A) Insurance NEVER pays to replace a car, even if it is totaled. They give you 80% of the current value.
B) I have 40K to replace MY car which the other guy totaled but which HIS insurance won't pay anything near what it costs me. I could sue him in court for damages to recover the rest of the money but insurance companies have seen to it that you really can't sue in court any more because they would have to do what people are paying them to do.
C) Your donation of a kidney is your choice. That is completely different than someone plowing into me which has happened with every car I have every owned. Mainly as I'm the last guy in line.