Most cases of fulminant hepatic failure (FHF) are related to viral hepatitis or to drugs and toxins. With improvement in supportive intensive care, the overall survival has increased, but specific forms of temporary hepatic support pending hepatic regeneration have been disappointing. With the widespread availability of orthotopic liver transplantation, this has become a viable option for those patients with FHF who are unlikely to survive with conservative treatment, although patient selection and timing of transplantation still presents a clinical dilemma.