If doctors regularly harvest healthy people’s organs nobody goes to the doctor. The families of the harvested regularly kill themselves, recipients, and doctors, and sometimes go on mass shooting sprees. Everyone lives in fear. Nobody on earth would want to live in such a community so all the best and most mobile folks leave. Others organize against it and can only be suppressed by a fascist dystopia.

It’s only actually a dilemma when considered in absolute isolation. Its against utility to harvest the organs in the sense that the system required to effect it is a massive negative.