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The bit-at-a-time donation is yet another item with many possible explanations. It may even be as simple as "this is the way it's always been done" - harking back to the beginnings when bit-at-a-time was the way it started (for whatever reason). Now, maybe, their equivalent of big-pharma wants to retain their investment in the infrastructure.
I'm not convinced any of the three held any real faith in the true-love=reprieve thing by they time they left the cottages. I'm not sure of Ruth's motives (was it truly repentance or just another form of manipulation?), but I see Tommy and Kathy going through with it because that's what you do near the end: if there's some option to be explored (to extend your life even just a few months) before you let yourself die then you explore it. It happens now, so I didn't see anything at all strange about it in the book.
Their passivity seems strange and disturbing, and it's one of the thoughts that clings after the book ends: how much of their passivity was a matter of upbringing, possibly of their genes, and how much is just human nature?
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