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FDA 814.1 Organization Policy on Humanitarian Use Devices
The Organization allows use of Humanitarian Use Devices (HUD) at JHM. It is recognized that a HUD is intended to benefit patients by treating or diagnosing a disease or condition that affects fewer than 4,000 individuals in the United States per year. A HUD is approved for marketing through an HDE application. An HDE application is a Pre-Marketing Approval application that is not required to contain clinical data demonstrating "effectiveness'' (as defined under (21 CFR 860.7 (e)(1).) The FDA may grant HUD designation to a device which meets the criteria in 21 CFR 814.102, and marketing approval for an HUD device through a Humanitarian Device Exemption (HDE). Only HUDs with approved HDEs may be used at JHM. An investigator must apply for and receive JHM IRB review before a HUD may be used, either under a protocol or on a case-by-case basis.
FDA regulations do not require use of an IRB approved consent form for use of a HUD when the HUD is used according to the marketed HDE indications. The JHM IRBs may issue an Information Sheet to be presented to patients when JHM IRB approval is granted. If an emergency situation exists such that it would not be possible to obtain informed consent prior to the use of the HUD, the physician shall provide the patient with written information about the device following the use or procedure and notify the IRB of such use.
Off-Label Use of a HUD with JHM IRB Approval
The JHM IRB may approve off-label use of the HUD, but off label use requires that a HUD research consent form must be used. If a physician determines that there is no emergency, but there is no alternative device for a patient's condition, the IRBs may consider case-by-case approval of use of the HUD with a research consent form.
Continuing Reviews of HUD Approvals by the IRB
FDA guidance permits IRBs to conduct continuing review of HUD applications under an expedited procedure. If the JHM IRBs choose to allow expedited continuing reviews of HUDs used according to their approved indications, the expedited reviewer should consider the risk and benefit information available and any accompanying Medical Device Reporting (MDR) reports. In cases in which the JHM IRB’s approval for use of the HUD is for off-label indications, continuing review will be conducted in convened session.
Emergency Use of a HUD without time for JHM IRB Approval
In an emergency situation, if a physician determines that either JHM IRB approval, or concurrence from an IRB Chair, cannot be obtained in time to prevent serious harm or death to a patient, a HUD may be administered without prior approval by the JHM IRB, or concurrence of the IRB Chair
The JHM IRB will review the notification to assure that the emergency use of the HUD met with FDA regulations. The physician will be notified of the outcome of this review.
(For additional reference, see FDA Guidance on HUDs/HDEs).