Figure explaines the possible process of selecting a patient with ALF for transplantation. Red lines indicate patients hospitalized with low ALFED scores, and blue line, those with mid-level ALFED score. Green lines indicate patients hospitalized with high ALFED score 6. All patients should be counseled about possible need for transplantation, and patients listed if ALFED is more than 3. In an LDLT setting, donor workup should be started. The patient should be reassessed every 12 h to determine his/her response to conventional medical treatment. Transplant decision can be tailor made to the patient's evolving condition. ALFED score at day 3 is the best predictor of prognosis (See text). ALF, acute liver failure; ALFED, Acute Liver Failure Early Dynamic Model; LDLT, living donor liver transplantation; Tx, transplantation.