1.4 UNMC Ceding Review to an External Central IRB
Last Revised: 1/22/20245/15/2025
1.0 Purpose
The purpose of this policy and procedure is to describe the Organization’s requirements for the UNMC IRB to cede review to an external IRB.
2.0 Policy
It is the policy of the Organization thatthat:
- 2.5.1. For research which constitutes greater than minimal risk, the external IRB is part of an accredited HRPP or has completed the OHRP QA Self-Assessment
ToolTool. - 2.5.2. For research which constitutes no more than minimal risk, the external IRB
reviewsis part of an accredited HRPP or has completed the OHRP QA Self-Assessment Tool, or, with specific approval of the IRB Executive Chair , in consultation with the IO as appropriate. Reviewing IRB must have appropriate systems to review the researchappropriately,in compliance with all federal, state, and local regulations, and the review criteria utilized by the external IRB are in compliance with the Organization’s ethical standards and with applicable laws andregulations, and with the specific approval of the IO, in consultation with the IRB Executive Chair as appropriate.regulations. - 2.5.3. The external Institution has a valid FWA, and the external IRB is registered with OHRP and FDA (as applicable).
- 2.
6.8.1. Clinical trials initiated by a UNMC investigator. - 2.
6.8.2. Use of a Humanitarian Use Device (HUD) subject to 21 CFR 814.124(a). - 2.
6.7.3.Emergency research subject to FDA regulations at 21 CFR 50.24.
3.0 Definitions
- 3.1. Cede Review: The Organization has agreed to transfer IRB review and oversight authority for specified research to another institution’s IRB (reviewing
or externalIRB) - 3.2. Reliance Agreement (also known as an Authorization Agreement): An agreement between two Organizations engaged in human subject research that documents respective authorities, roles,
responsibilities,andcommunicationresponsibilitiesbetween an organization betweenof thereviewing and relying IRBs.organizations. - 3.3. Relying Institution: A participating Institution that cedes IRB review to the IRB of record (reviewing IRB) designated under a Reliance Agreement.
- 3.4. Reviewing
IRB (or External IRB):IRB: The IRB which is responsible for conducting IRB review and approval as described in 45 CFR 46.109 for cooperative human subject research. For the purpose of this policy, reviewing IRB and external IRB are the same.
4.0 External IRB, UNMC IRB, and PI Responsibilities
- 4.1. It is the responsibility of the external IRB (as reviewing IRB) to:
- 4.1.1. Conduct review of the research in full accordance with applicable federal and state regulations, and all relevant policies of the external IRB (including, but not limited to, initial review, continuing review, review of amendments, noncompliance, unanticipated problems involving risk to subject or others, deviations, adverse events, study holds, suspensions, and terminations).
- 4.1.2. Obtain any additional approvals from DHHS when the research involves pregnant women, fetuses, and neonates; or children; or prisoners (as applicable per DHHS and FDA regulations).
- 4.1.3. Report all determinations of serious or continuing noncompliance, unanticipated problems involving risk to the subject or others, and suspensions or terminations to the Relying
Institution, Institutional OfficialsInstitution and to Federal Agencies. - 4.1.4. Report to the UNMC IRB:
- 4.1.4.1. Any unanticipated problems involving risk to the subject or others associated with subjects enrolled at the institution.
- 4.1.4.2. Any serious or continuing noncompliance.
- 4.1.4.3. Any serious complaints which impact the rights and welfare of research subjects.
- 4.1.4.4. The results of any external audits conducted by FDA, OHRP, sponsors, and CROs.
- 4.1.4.5. Any reports filed with the FDA or OHRP.
- 4.1.4.6. Any FDA Form 483 or warning letter pertaining to the study or IRB review.
- 4.1.4.7. Any other communication from FDA or other governmental agency citing improper or inadequate research practices.
- 4.1.5. Notify the Investigator and the Institution
(when applicable)of the IRB’s determinations. - 4.1.6. Provide a Point of Contact (POC) and contact information for UNMC researchers and research staff to obtain answers to questions, express concerns, and convey suggestions regarding the use of the external IRB.
- 4.1.7. Upon written request, provide UNMC with access to relevant records related to IRB review (including, but not limited to minutes, approved protocols, consent forms, and other records that document the IRB’s determinations).
- 4.2. It is the responsibility of the UNMC
IRBORA and HRPP (on behalf of the relying institution) to:- 4.2.1. Review the submitted CIRB application to ensure that (1) there is review and approval of appropriate other committees as described in HRPP 1.10; (2) the research will comply with certain HRPP policies related to the conduct of the research at the organization (as described in addendum 2; (3) the final CFs are accurate regarding required institutional boilerplate language; and (4) advertisements and recruitment methods are acceptable (as per HRPP 3.5 and 3.6).
