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Background: Solid organ transplantation (SOT) offers improved long‐term survival for youth with end‐stage organ disease. From a neurodevelopmental, cognitive, and academic perspective, children with solid organ transplant have a number of unique risk factors. While cognitive functioning may improve post‐transplantation, it is important to understand the trajectory of neurocognitive development starting in transplant candidacy to evaluate the implications of early deficits. Aim: The aim of this paper is to describe the neurocognitive risks and long‐term implications for adolescent transplant recipients. Method: This paper provides an overview of neurocognitive functioning in youth with end‐stage organ dysfunction with discussion of implications for adolescent transplant recipients. Results: Post‐transplant, adolescent, and young adult solid organ transplant recipients exhibit significant levels of executive dysfunction, with implications for decision‐making, regimen adherence, and transition to adult transplant care. Conclusion: Transplantation may reduce the risk for poor long‐term neurocognitive effects, yet adolescent transplant recipients remain at increased risk, particularly in executive functioning, which has implications for adherence and transition to adulthood. Baseline and follow‐up assessments for youth with end‐stage organ disease and transplant are important for the monitoring of neurocognitive development and may be used to mitigate risk for low adherence to post‐transplantation treatment regimens and reduce barriers to transitioning to adult transplant care. [ABSTRACT FROM AUTHOR]