I'm an RN on liver/kidney transplant floor. I'm not actively involved in the decision process of who gets the organ, but I do know some of the background.
Yes, there is some sense of "worthy" in deciding who gets the organ. There are probably about 100 needs per 1 liver. We don't want to waste the liver. I'm sorry if it's a strong word, but that's how it's perceived. Donors are picked based on several criteria (I don't know the exact list, but...) ability to afford the meds for the rest of their life. Family support to handle frequent hospitalizations for the rest of their life. How likely they are to care for the liver. Reason for needing the liver - should a lifelong alcoholic receive the liver over a non-self-induced cause just because he's been on the list longer? Level of illness - if the receipient is more likely to die during surgery or during post-op because he is so sick, that's considered. Again, we want the organ to last. There aren't enough organ donors - the TOP priority of these decisions is that the organ is put to good use.
And yes, a family can chose a recipient. For instance, it's not too uncommon for a young adult to die in a car accident and his/her family knows a family friend who is awaiting an organ. That transplant can occur if all falls into place - the donor and recipient are matched, the organ is harvested appropriately, the distance works out ok (you don't want many hours between harvesting and transplantation). Even if the receipient has been on the list for a short amount of time, that transplant can occur.
I didn't care for that movie, though I can't exactly put my finger on why not. It was a waste of the character's life, I guess, mostly. He could've saved many lives by actively choosing to live and to do so.
Anne