The Centers for Medicare and Medicaid Services killed a Biden-era rule that required racial considerations in kidney transplant allocations.
CMS published a final rule Monday scrapping the Biden administration’s Increasing Organ Transplant Access (IOTA) Model, which mandated hospitals consider race, ethnicity, and “equity” when deciding who receives kidneys.
“Allocation and transplantation decisions should be made based on objective and measurable medical criteria… and should not be made on the basis of race.”
The Trump CMS rule, set to take effect July 1, 2026, came after America First Legal and others argued transplant decisions “should remain grounded in objective medical criteria.”
The Biden rule encouraged 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,” AFL stated.
AFL attorney Megan Redshaw called the move a restoration of “a transplant system grounded in medical need and clinical urgency.”
“Life-saving transplant decisions should be guided by medical criteria and clinical urgency — not race,” Redshaw said.
The Biden rule also paid hospitals to do more transplants while penalizing those not meeting its specifications — tying “institutional revenue to transplant counts” in a system “already marred by ethical failures, oversight breakdowns, and documented patient-safety concerns,” AFL noted.
The policy stemmed from Biden’s 2021 executive order “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government,” which forced racial preferences across federal programs — from business and housing to health care.
Biden’s HHS even suggested the necessity of “racial concordance” between health care workers and patients — the theory that health outcomes worsen when doctor and patient races differ, creating a backdoor racial quota system for the medical profession.
