720 F.Supp.3d 864
C.D. Cal.2024Background
- Anthony Randall, a Black man, was a kidney transplant candidate and on the national waitlist managed by United Network for Organ Sharing (UNOS), with Cedars-Sinai Medical Center (CSMC) as his referring hospital.
- For years, UNOS permitted and encouraged use of race-based adjustments to kidney function (eGFR) scores, causing Black patients like Randall to accrue less 'wait time,' reducing their access to transplants.
- Evidence emerged in 2011 that the eGFR adjustment lacked scientific basis, but policy reforms only occurred in 2022, with slow corrective measures for past discrimination.
- Randall filed a putative class action, alleging racial discrimination and related claims against UNOS and CSMC, seeking damages and injunctive relief.
- Defendants moved to dismiss, arguing the claims were time-barred, failed on the merits, or could not proceed due to mootness and other legal defects.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing for Injunctive Relief | Has live claim at suit's filing; later kidney transplant irrelevant | Randall's transplant means no ongoing injury; claim is moot | No standing for injunctive relief—claim is moot |
| Statute of Limitations (all claims) | Only discovered race-based discrimination in March 2023 | Should have known earlier; claims are time-barred | Not time-barred; accrual delayed until actual discovery |
| Discriminatory Acts (Title VI, Unruh, UCL) | UNOS/CSMC encouraged and used race-based eGFR, causing harm | Did not develop or encourage the policy; no actionable discrimination | Adequately pleaded; claims may proceed |
| Fiduciary Duty (against Cedars-Sinai) | Hospital-patient relationship includes duty to avoid discrimination, act promptly | No fiduciary duty owed relating to racial discrimination/waitlist calculation | Fiduciary duty plausibly alleged; claim may proceed |
| UNOS subject to Unruh/UCL as a business | UNOS performs commercial functions and receives significant federal funds | Nonprofit status exempts from these statutes | UNOS plausibly operates as a business subject to the statutes |
| UCL claim – available remedies | Can recover restitution or injunctive relief | No qualifying claim since received kidney; no monetary loss to UNOS alleged | No standing for UCL remedies; claim dismissed with leave |
Key Cases Cited
- Ashcroft v. Iqbal, 556 U.S. 662 (pleading standard for motions to dismiss)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (plausibility pleading standard)
- Virginia House of Delegates v. Bethune-Hill, 139 S. Ct. 1945 (actual controversy must persist at all litigation stages)
- Genesis Healthcare Corp. v. Symczyk, 569 U.S. 66 (mootness if no personal stake remains)
- O'Shea v. Littleton, 414 U.S. 488 (named plaintiff's mootness pre-certification moots class claim)
- Sosna v. Iowa, 419 U.S. 393 (class certification affects mootness of class actions)
- United States v. Cnty. of Maricopa, Arizona, 889 F.3d 648 (Title VI modes of discrimination)
- Cel-Tech Commc'ns, Inc. v. Los Angeles Cellular Tel. Co., 973 P.2d 527 (scope of California UCL)
- Brennon B. v. Superior Ct., 513 P.3d 971 (nonprofit status and Unruh Act)
- Moore v. Regents of Univ. of California, 793 P.2d 479 (hospital/doctor fiduciary duties)