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WASHINGTON, D.C. – America First Legal (AFL) has sued the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and Health Resources and Services Administration (HRSA) to compel the release of records exposing the Biden Administration’s injection of racial preferences into life-and-death organ transplant decisions through its Increasing Organ Transplant Access (IOTA) Model.
Shortly after taking office, President Biden signed Executive Order 13985, “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government,” directing agencies to embed “equity” considerations into all aspects of federal policy. In response, HHS and its sub-agencies began reshaping organ transplantation policy around race-focused frameworks, including kidney transplant evaluation, reporting, and reimbursement.
The IOTA Model, which took effect on July 1, 2025, is a mandatory six-year federal program designed as a response to what the Biden Administration described as the “unbearable human costs of systemic racism.” Under the program, 103 transplant hospitals are urged to incorporate “health equity” plans into transplant access practices — including referral, evaluation, and waitlisting — rather than relying exclusively on clinical urgency and medical criteria.
On August 14, 2025, AFL submitted Freedom of Information Act (FOIA) requests to HHS, CMS, and HRSA seeking records related to the development, approval, implementation, and oversight of the IOTA Model, including internal communications, agency guidance, hospital-submitted health equity plans, and documents reflecting how race-based considerations were incorporated into kidney transplant policy and oversight.
Despite acknowledging AFL’s FOIA requests, the agencies failed to issue required determinations, produced no responsive records, and provided no timeline for disclosure, leaving litigation as the only path to transparency.
AFL’s lawsuits seek court orders compelling immediate searches, prompt production of all non-exempt records, detailed justification for any withholdings, and expedited processing as required by law.
“The Biden Administration designed the IOTA Model to push race into kidney transplant decision-making, and that program remains in operation today,” said Megan Redshaw, attorney for America First Legal. “With thousands of Americans dying on transplant waitlists each year, the public has a right to full transparency into how this program was created, because discrimination has no place in medicine.”
This lawsuit is part of AFL’s broader campaign to dismantle the Biden Administration’s DEI infrastructure and restore Merit-Based Medicine to America’s healthcare system.
Read the HHS complaint here.
Read the HRSA complaint here.
Read the CMS complaint here.
Read more about the investigation here.
Learn more about AFL’s Merit-Based Medicine initiative here.
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