Trump-aligned lawfare group claims Biden-era kidney transplant rule violates civil rights laws by encouraging hospitals to consider race in organ allocation decisions. The group, led by former White House aide Stephen Miller, is petitioning two of the government’s top federal health agencies to immediately repeal a Biden-era regulation they claim promotes organ transplantation allocation based on race, not medical need. The rule was created by the Health and Human Services Department (HHS) and the Centers for Medicare and Medicaid Services (CMS) as part of a broader effort to address systemic disparities in transplantation rates. The rule’s goal was to encourage hospitals to consider race as a factor in determining organ allocation decisions, but critics argue this approach is discriminatory and undermines the principle of equal treatment under the law.
The IOTA Model, as it is known, is designed to score hospitals participating in the rule across three domains – achievement, efficiency, and quality – and provide financial incentives or penalties based on their performance. The rule’s equity agenda was embedded more subtly through a ‘voluntary’ health equity plan that participating hospitals are encouraged to complete. The plan pushes hospitals to identify ‘health disparities’ and set ‘equity goals’ to monitor and evaluate progress in reducing targeted health disparities, which will be measured by ‘one or more quantitative metrics’ that the IOTA participant uses to measure the reductions in target health disparities arising from the health equity plan interventions.
Despite the rule’s focus on reducing racial disparities in transplantation, critics argue that it effectively normalizes ‘identity-based preferences’ within the nation’s organ transplant system. The Trump-aligned lawfare group argues that the IOTA Model is a leftover remnant of an unlawful equity agenda that encouraged hospitals to view lifesaving care through a DEI lens, violating Title VI of the Civil Rights Act, Section 1557 of the Affordable Care Act, and the equal protection clause. The group also argues that the rule exceeds CMS’ statutory authority under the Social Security Act and is ‘arbitrary and capricious’ under the Administrative Procedure Act.
The debate over the IOTA Model reflects a broader ideological divide over the role of diversity, equity, and inclusion (DEI) in public policy. While the Biden administration believes that integrating DEI principles into healthcare can help address longstanding systemic inequities, critics argue that such approaches risk undermining objective medical decision-making. The ongoing legal challenge to the IOTA Model highlights the complex intersection of public policy, civil rights, and healthcare equity in the United States.