Acute on Chronic Liver Failure (ACLF) is a severe condition that can be seen in all patients with liver disease and is associated with high short-term mortality. Decompensated cirrhosis and organ failures resulting can lead to an admission in Intensive Care Unit (ICU) where only few tools can be used to evaluate the safety or futility of care, including liver transplantation. High short-term mortality for patients with ACLF admitted in ICU is a reason to ethically propose a liver transplantation as a curative treatment despite the existence of multi-organ failures. However, caution is advised for patients with grade-3 ACLF as they have to be attentively selected by a multidisciplinary approach, carefully evaluated and may benefit from an early transplant with a low-risk donor graft. Recent use of perfusion machine to increase outcomes after liver transplant in these urgent situations still needs to be evaluated. This review summarizes the ACLF entity and presents some recommendations about liver transplantation (LT) candidates in terms of selection, evaluation and timing of LT.