- 4.2.2. Assure that appropriate agreements are in place, including, but not limited to (1) Executed sponsored agreement; (2) Data Use, Data Transfer and/or Material Transfer Agreements; (3) Business Associate agreements as appropriate; and (4) IRB Reliance Agreement between UNMC IRB and external IRB
- 4.2.4.1. Notify the external IRB of the termination, suspension, or modification of any clinical privileges of the Organization’s Medical Staff who are participating in the studies authorized by the external IRB.
4.3.1. Complete all requirements for submission of request to utilize the CIRB to the ORA.
PI must submit the Central IRB Application (CIRB) through RSS. It is recommended that the PI contact the ORA to determine if the proposed research will qualify for external IRB review prior to submission of the application. Acceptance of the application by the ORA does not signify that review will be ceded. The application must be accompanied by all supporting documents (protocol, investigator’s brochure, consent templates, surveys, and any other study documents).4.3.2. Complete all requirements for submission to the external IRB.
Cooperate with the external IRB to include UNMC required consent form language (addendum 1 to this policy) in final consent forms. Cooperate with external IRB to include any COI disclosure language in final consent forms.4.3.3. Comply with all relevant UNMC HRPP
policies,policiessuchdescribedas,in addendum 2 below (including, but not limited to, those related to compensation, advertisement, ethical access, short form consent, process and documentation ofconsent.consent).4.3.4. Comply with all determinations and requirements of the external IRB.
4.3.5. Comply with the external IRB’s requirements for initial and continuing review, record keeping, and reporting in a timely manner.
4.3.6. Promptly report the following to the external IRB (in accordance with their policies):
-
4.3.6.1. Any proposed changes to the research.
-
4.3.6.2. Conflict of interest (COI) management plans (in accordance with HRPP policy 1.25 Financial Conflicts of Interest). The UNMC PI and research staff must comply with all determinations.
-
Note: The external IRB may impose additional safeguards; however, the external IRB may not be less stringent than what is required by the UNMC COI management plan.
4.3.6.3. Incidents of noncompliance.noncompliance Copiesas ofdefined all reports toby the federalreviewing governmentIRB (e.g.,policies.
4.3.6.4. Protocol deviations.
4.3.6.5. Any complaints from subjects or others.
4.3.6.6. Data Safety Monitoring Reports
4.3.6.7. Internal adverse events and other events which may qualify as an unanticipated problem involving risk to the subject.
4.3.7. Promptly report to the UNMC IRB
- 4.3.7.1. Any new or modified conflicts of interest of responsible personnel (per HRPP policy 1.25 Financial Conflicts of Interest), and any new or modified management plans.
- 4.3.7.2. Additional requirements by the external IRB to the UNMC COI management plan.
- 4.3.7.3. Incidents of non-compliance that have been determined to be serious and/or continuing, or an unanticipated problem, by the reviewing IRB.
- 4.3.7.4. Copies of all reports to
OHRPOHRP,and/orFDAFDA.and sponsoring agency. - 4.3.7.5.
ReportsCopies of internal adverse event reports that the reviewing IRB determines are unexpected, AND related to, or possibly related to, the research intervention or procedures. - 4.3.7.5.1. Reported events will be reviewed by the ORA but not referred to the convened IRB.
4.3.8. Ensure all investigators and research staff haveare thequalified appropriateby qualificationseducation, training, experience and expertiselicensure (as applicable) to conduct the research.
4.3.9. Ensure that all research personnel understand their responsibility in enrolling participantsinvolved in the research; including obtainment, documentation, and maintenance of recordsprocess of consent foror eachassent subject/LAR.
4.3.10. Conduct monitoring in addition to, or in cooperation with, the external IRB and the ORA.
4.3.11. Notify the ORA when a study is completed
5.00. ProceduresExempt Research
5.1.
ForTheallOrganizationnon-exemptwillhuman subject research,accept thePI must submit the Central IRB Application (CIRB) through RSS. The application must be accompanied by the following documents:5.1.1. Full protocol
5.1.2. Sponsor’s template consent forms and/or information sheets
Note: It is recommended that the PI contact the ORA to determine if the proposed research will qualify for external IRB review priorand to submissionapproval of the application. Acceptance of the application by the ORA does not signify that review will be ceded.
5.2. The IRB Administrator must determine that the request to utilize an external IRB satisfies the requirements of Section 2 above. The administrator, in consultation with the Executive Chair, as appropriate, will then present to the IO the request to allow the UNMC IRB to cede IRB review to the external IRB.
5.3. If the IO approves the request, the UNMC IRB Administrator will review the Central IRB Application to determine that:
5.3.1. The research satisfies UNMC requirements including, but not limited to:
5.3.2. Appropriate agreements are in place, including, but not limited to:
5.3.3. The UNMC IRB Administrator will issue a conditional acceptance letter to the investigator, with conditions based on Organizational requirements.
