767 F.Supp.3d 746
M.D. Tenn.2025Background:
- Plaintiff Dexter Welch, a Black man with end-stage kidney disease, alleges VUMC and UNOS used a race-based eGFR multiplier ("eGFR AA" ~×1.21) that inflated Black patients’ eGFR, delaying waitlist accrual and transplant offers.
- UNOS operates the national Organ Procurement and Transplantation Network (OPTN) and owns UNet; transplant centers (including VUMC) submit patient data into UNet and register wait times per OPTN policies.
- UNOS revised OPTN policy in July 2022 to prohibit race-adjusted eGFR submissions and in Jan 2023 required backdating/wait-time adjustments for affected Black candidates; UNOS/VUMC processed many, but not all, adjustments.
- VUMC discovered a 2011 record showing Welch’s eGFR would be ≤20 under a race-neutral formula; UNOS adjusted Welch’s wait time by 2,417 days in late 2023; Welch was placed inactive in Oct 2022 and filed suit April 9, 2024.
- Claims: Title VI (42 U.S.C. § 2000d), Tennessee Human Rights Act (THRA), breach of fiduciary duty, and related relief; motions included UNOS & VUMC motions to dismiss, cross-motions for summary judgment.
- Disposition in part: Court dismissed Welch’s request for injunctive relief (standing/redressability), granted summary judgment to UNOS on Title VI (no "Federal financial assistance"), denied VUMC’s dismissal motions, denied summary judgment on most discrimination claims, and granted summary judgment to VUMC on the fiduciary claim.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing for injunctive relief | Welch: ongoing injury (may die without kidney); injunction stopping race-based practices would help | UNOS: race-based coefficient no longer used; injunction would not redress Welch (he already got adjustment and is inactive) | No redressability; injunctive-relief claim dismissed against UNOS |
| Whether UNOS receives "Federal financial assistance" under Title VI | Welch: alleged ~10% of UNOS budget from federal sources; contracts function as subsidy/assistance | UNOS: payments are procurement/compensation under contract, not assistance/subsidy | Court: HHS contract is compensation, not federal assistance; UNOS entitled to judgment on Title VI claim |
| Timeliness (statute of limitations) | Welch: discovery rule—did not learn of race-based impact until Dec 2023; suit timely | Defs: Welch should have known earlier (e.g., 2018 waitlist entry) | Court: discovery rule applies; claims timely (filed Apr 2024) |
| Intentional discrimination (Title VI / THRA) | Welch: policy and practice (UNOS/centers) knowingly used race coefficient; deliberate indifference; caused fewer offers | Defs: use was longstanding medical practice/standard of care; no discriminatory intent; multiple factors determine offers | Genuine disputes of material fact exist re: intentional discrimination and deliberate indifference by VUMC (summary judgment denied as to VUMC on Title VI/THRA); UNOS Title VI fails on assistance threshold but THRA/intent issues survive against UNOS |
| Breach of fiduciary duty / respondeat superior (VUMC) | Welch: VUMC/doctors had fiduciary duty, failed to disclose use and delayed recalculation | VUMC: hospitals do not owe independent fiduciary duty; plaintiff has no admissible evidence tying specific agents/acts to VUMC vicarious liability | Court: dismissed fiduciary claim against VUMC at summary judgment for lack of admissible evidence proving agent, scope, and vicarious liability |
| Applicability of Tennessee Health Care Liability Act (THCLA) | VUMC: claims sound in medical-malpractice and are barred for THCLA noncompliance | Welch: claims allege race-based exclusion/access discrimination, not malpractice | Court: gravamen is discrimination/access deprivation, not malpractice; THCLA does not bar the discrimination claims |
Key Cases Cited
- Lujan v. Defenders of Wildlife, 504 U.S. 555 (1992) (standing requires injury, traceability, redressability)
- Whitmore v. Arkansas, 495 U.S. 149 (1990) (redressability requirement for equitable relief)
- Ashcroft v. Iqbal, 556 U.S. 662 (2009) (pleading standard for plausibility under Rule 12(b)(6))
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (plausibility pleading standard)
- Personnel Administrator v. Feeney, 442 U.S. 256 (1979) (discriminatory purpose requires more than awareness of consequences)
- United States ex rel. Felten v. William Beaumont Hosp., 993 F.3d 428 (6th Cir. 2021) (statutory interpretation principles; starting with text)
- DeVargas v. Mason & Hanger-Silas Mason Co., Inc., 911 F.2d 1377 (10th Cir. 1990) (distinguishing subsidy/assistance from government compensation)
- Randall v. United Network for Organ Sharing, 720 F. Supp. 3d 864 (C.D. Cal. 2024) (persuasive on discovery-rule/timeliness and fiduciary non-disclosure theory)
- Kollaritsch v. Michigan State Univ. Bd. of Trustees, 944 F.3d 613 (6th Cir. 2019) (deliberate indifference and causation analysis in education/Title IX context)
- Students for Fair Admissions, Inc. v. President & Fellows of Harvard Coll., 600 U.S. 181 (2023) (distinguishing Title VI/Title VII from constitutional equal protection and discussing "because of"/but-for causation)