Could a well-intentioned policy on organ transplants be hiding a dangerous bias?
A Trump-aligned legal outfit, America First Legal (AFL), founded by White House aide Stephen Miller, is pushing the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to scrap a Biden-era regulation they argue prioritizes identity politics over medical necessity in kidney transplant allocations, as Fox News reports.
Let’s rewind to the start of this saga. Back when former President Joe Biden took office, he signed Executive Order 13985, tasking federal agencies with sniffing out systemic barriers for underserved communities in federal programs. This set the stage for equity-focused policies across government, including in healthcare.
By December 2021, CMS was openly seeking public input on reducing disparities in organ transplantation. Data from CMS paints a stark picture: Black Americans are nearly four times more likely, and Latinos 1.3 times more likely, to suffer kidney failure compared to White Americans, yet they’re less likely to land on transplant waitlists or receive organs.
Enter the Increasing Organ Transplant Access (IOTA) Model, a Biden administration rule that became official and started operating as a six-year mandatory payment program for selected hospitals. This model scores 103 hospitals on kidney transplant performance across achievement, efficiency, and quality, dangling financial rewards or penalties based on results.
Here’s where AFL smells a rat. While an explicit equity adjustment was dropped before the rule’s finalization, a “voluntary” health equity plan encourages hospitals to target disparities with measurable goals -- yet participation in the broader program isn’t optional. AFL claims this setup subtly nudges hospitals toward identity-based decision-making.
AFL isn’t mincing words, alleging that 67 of the participating hospitals are still leaning into diversity, equity, and inclusion (DEI) efforts. They argue this normalizes preferences based on identity rather than medical need in a system already under scrutiny for ethical lapses.
The group ties this to a broader Biden push for “modernization” of the national organ transplant system, which included equity-focused tweaks to how race and ethnicity data are labeled in reports for the Organ Procurement and Transplantation Network (OPTN). AFL sees this as part of an agenda to weave DEI into life-and-death medical decisions.
Adding fuel to the fire, HHS recently announced reforms to OPTN after a federal probe uncovered horrifying practices by a major organ procurement group, including premature organ retrievals. AFL argues that piling equity pressures onto a flawed system is a recipe for disaster.
“The IOTA Model is a leftover remnant of an unlawful equity agenda that encouraged hospitals to view lifesaving care through a DEI lens,” said AFL attorney Megan Redshaw. Call it a noble goal with a flawed execution -- pushing for fairness shouldn’t mean sidelining clinical need for social engineering experiments.
“This rule treats race as a substitute for medical judgment, and it risks condemning patients to die on waitlists based on immutable traits instead of clinical need,” Redshaw added. If true, this isn’t just a policy misstep; it’s a moral failing that could cost lives under the guise of progress.
AFL’s legal arsenal is loaded, claiming the IOTA Model violates federal laws like Title VI of the Civil Rights Act, Section 1557 of the Affordable Care Act, and even Supreme Court precedents. They’re also challenging CMS’s authority under the Social Security Act, calling the rule arbitrary and overreaching.
To dig deeper, AFL has filed Freedom of Information Act requests to uncover how far the Biden administration’s equity focus infiltrated organ transplant policies. Transparency here isn’t just academic -- it’s about ensuring a system meant to save lives doesn’t play favorites.
Neither HHS nor CMS responded to media inquiries in time for this report, leaving questions unanswered about their defense of the IOTA Model. Silence from the agencies only fuels skepticism about whether this policy truly serves patients or a political narrative.
At its core, organ transplantation should be a bastion of fairness, guided by medical urgency, not identity checkboxes. AFL’s challenge might be a wake-up call to strip away ideological baggage from healthcare policies -- because when lives hang in the balance, there’s no room for anything but merit.
