Haven't had one of these for awhile. This thread is for questions or comments that you've felt silly about not knowing/understanding. Let's try to exchange info that seems obvious, knowing that due to the illusion of transparency it really isn't so obvious!
This situation seems different for me for two reason:
Off-topic way: Killing the "donor" is bad for similar reasons as 2-boxing the Newcomb problem is bad. If doctors killed random patients then patients wouldn't go to hospitals and medicine would collapse. IMO the supposedly utilitarian answer to the transplant problem is not really utilitarian.
On-topic way: The surgeons transplant organs to save lives, not to make babies. Saving lives and making lives seem very different to me, but I'm not sure why (or if) they differ from a utilitarian perspective.
You're fixating on the unimportant parts.
Let me change the scenario slightly to fix your collapse-of-medicine problem: Once in a while the government consults its random number generator and selects one or more, as needed, people to be cut up for organs. The government is careful to keep the benefits (in lives or QALYs or whatever) higher than the costs. Any problems here?