Purpose: The purpose of this invited review was to identify and discuss (a) the welfare issues that can occur when cull dairy cows are sent for slaughter, (b) factors that can affect the occurrence and severity of these issues and how they relate to on-farm management decisions, (c) measures that can mitigate these issues, and (d) proposals to improve the welfare of cull dairy cows. Sources: Peer-reviewed literature, book chapters, reports, and guidance documents were sources of information. Synthesis: Severe welfare issues occur when some cull dairy cows that are not fit for the intended journey are transported to slaughter. These issues are even greater if compromised cows are sent to slaughter via an auction market. The decision to send a cull cow to slaughter needs to be made before the cow becomes unfit for the likely journey. If a cow becomes unfit for transport, it should be euthanized on the farm. Some cull cows arrive at slaughter plants and are observed at markets with distended udders, severe lameness, and disease. The numbers of cows with these severe welfare issues could be reduced by improved on-farm decision making about when and how to manage cows with health issues, when to euthanize sick or injured cows, and when a cow is fit for transport and for sale at a market. Dairy producers need to understand the welfare implications of how they manage their cull dairy cows, and that some changes in their management practices are required. Conclusions and Applications: This review identified that research on the assessment of the fitness of cull dairy cows for transport and on the factors that influence their welfare during transport and marketing are required. Research about how to motivate dairy producers to incorporate the welfare implications of their management of cull cows into their culling decisions and how to increase their use of industry recommendations about the care of cull cows are priorities.