Really, between the wealthy and powerful being able to manipulate the system, the organ black market, and the unspeakable ethics of deciding who lives and dies based on X medical criteria (as no doubt it varies around the world), the only viable solution is universal donation by default.
I think for that reason it should be lobbied for rigorously world wide. As others have pointed out, universal donation would very quickly solve these dilemmas, even with the opt-out being integral to the law changes.
People just don't think about doing organ donation; it's a morbid topic for them. As is thinking about pre-planning for their funerals. That's something that traditionally is thought of as an old person's concern. And nobody thinks about how they could die at any time from an accident. And they just don't get the continuous reminders and education about the topic enough, or I seriously think there would be many more organs available now.