In patients with decompensated cirrhosis and multi-organ failure, intensive care units must coordinate care between hepatologists, transplant surgeons, intensivists, and nephrologists to optimize patient outcomes. This roundtable highlights the importance of well-coordinated processes between floor units and ICU teams, including early response systems and regular multidisciplinary rounds to discuss management strategies and transplant considerations. Different specialists must collaborate effectively to make decisions about various treatments, including terlipressin administration, dialysis initiation, and transplant timing, particularly in challenging cases like alcoholic hepatitis. This activity also covers how teams must carefully balance improving kidney function against maintaining transplant priority scores.