Global coffee production is expanding, contributing to environmental degradation, notably through extensive use of inorganic fertilizers. Volatile prices, climate change, rising input costs, and pressure to decrease carbon footprints represent key challenges for farmers. Regenerative soil management and the use of organic management as an alternative to conventional mineral fertilizers offer one potential solution to address these challenges. However, information is limited regarding the potential options available for farmers, and their potential environmental, economic, and social impacts. We undertook a systematic review of the literature to assess the benefits and trade-offs from adopting different organic management approaches following PRISMA guidelines. We identified 43 peer-reviewed articles, predominantly focusing on agroforestry, plant-derived additions, soil management or animal manure to improve livelihoods and environment. Research priorities differ by region and there is a skew toward researching the environmental impacts of regenerative techniques. Our synthesis demonstrates multiple potential environmental benefits to organic management, but increasing economic risks and trade-offs for farmers, particularly in transitioning to organic management. We also highlight the social barriers facing farmers, from education to access to knowledge networks to support implementation. These challenges must be addressed to support any future sustainable transitions to organic management in coffee.