This review advances the idea of organizational anatomy as a biological metaphor for understanding how structure, internal functioning, and institutional health shape sustainable performance in modern firms. Viewing organizations as living systems—capable of growth, deterioration, adaptation, or dysfunction—provides a compelling framework for examining how structural design, communication pathways, and decision hierarchies influence effectiveness. This paper argues that just as biological organisms require healthy organs, coordination systems, and functional balance, organizations require coherent structures, healthy internal relationships, and responsive governance mechanisms. When misaligned, organizations experience “pathologies” such as inefficiency, strategic paralysis, role confusion, weak coordination, and declining performance. Conversely, structurally healthy organizations demonstrate clarity, adaptability, psychological safety, and sustained productivity. The review emphasizes that no single organizational design is universally optimal; effectiveness depends on contextual realities, organizational maturity, and environmental pressures