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WASHINGTON, D.C. – America First Legal (AFL) launched a new investigation into the Biden Administration’s effort to embed diversity, equity, and inclusion (DEI) into the nation’s organ transplant system.
AFL filed three Freedom of Information Act (FOIA) requests with the U.S. Department of Health and Human Services (HHS), the Health Resources and Services Administration (HRSA), and the Centers for Medicare & Medicaid Services (CMS) to expose how the Biden Administration injected racial preferences into life-and-death organ transplant decisions through the Increasing Organ Transplant Access (IOTA) Model.
The IOTA Model is a mandatory, six-year federal program that took effect on July 1, 2025. It fundamentally changes how transplant hospitals decide who receives a kidney in the transplant process. Instead of relying solely on medical urgency, the Biden Administration directed hospitals to factor in race, ethnicity, and “equity” when making allocation decisions.
Under this program, select hospitals must operate within an equity-driven framework that pressures them to adopt race-conscious organ allocation policies. As part of the model, hospitals are encouraged to submit “Health Equity Plans” to CMS that:
Identify “target health disparities” based on race, ethnicity, or socioeconomic status. Develop and implement “targeted strategies to address those gaps.” Perform a “resource gap analysis” to determine staffing, funding, and operational needs to meet equity goals. Establish performance measures and benchmarks designed to achieve predetermined racial and ethnic outcomes in transplant access set by the Biden Administration.
Although CMS labeled these plans “voluntary” in the final rule, participating hospitals remain under a system that encourages race-conscious policies in clinical decision-making. In practice, this means already scarce organs can be diverted from patients with the greatest medical need to patients who help hospitals meet predetermined equity targets—placing identity over clinical need.
The three FOIA requests demand:
HHS: All records showing how the IOTA Model was conceived, coordinated, and approved, as well as communications within the Biden Administration regarding the use of “equity” as a factor in organ allocation. This includes policy analyses, legal reviews, and strategic planning documents related to integrating DEI objectives into the national transplant system.
CMS: All “Health Equity Plans” or draft plans submitted by hospitals participating in the IOTA Model, any related guidance or templates provided to hospitals, internal reviews or evaluations of these plans, and communications showing how CMS tied equity-based organ allocation to financial incentives or other program requirements.
HRSA: Records showing HRSA’s role in advancing the Biden Administration’s directive to address inequities in the “transplant waitlist process by reducing racial and ethnic variation both in patient referrals and in organ procurement”—an approach that pressures hospitals and outside organ procurement organizations to adjust referral and listing practices around race and predetermined “equity” ratios.
“The Biden Administration deliberately wove race and equity mandates into the organ transplant system, risking the lives of patients who may be denied a kidney because of their skin color rather than their medical need,” said Megan Redshaw, counsel for America First Legal. “The public has a right to see exactly how these discriminatory policies were conceived, justified, and encouraged inside the federal government.”
America First Legal remains committed to exposing and dismantling the Biden Administration’s unlawful attempts to inject race-based decision-making into federally regulated healthcare systems.
Read the FOIA request for HHS here.
Read the FOIA request for CMS here.
Read the FOIA request for HRSA here.
Learn more about AFL’s Merit-Based Medicine initiative here.
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