The organic dairy industry in the US has been growing steadily since 1990, and organic farmers have struggled to produce enough supply to meet the growing domestic demand. The whole certified organic process relies on several preventive management practices (e.g., transition cow program, vaccination, water quality, nutrition, reproduction) that ultimately will allow the animal to produce nutritious high quality milk. The basic physiological functions to prevent metabolic disorders in transition cows are dry matter intake and maintenance of calcium and energy balance (ketosis). These factors also determine the status of the immune system of the animal; thus, the prevalence of infectious diseases (e.g., metritis and mastitis), the risk of culling within 60 DIM, and performance of lactating dairy cows. Reproductive failure and mastitis are the top 2 reasons for early removal of lactating cows from dairy herds. This causes severe economic losses to organic dairy producers because of decreased milk yield and quality as well as increased replacement costs. Designing and implementing a proactive transition management program (i.e., protocols) that focuses on monitoring the leading risk factors (e.g., diets and feed management, water quality, comfort of pre- and postpartum cows [e.g., resting time], calving management, and personnel training) will significantly reduce calving-related diseases and the risk of culling while optimizing performance of lactating dairy cows. Therefore, best transition cow management practices during the weeks before and after calving are key determinants to avoid a drop in dry matter intake, hypocalcemia, and ketosis; and the subsequent negative effect on the immune system of animals in organic dairy herds.