patients can connect to ORDELL?
Check the patient blood information and match the blood types to the initials displayed around the circular mechanism.
The three required sources are:
| Initials | Patient | Blood type |
| H.M. | Hannah McGregor | O− |
| T.F. | Thomas Fergusson | O+ |
| S.W. | Sarah Watson | A+ |
These are the three paths you need to route into the center.
So the final answer is:
H.M. + T.F. + S.W. → ORDELL
The other patient initials should not have a route reaching the center.
How to solve the circular blood dial
Now comes the hands-on part.
The circular mechanism contains multiple rotating sections with blood pathways running between the patient initials and the central ORDELL panel.
Rotate the different sections until you create uninterrupted paths from:
- H.M.
- T.F.
- S.W.
to ORDELL.
You don’t need to connect every available blood source. In fact, trying to route every line into the center is the wrong approach.
Instead, focus only on the three compatible sources:
H.M. = O−
T.F. = O+
S.W. = A+
Once each of those three has a continuous path into the middle, the mechanism is correctly arranged.
The exact appearance of the rings can be easier to understand visually than through a sequence of individual rotations, since each section changes the connected pathways. Rather than memorizing every turn, follow the three required initials and keep adjusting the rings until all three routes reach ORDELL.
When the paths are aligned, interact with the ORDELL panel in the middle.
That confirms the solution and opens the passage.
Why the two parts of the puzzle use different blood bags
This is the part that can really throw players off.
You just placed Sarah Watson, Matthew Clark, and George McEwan into the wall stations, so it’s natural to assume those same three people must be the answer to the circular mechanism.
They aren’t.
The first stage is an inventory and placement puzzle. You need the correct three blood bags and must put them into the appropriate physical positions:
- Sarah Watson
- Matthew Clark
- George McEwan
The second stage is a blood-compatibility puzzle. Here, you’re looking at Simon’s A+ blood type and determining which patient blood types can connect to him.
That produces a different trio:
- Hannah McGregor — O−
- Thomas Fergusson — O+
- Sarah Watson — A+
Sarah appears in both stages, but Matthew and George are not the final circular-dial answers.
Once you understand that the game is testing two different things back-to-back, the whole sequence becomes much less confusing.
What happens after solving the ORDELL puzzle?
After you correctly connect H.M., T.F., and S.W. to the center, interact with ORDELL.
The locked passage opens, but the Medical Center section isn’t immediately over.
Continue through the newly opened corridor until you reach another locked door.
You’ll need the Room 204 Key to proceed.
The Room 204 Key was obtained earlier during the A Different Place section at the Haldane Hotel. It can be found on the bathroom counter after solving the hotel door puzzle.
Use the key on the locked door at the end of the Medical Center corridor. After the following sequence, the story moves on to the next section.
Silent Hill: Townfall blood transfusion puzzle — quick solution
For anyone who just wants the answers without the full explanation, here’s the complete sequence.
Blood bag placement
- First position on the left: Sarah Watson
- Next position on the left: Matthew Clark
- Position on the right: George McEwan
Then:
Activate the switch beside the large double doors.
Circular blood dial
Simon Ordell has A+ blood.
The compatible blood types shown by the puzzle are:
- O−
- O+
- A−
- A+
The three patient paths you need are:
- H.M. = Hannah McGregor = O−
- T.F. = Thomas Fergusson = O+
- S.W. = Sarah Watson = A+
Rotate the circular sections until:
H.M. + T.F. + S.W. → ORDELL
Do not route the other patient initials to the center.
Finally, interact with ORDELL.
The passage opens.
After the puzzle
Continue through the corridor and use the Room 204 Key on the locked door farther down the Medical Center.
The key was obtained during A Different Place at the Haldane Hotel, where it can be found on the bathroom counter after solving the hotel door puzzle.
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Final blood transfusion puzzle checklist
For a clean run through the puzzle, keep this sequence in mind:
Place the bags
Sarah Watson → left first
Matthew Clark → left next
George McEwan → right
Activate
Switch beside the large double doors
Check Simon’s blood
Simon Ordell → A+
Compatible blood types
O−, O+, A−, A+
Connect
H.M. → ORDELL
T.F. → ORDELL
S.W. → ORDELL
Confirm
Interact with ORDELL
Continue
Use the Room 204 Key at the locked door farther down the corridor.
The biggest thing to remember is that the three bags used in the first stage are not simply the three answers for the final dial. The wall placement requires Sarah, Matthew, and George, while the compatibility mechanism requires Hannah, Thomas, and Sarah.
Once you separate those two objectives, the Medical Center’s blood transfusion puzzle becomes far easier to crack.
Disclaimer: Puzzle details and terminology can vary slightly between walkthroughs, particularly the numbering used for the blood-bag stations. This guide uses the physical left/right arrangement confirmed across multiple current walkthroughs.
Image Credit:
- Featured Image: Rebel Wolves / YouTube via Perfect Paradox
- Image 2: Rebel Wolves / YouTube via Perfect Paradox
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