I am conflicted on organ donation. On one hand, it makes our species as a whole weaker as people who should have died stay alive and procreate, breeding even more weak and sickly people. On the other, it maximizes the use of resources. Difficult.
Humans that have automobile accidents need organs, too.
Having been in one, yes they do. But we don't discriminate between people who are useful and people who are pieces of shit in the current medical system, and most people are pieces of shit.
The problem with organ donation "scarcity" would be solved if being on the registered donors list way BEFORE needing an organ would be a requirement to later receive an organ. I would give a two year moratory starting today and who hasn't been on the list for at least 1 year on the date of need would NOT be anymore suitable for receiving an organ. Watch the donors list skyrocket in no time. Conflict solved. Selfishness can be a great mover if used right.
Also, addressing your concern, most people receiving an organ have probably already breed their weaklings.....