It is theorized that charcoal hemoperfusion and hemodialysis with a highly permeable membrane should be synergistic in the management of fulminant hepatic failure. Previous studies have shown marked differences between these two treatments in their effects in the various biochemical abnormalities of this serious clinical problem. Survival rates in patients treated with charcoal hemoperfusion approximate the rates in those treated with hemodialysis with a highly permeable membrane but are only slightly better than in untreated cases. The excellent recovery of two patients with fulminant viral hepatitis in stage III and IV coma treated with this combined regimen indicates that further studies should be done to confirm this thesis.