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PhilGoetz comments on Human errors, human values - Less Wrong
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If the likelihood of me needing a life-saving organ transplant at some point in my life is the same as for most other people, then I think I'd bite the bullet and agree to a system in which random healthy people are killed for their organs. Why? Because I'd have 5x the chance of being saved than being killed.
In current practice, organ transplant recipients are typically old people who die shortly after receiving the transplant. The problem is still interesting; but you have to impose some artificial restrictions.
Sure, it's just a thought experiment, like trolley problems. I've seen it used in arguments against consequentialism/utilitarianism, but I'm not sure how many of utilitarians bite this bullet (I guess it depends what type of consequentialist/utilitarian you are).