At RILDT, we are one of the very few liver units in the country having the ability to manage sick patients and undertake liver transplantation on an emergency basis. In our hospital we get many patients with Acute Liver Failure, which refers to a severe failure of liver function within a matter of days to weeks in a previously healthy person. The most common cause of ALF in India is viral infection due to hepatitis viruses. Other causes of ALF are overdose of paracetamol, consumption of poisonous materials like phosphorus compounds (found in rat killer poison), autoimmune hepatitis and Wilson’s disease. Patient with acute liver failure usually present with jaundice, bleeding problems and altered behaviour.Patients with acute liver failure need urgent transfer to a hospital with liver transplant service to have a successful outcome. Some of these patients may recover with medical treatment alone. This treatment has to be provided in an intensive care unit with careful monitoring by the liver physicians and intensive care specialists. Patients who reach certain criteria on blood tests need urgent liver transplantation as they will not survive with medical treatment. Urgent living donor or deceased donor liver transplantation is lifesaving in this situation and Rela Hospital is one of the best liver transplant hospitals in Chennai.