The heavy metal contamination of water systems has become a major environmental concern worldwide. Photocatalysis using metal-organic frameworks (MOFs) has emerged as a promising approach for heavy metal remediation, owing to the ability of MOFs to fully degrade contaminants through redox reactions that are driven by photogenerated charge carriers. This review provides a comprehensive analysis of recent developments in MOF-based photocatalysts for removing and decontaminating heavy metals from water. The tunable nature of MOFs allows the rational design of composition and features to enhance light harvesting, charge separation, pollutant absorptivity, and photocatalytic activities. Key strategies employed include metal coordination tuning, organic ligand functionalization, heteroatom doping, plasmonic nanoparticle incorporation, defect engineering, and morphology control. The mechanisms involved in the interactions between MOF photocatalysts and heavy metal contaminants are discussed, including light absorption, charge carrier separation, metal ion adsorption, and photocatalytic redox reactions. The review highlights diverse applications of MOF photocatalysts in treating heavy metals such as lead, mercury, chromium, cadmium, silver, arsenic, nickel, etc. in water remediation. Kinetic modeling provides vital insights into the complex interplay between coupled processes such as adsorption and photocatalytic degradation that influence treatment efficiency. Life cycle assessment (LCA) is also crucial for evaluating the sustainability of MOF-based technologies. By elucidating the latest advances, current challenges, and future opportunities, this review provides insights into the potential of MOF-based photocatalysts as a sustainable technology for addressing the critical issue of heavy metal pollution in water systems. Ongoing efforts are needed to address the issues of stability, recyclability, scalable synthesis, and practical reactor engineering.