The Romano Clan does accept Humans. A large number of Humans are needed to help feed her large clan. They can either find Elena and approach her themselves and ask to join so the Vampires may feed from them or Elena will ask them to join her clan. They can refuse for whatever reason and she will leave them alone. Bridgette will take care of them and keep them healthy. The Vampires that feed from them are not allowed to turn them and they are not allowed to drain a Human completely. Elena cares for her Humans as she cares for her Vampires because she needs them to keep her clan alive.

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The only way the Humans can become a Vampire is if they contract a disease that Bridgette cannot cure, they can prove to Elena that they would be a worthy addition to the clan, or a Vampire falls in love with them.