This needed to end.
A leading legal group aligned with President Donald Trump — founded by former White House adviser Stephen Miller — is demanding that two major federal health agencies immediately roll back a controversial Biden-era rule they say quietly injects racial politics into the nation’s organ transplant system.
According to America First Legal (AFL), the Biden administration created a system that encourages hospitals to consider race and “equity goals” when making decisions about lifesaving organ transplants, instead of focusing strictly on medical urgency and established clinical standards. AFL argues this is dangerous, discriminatory, and flatly illegal.
How Biden’s Rule Slipped Race-Based Policies Into Healthcare
The regulation in question, known as the Increasing Organ Transplant Access (IOTA) Model, was introduced by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). Hospitals forced into the program are scored in three areas: achievement, efficiency, and quality.
Although an early draft of the rule openly included an “equity performance adjustment,” that language was removed before publication. But critics warn the race-based agenda simply reappeared through the back door.
A “voluntary” Health Equity Plan, inserted inside a mandatory federal model, asks hospitals to:
- Identify “health disparities”
- Create “equity goals”
- Track race-related metrics that influence transplant outcomes
AFL says that even though the plan is labeled “voluntary,” the structure of the rule pressures hospitals to treat race as a factor in transplant decisions — something federal law forbids.
“A federal rule cannot normalize discrimination — even when disguised as ‘equity,’” AFL wrote in its petition.
Hospitals Still Carrying Out DEI Even as Risks Grow
The mandatory program officially began on July 1. But AFL reports that 67 of the 103 hospitals forced into the IOTA program are still conducting diversity, equity, and inclusion (DEI) initiatives tied to transplant procedures.
AFL attorney Megan Redshaw warned that this trend could deprive the sickest patients of urgently needed organs:
“Federal law requires organ allocation be based on medical criteria, not race or identity. This rule inserts political pressure into a lifesaving system already dealing with major ethical failures.”
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Biden’s Executive Orders at the Center of the Controversy
This debate began almost immediately after Joe Biden entered office. In January 2021, he signed Executive Order 13985, instructing every federal agency to conduct “Equity Assessments” and incorporate equity goals into federal programs.
That directive eventually shaped CMS’s push to inject “equity” into organ donation policies. By late 2021, the agency was formally asking the public how it could “increase equity” in organ transplantation — citing racial statistics and outcome discrepancies among certain demographic groups.
AFL argues that these initiatives reflect a broader effort by the Biden administration to embed DEI into medical systems nationwide, often without clear legal authority.
Outside Groups, DEI Pressure, and Federal Investigations
AFL says it is investigating the possibility that outside activist organizations were involved in shaping the final IOTA rule. The group has filed multiple FOIA requests seeking communications between CMS and third parties.
One example AFL points to is a Biden-backed “modernization” plan for the national organ transplant network. The plan specifically highlights expanding “equity” and updating how race and ethnicity are labeled in donor data reports.
Meanwhile, the nation’s transplant system has already been under intense scrutiny due to federal investigations revealing disturbing cases — including instances where organs were reportedly procured from patients who were still alive or improving. This, AFL argues, underscores the danger of adding politically motivated rules to an already troubled system.
Legal and Constitutional Violations Alleged
AFL says the Biden-era transplant rule violates:
- Title VI of the Civil Rights Act
- Section 1557 of the Affordable Care Act
- The Equal Protection Clause
- Multiple Supreme Court precedents
- Executive orders issued by President Donald Trump
They also argue that CMS exceeded its legal authority under the Social Security Act and that the policy is “arbitrary and capricious,” making it invalid under the Administrative Procedure Act.
Redshaw summarized the concerns bluntly:
“The Biden Administration built this transplant policy on the false idea that fairness requires discrimination. Patients could be left to die on waitlists because politics replaced medical judgment.”
HHS and CMS did not respond to Fox News Digital’s request for comment.