5.3.4. The following items are available to investigators and may be provided to the external IRB:
5.3.5. Once all Organizational requirements have been met (as specified in HRPP policy 2.2 Section 8.0: Full IRB Review and HRPP policy 2.3 Section 13.0: Expedited Review) and the IRB Reliance Agreement is fully executed, the IRB Administrator will provide the PI with an acceptance letter granting acceptance of IRB oversight by the external IRB.
5.3.6. The study may not be initiated until the acceptance letter has been provided to the PI.
Note: Once it has been determined that an external IRB will serve as the IRB of record for any given study, all communications from the PI and other study personnel regarding IRB review of the study or its status must be with the external IRB, except as specified in Sections 4.3.7 above. UNMC IRB staff do not have the authority to respond to questions or concerns on behalf of the external IRB.
Note: The external IRB policies and procedures for stamping (or not stamping) consent forms with the approval dates take precedence. The UNMC IRB will not review or provide an approval stamp on any consent forms or information sheets approved by an external IRB.
5.4. Forsubject research exempt under 45 CFR 46.104,104 aand copy21 CFR 56.104
5.5.2. The ORA,Organization thedoes not enter into reliance for studies determined to be exempt per 46 CFR 46.104.
Addendum 1: UNMC Required Consent Form Language
Title:
Contraception/Pregnancy Language for FDA regulated research: Insert appropriate contraceptionform language based on FDA Pregnancy and Lactation Labeling Rule and/or FDA Use-In-Pregnancy category, as per HRPP Policy 3.9 Contraception Requirements.
Category A and Some Category B Drugs (do not require contraception) It is possible that the medicines used in this study could injure a fetus if you or your partner becomes pregnant while taking them. You have already been told what is known about this possibility, and you are encouraged to ask further questions.
Category B, C and D Drugs It is possible that the medicines used in this study could injure a fetus if you or your partner becomes pregnant while taking them. You have already been told what is known about this possibility, and you are encouraged to ask further questions.
You may want to discuss this with others before you agree to take part in this study. If you wish, we will arrange for a doctor, nurse, or counselor who is not part of this study to discuss the potential risks and benefits with you and anyone else you want to have present.
Because of the potential risks, you or your partner must not become pregnant while participating in this study. Women must have a negative pregnancy test before entering the study (and before each treatment as appropriate).
If you are sexually active and can get pregnant, or can get your partner pregnant, you must use ONE (or TWO) appropriate method of birth control every time you have sex, or you must not have sex.
You can get additional information about methods to avoid pregnancy by calling the UNMC Research Subject Advocate's Office at (402) 559-6941.
You or your partner will need to continue to avoid pregnancy for X months after finishing the research.
Should you or your partner become pregnant while on this study, you should immediately notify the study personnel. The investigator will assist you in finding appropriate medical care. The investigator also may ask to be allowed to continue getting information about your pregnancy. You can refuse to provide this information.
Category X drugs: Since studies of the drug in humans, or investigational or post-marketing data, have demonstrated fetal risk, contraception is required and the language must be atinserted least as protective as Category D language above. Ofteninto the sponsor and/or FDA require inclusion of specific language relating to fetal risk, monitoring for pregnancy and prevention of pregnancy in the consent form. The language cannot be modified.
The consent form should indicate how frequently pregnancy testing will be performed, how often subjects will be informed of results, and whether subjects will be removed from the study if they become pregnant. If the study involves minors, the consent form must disclose that the results of the pregnancy testing will be shared with the parents. For more information, please see UNMC HRPP policy 3.10 Pregnancy Testing.
Costs to Subject (required for all clinical trials): You will have to pay any insurance deductibles and co-payments. If you want to speak with someone about your insurance, just tell us.
Payment:
If SSNICF is required for payment, then use the following standard statement:
In order to pay you, you will have to provide your social security number. You can choose not to provide this and still participate in the research but we will be unable to pay you.
If this study has a tissue bank include this standard statement:
We do not plan to pay you if any new drugs or products are made using the sample(s) you donated. It is our policy that all donated samples belong to the organization.
Subject Injury Language for greater than minimal risk research Add the following to consent form subject injury language:
Your health and safety is our main concern. If you are injured or have a medical problem because of this study call someone listed at the end of this consent form. You can get emergency medical treatment at Nebraska Medicine. You can also go to your doctor, the nearest emergency room or call 9-1-1.
{Insert the commercial sponsor language}
We have no plans to pay for your treatment or give you any other money or compensation. Signing this does not mean you have given up any of your legal rights.
