We present the case of a 41-year-old male with type A blood group and a diagnosis of fulminant liver failure of an unknown cause, who was admitted to the Intensive Care Unit (ICU) with severe coagulopathy (INR 6), hyperammonemia (250 umol/l) and grade IV encephalopathy (four King's criteria and both Clichy's criteria). He also had GCS 8/15, despite TDE-MARS, dialysis and ventilator support via endotracheal tube due to encephalopathy. He was registered as status 0 for liver transplant. In the absence of a compatible donor, the patient received an ABO incompatible liver transplant (LT), group O, using the piggyback technique, without any complications. He required transfusion of five units of plasma but did not require a blood transfusion.