Trump-Aligned Legal Group Investigates Biden’s Organ Transplant Program Over Ethical Concerns
On Thursday, America First Legal, a Trump-aligned group founded by Stephen Miller, former White House aide to former president Donald Trump, filed Freedom of Information Act (FOIA) requests targeting the Biden administration’s Increasing Organ Transplant Access Model. The move comes as part of a broader probe into the program’s ethical implications and potential for outside influence. The organization has directed its requests to the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration.
The Increasing Organ Transplant Access Model (IOTA) is a six-year mandatory program, finalized in December 2024 and set to take effect in July 2025. It aims to expand access to kidney transplants but has drawn criticism from Trump officials and allies. Concerns include the potential for external manipulation, with some arguing that the model’s use of financial incentives and penalties could be influenced by third-party entities with improper motives.
America First Legal, which is not officially part of the Trump administration, was founded by Miller after his first presidential term, although he left the group before rejoining the White House in 2025 as Trump’s deputy chief of staff. Laura Stell, counsel for America First Legal, emphasized in a statement that ‘self-interested third parties should play no role in shaping America’s organ transplant policy.’ She stressed the need for ‘utmost certainty that CMS developed the program without influence from entities with improper motives.’ The group’s investigation seeks to uncover any potential compromise or influence in the program’s development and implementation.
The IOTA model was designed to improve care for Medicare and Medicaid patients by testing the effectiveness of financial incentives and penalties. It will affect more than 100 U.S. transplant hospitals over six years, imposing mandatory financial incentives and penalties tied to a final performance score. The program aims to address the long waiting list of patients needing transplants, with as many as 90,000 people on the list as of last fall. However, the role of outside groups, including during the rule’s drafting, has raised concerns and led to calls for additional scrutiny from Trump allies.
The Department of Health and Health Services Secretary Robert F. Kennedy Jr. also cited concerns from the HRSA-led probe, which found that third-party groups or for-profit organizations ‘may have unduly influenced the IOTA Model.’ The department noted that the study revealed ‘clear negligence and disturbing practices’ by a large organ procurement organization, prompting the launch of a new reform initiative. The ongoing scrutiny highlights the complex ethical and administrative challenges of implementing such a high-stakes public health program.
With its investigation, America First Legal aims to ensure transparency and ethical standards in the development and implementation of the IOTA model. The group’s actions reflect broader legislative concerns over the balance between financial incentives in healthcare policy and the need for ethical oversight, raising important questions about the role of private entities in shaping public health initiatives.