For myself, the concerns I have are about consent: how well are the risks explained to and understood by all parties involved, and what happens if one of the parties says no (especially the less powerful group). It should in theory be possible to mostly resolve those issues with consent, though in practice, even among adults it seems we have trouble with it, as the original article makes clear.
There are some philosophers who point out that a lot of the suffering from these sorts of trade-offs are actually felt by people who aren't even born yet- those who grow up amid the dust and debris, those exposed in utero, etc. which raises all sorts of even more difficult questions about consent.
Again, I have no answer for this, but I think it is good practice for humans to at least regularly think about these sorts of moral trade-offs being made by our civilization, because we each have our own point where we have to be the one who walks away from Omelas.