TRUMP-ALIGNED LAWFARE GROUP CHALLENGES BIDEN’S ORGAN TRANSPLANT RULE AMID CIVIL RIGHTS CONCERNS
A Trump-aligned legal group is challenging a Biden-era regulation on kidney transplant allocation, arguing it violates civil rights laws by encouraging hospitals to consider race in organ distribution decisions. The regulation, part of the Increasing Organ Transplant Access (IOTA) Model, mandates hospitals to participate in a health equity plan aimed at addressing racial disparities in transplantation. The group claims the policy normalizes race-based preferences, violating Title VI of the Civil Rights Act and other legal standards.
The IOTA Model, developed by the Health and Human Services Department (HHS) and the Centers for Medicare and Medicaid Services (CMS), scores hospitals based on three domains—achievement, efficiency, and quality—and implements financial incentives or penalties based on their performance. Although the rule initially included an equity performance adjustment, that part was removed before finalization. Instead, the equity agenda was embedded through a ‘voluntary’ health equity plan, which encourages hospitals to identify health disparities and set equity goals to monitor progress in reducing them.
According to the America First Legal (AFL) group, 67 out of 103 mandated hospitals are still engaged in Diversity, Equity, and Inclusion (DEI) efforts. The group argues this represents a normalization of ‘identity-based preferences’ within the organ transplant system. AFL claims the rule exceeds CMS’ statutory authority and is ‘arbitrary and capricious,’ violating the Administrative Procedure Act. The group is also challenging the rule’s compliance with Title VI of the Civil Rights Act, Section 1557 of the Affordable Care Act, the equal protection clause, and precedents from U.S. Supreme Court rulings.
AFL, the lawfare group founded by Stephen Miller, a former White House aide to President Donald Trump, argues the IOTA Model is a remnant of an ‘unlawful equity agenda’ that encouraged hospitals to view lifesaving care through a ‘DEI lens.’ The group contends that the rule treats race as a substitute for medical judgment, risking patients’ lives on waitlists based on immutable traits rather than clinical need.
The IOTA Model is part of a broader initiative by the Biden administration to address systemic inequities in healthcare. In 2021, President Biden signed Executive Order 13985, directing federal agencies to conduct ‘Equity Assessments’ to identify barriers faced by underserved communities. This policy is part of a series of initiatives aimed at addressing disparities in healthcare access, including the request for public input on how to reduce disparities in organ transplantation.
CMS highlighted that Black Americans are almost four times more likely, and Latinos are 1.3 times more likely, to develop kidney failure compared to White Americans. Despite these higher risks, data shows that Black and Latino patients on dialysis are less likely to be placed on the transplant waitlist and have a lower likelihood of transplantation. As a result, CMS sought public input on how to advance equity within the organ transplantation system.
The Biden administration’s approach has drawn criticism from Trump and his allies, who argue that integrating DEI principles into the organ transplant framework undermines evidence-based medical practices. AFL is pursuing the repeal of the rule, citing concerns about its legitimacy and its potential to harm patients by prioritizing race over medical need. The group claims the administration built the policy on the premise that fairness requires discrimination, which it argues risks condemning patients to death on waitlists based on immutable traits rather than clinical need.
The HHS and CMS have not provided a formal response to the petition or requests for comment. The ongoing legal battle highlights the broader ideological clash between the Biden administration’s focus on equity and racial disparities and the Trump-aligned group’s push to prioritize medical need over identity-based considerations in healthcare decisions.