A kidney can cost up to USD 200,000. Humans have two kidneys but normally require just one to live. Individuals can donate one to relatives for altruistic reasons. But to pay USD 200,000 - or any other amount - to obtain a kidney, no country in the world allows that. Except for Iran. This global blanket ban has pushed the trade of organs underground and it now ranks as the fourth most lucrative illegal activity – behind only drugs, arms, and human trafficking. Rising incidence of end-stage kidney disease will increase demand for replacement kidneys, both gifted and bought. This essay studies this trade using two case studies, one of a Nigerian leading legislator arrested in the UK for getting a kidney for his daughter and another on kidney demand in Iran where trade in organs is permitted. The global value of the trade is studied, and literature gaps are discussed. The inadequacies of the current system are highlighted and improvements suggested, based on best practices around the world.