I've been thinking about the terrible shortages of organs for some time, and I keep coming back to the question of whether we shouldn't do several things:
1) Pass laws making organ donation the default position for everyone in society -- that is, it is assumed that your organs are available for donation to whomever will benefit unless you take specific, positive action to refuse donating your organs when they are no longer doing you any good; AND
2) Revise the rules on who gets the donated organs to put adults who refuse the default position and their children at the bottom of recipient lists.
That is, if you are unwilling to donate your organs, you will only be given donated organs when there is no more suitable candidate for a transplant available who is also willing to be a donor for others. And if you have opted out your children, same rule applies -- children of those who exempt themselves from donating will only be given organs from a child donor if there is no more suitable child available who can benefit from those organs.It sounds terribly brutal or even bigoted to see it stated that way, though my intent is neither to be brutal nor to harm people of any religious group. But in a pluralistic society where there are far more people who need organ transplants than there are donors, something has to be done to increase the odds of people donating. It seems just (as in justice) to have organs preferentially given to those who have indicated a willingness, were the roles reversed, to be the donor as well as the donee. It doesn't matter whether your organs are medically fit such that they would be accepted, it's whether or not you positively opted out when you didn't know whether you would need them that matters.
More importantly, this avoids the whole "Why shouldn't we let the rich arrange with the poor to sell their organs?" problem that crops up now and again. The proposal above is even-handed and avoids any hint of privilege based on anything but your own willingness to contribute into the system that might benefit you in the same way that you might benefit.