Image CreditBreccan F. Thies / The Federalist
The Centers for Medicare and Medicaid Services (CMS) ended a Biden administration policy that required racial considerations be made to determine who was eligible to get a kidney transplant.
CMS published a final rule Monday governing the Increasing Organ Transplant Access (IOTA) Model, a mandatory, six-year program that ostensibly sought to “increase access to kidney transplants for patients with end-stage renal disease.” However, the Biden rule, which took effect July 1, 2025, also required participating hospitals to consider race, ethnicity, and “equity” in the decision-making process for allocating organs to patients.
“CMS also wants to reiterate that allocation and transplantation decisions should be made based on objective and measurable medical criteria through the framework set up by the [Organ Procurement and Transplantation Network] OPTN … and should not be made on the basis of race or other criteria not laid out by the goals described in this section of the [Code of Federal Regulations],” the Trump CMS final rule, set to take effect July 1, 2026, states.
The rule came in response to public comment made by America First Legal (AFL) and others arguing that “transplant allocation decisions should remain grounded in objective medical criteria,” the rule states.
As AFL pointed out, the Biden rule encouraged transplant hospitals to “identify disparities among racial and demographic groups, develop Health Equity Plans, conduct resource gap analyses, establish equity-focused goals, and implement targeted interventions designed to preference selected populations.”
The Biden CMS said that “Health Equity Plans,” which were meant to determine areas where hospitals were not meeting its equity goals and then recommend remedial action, were “voluntary,” but AFL stated that they were actually embedded into the IOTA Model.
“The Biden Administration designed the IOTA Model to advance its broader equity agenda within the nation’s organ transplant system,” AFL attorney Megan Redshaw said in a press release. “Life-saving transplant decisions should be guided by medical criteria and clinical urgency — not race. We applaud CMS for removing this framework and restoring a transplant system grounded in medical need and clinical urgency.”
The Biden IOTA Model also sought to fast-track transplants and increase their raw number by paying hospitals to do more, while penalizing hospitals that are not performing to their specifications.
“Tying institutional revenue to transplant counts encourages aggressive procurement and transplant practices in a system already marred by ethical failures, oversight breakdowns, and documented patient-safety concerns,” AFL stated.
The Biden rule was an outgrowth of an executive order — “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” — that claimed the “unbearable human costs of systemic racism” and forced government programs to have non-white racial preferences for program allocation across numerous initiatives, including in business, federal contracting, housing, health care, and much more.
The Biden administration even went as far as to suggest the necessity of “racial concordance” between health care workers and patients. “Racial concordance” is the theory that health outcomes are worse when the race of the doctor is different than the race of the patient, and that therefore patients should be race-matched with a doctor. It is also an artificial way of shoehorning tacit racial quotas into the medical profession, which was the goal of the Biden administration and many medical schools.
Breccan F. Thies is the White House correspondent for The Federalist. He is a co-recipient of the 2025 Dao Prize for Excellence in Investigative Journalism. As an investigative journalist, he previously covered education and culture issues for the Washington Examiner and Breitbart News. He holds a degree from the University of Virginia and is a 2022 Claremont Institute Publius Fellow. You can follow him on X: @BreccanFThies.
