Should we keep people from dying from lung cancer because they smoked? Should we not try to help people dying from liver disease because they’re alcoholics?
When the smoker/drinker fully admits they have zero intention of quitting, I would much rather give my lung/liver to someone who isn’t going to get a full, healthy life out of it, rather than someone who clearly would rather continue abusing it and burn through it in a couple years.
Organs are a limited resource, that’s why there is a list - and we should absolutely dedicate limited resources to doing as much good as possible