This chapter investigates the nature of China’s illicit organ trafficking practices in their broad social, economic and political contexts, and links this with policy and governance issues in China. It examines the combination of various underlying factors reflected in the pattern of underground organ sales in China. The chapter explains why the issue of illicit organ trade had remained intact for decades despite rigorous questioning from international community about the Chinese government’s complicity in the black market. The nature of the clandestine black market of human organ trade is closely linked with globalization. Huang’s public acknowledgement of the extent of black market organ sales particularly the unlawful extraction of organs from executed convicts was followed by several legislative and policy changes. The Transplantation Society and the International Society of Nephrology convened an international summit in Istanbul, Turkey in 2008 to address the unethical practices associated with transplantation.