Yeah, but I think in this case there's an issue where the choosing party lacks the ability to make an informed decision. The risk-weighted long-term medical costs of removing a kidney (in less-than-ideal operating conditions!) and living with just one (probably in an environment where kidneys work overtime due to low-quality resources!) make it a rather expensive proposition. It would've been easier to scrap/work/beg for food than for the potential medical after-care they'll need over time, in terms of the total long-term cost of maintaining their life and/or health levels. But those that understand this are withholding that level of understanding and forcing it to look like a rational Hobson's choice to the donor.