The number of patients with advanced hepatic failure increases as a result of frequency of hepatitis C, the obesity and the increase in the average of the population age. However the number of transplants remains stable. For these reasons the proportion of patients with advanced hepatic failure and without possibility of transplant will be higher in next years. These patients have many physical and psychosocial symptoms that affect their quality of life. The challenge for palliative care professionals is to attend properly all the patients who need palliative treatment Objectives:1. To revise the methods in order to establish the prognosis of hepatic disease and so the moment in which to include these patients in palliative care programs. 2. To show the more frequent symptoms in patients and how to diagnose them early. 3. To establish the best therapeutic approach and the correct use of drugs in hepatic failure. Material and methods: the review of the most outstanding medical literature focused in the last years, fundamentally in gastroenterology and hepatology journals, considering that palliative care bibliography is scarce. Results: the results induce us to think that the MELD (model for end stage liver disease) is the most appropriate method to establish the situation of the disease because of his greater objectivity and accuracy. The early evaluation of the symptoms, especially in hepatic encephalopathy provides the treatment and improvement in the quality of life. The checking of the more used pharmacokinetic drugs and the indication or contraindication in its use, with its appropriate dose will permit us to improve the quality in our everyday practice. Conclusion: the hepatic failure represents an important challenge for non oncological palliative care. The appropriate establishment of the prognosis will help to improve the inclusion of these patients in palliative care programs and so will get an improvement in the symptoms relief and in his quality of life. Copyright © 2010 Arán Ediciones, S.L.