Objective: Approximately 13 million adults living in the U.S. speak a language other than English in the home, frequently resulting in elevated rates of socio-economic impoverishment (e.g., reduced access to healthcare). Inasmuch, such under-represented populations are disproportionately impacted by chronic medical conditions (i.e., hypertension), which may ultimately necessitate organ transplantation. Although pre-operative neuropsychological assessment has considerable value in predicting adherence to a complicated post-surgical immunosuppressant treatment regimen, cultural and linguistic differences may preclude reliable and valid assessment of non-native English speaking persons with end-stage organ failure. Methods: This case series will examine two Spanish-speaking surgical candidates (Male = 67 y.o. and Female = 52 y.o.) assessed via Clinical Interview (both individually and with collaterals), Record Review, the Repeatable Battery for the Assessment of Neuropsychological Status-Spanish Research Edition and the Neuropsychological Screening Battery for Hispanics. Results: Both patients demonstrated multi-domain clinical neuropsychological impairment (>1.5 S.D. below the normative mean), suggesting a possible dementia or encephalopathy. However, consideration of additional factors, such as functional status and level of psychosocial support, suggested that one patient was likely an appropriate surgical candidate, while the other was at-risk of poor post-operative outcomes. Conclusions: Psychosocial, cultural, and ethical considerations are imperative when interpreting neuropsychological findings in high-stakes assessments.