HIPAA Language:
We also will get medical information about you (like medical record number, medical history, or the results of physical exams, blood tests, x-rays or other medical or research procedures). We call this protected health information" or PHI. PHI is protected by a law called the HIPAA Privacy Rule. We will collect the smallest amount of PHI that we can. We will keep your PHI as confidential as possible.
By signing this consent form, you are letting us (the researchers listeddescribed on this consent form and other people involved in this research at the Organization) have access to your PHI. Your PHI will be used only for the purposes described in the section "What is the reason for doing this research study?"
You can change your mind and tell us to stop collecting your PHI for use in this research at any time by writing to the principal investigator. We can still use the PHI we have already collected. If you tell us to stop collecting your PHI, you will have to stop being in this research.
The UNMC Institutional Review Board (IRB) Institutional officials designated by the UNMC IRB Thewebsite HHShttps://guides.unmc.edu/books/institutional-review-board-irb-guidebook/page/cirb---forms-links
Office
The Food and Drug Administration (FDA) {if study involves FDA regulated drug, device, or biologic} National Institutes of Health (NIH) {if study is funded by the NIH}
Researchers at insert the name of the institution(s) involved in the study if this is a multi-institution study where PHI will be shared with other researchers
Your health insurance company {if the Institution expects third party payers to pay for clinical procedures performed during the course of the research}
The Fred & Pamela Buffett Cancer Center Scientific Review Committee (SRC) {if the research involves patients with cancer}
{insert name of sponsor}, which sponsors this research and may pay the Organization to do this research
{insert name of CRO} which has been hired by the sponsor to help run the research
The Data and Safety Monitoring Committee (DSMC)
{name of NCI National Cooperative Group}
The National Cancer Institute's (NCI) Clinical Trial Reporting Program
NOTE: Choose one of the statements that appropriately represents your study:
You are letting us use and share your PHI for as long as the research is going on.
Or:
You are letting us use and share your PHI for as long as the sponsor needs so it can get approval from the FDA.
Or:
There is currently no plan to end this study. You are letting us use and share your PHI for as long as we want.
What are your rights as a research participant?
You have rights as a research subject. These rights have been explained in this consent form and in The Rights of Research Subjects that you have been given. If you have any questions concerning your rights, or want to discuss problems, concerns, obtain information or offer input, or make a complaint about the research, you can contact any of the following:
The investigator or other study personnel
Institutional Review Board (IRB) Telephone: (402) 559-6463.
Email: IRBORA@unmc.edu
Mail: UNMC Institutional Review Board, 987830 Nebraska Medical Center, Omaha, NE 68198-7830 Research Subject Advocate
Telephone: (402) 559-6941 Email: unmcrsa@unmc.edu
Addendum 2: UNMC HRPP Policies to be followed by institution investigators
DOCUMENT HISTORY:
Written: not documented (Approved: not documented)
Revised: 5/30/2017 - revision not documented
Revised: 2/28/2018 - revision not documented
Revised: 10/21/2021 - Added organizational policy to comply with Common Rule and NIH requirements regarding use of a single IRB; deleted redundant policy statements; clarified requirements for accreditation of reviewing IRB; modified types of research not eligible for use of external IRB; moved list of UNMC policies that must be followed to addendum 2; clarified responsibilities of external IRB, UNMC IRB and investigators; clarified ORA and IRB procedures; clarified required documents to be submitted by PI; other minor reorganization of policy; added Addendum 1 and 2. Notification: not documenteddocumented.
Revised: 12/8/2022 - modified addendum 1 to correct inconsistencies with Consent Form template (Subject Injury, HIPAA, and Participant Rights sections).
Revised: 8/25/2023 – Added responsibility for UNMC HRPP regarding notification of reviewing IRB when local policies that impact IRB review are updated (section 4.2.11).
Revised: 1/22/2024 - added UNMC IRB and HRPP responsibility to ensure that UNMC applies its FWA to all research and ensure that the IRB review is consistent with the requirements of the UNMC’s FWA (section 4.2.9) and ensure that, should termination of a reliance agreement occur, it is clear who will have the responsibility of continued oversight of study activities until closure or transfer of the study (section 4.2.10).
Revised 5/15/2025 - Revised globally to focus on responsibilities of the various components and delete procedures more appropriate for SOPs; clarified the additional requirements for use of a non-accredited IRB as the CIRB (section 2.5.2); clarified that the organization will not rely on a non-domestic IRB or Ethics Committee (section 2.7); removed the restriction on use of a CIRB for (1) emergency research subject to FDA regulations at 21 CFR 50.24, (2) research that involves the use of vaccines developed or manipulated at UNMC, and (3) research involving gene transfer (section 2.8); clarified that research may not begin at the Organization until all institutional requirements been completed, but that the IO and Executive Chair have the authority to allow exceptions to institutional requirements (section 2.10); clarified that research may not commence until acceptance has been issued by ORA (section 2.12); moved to section 2.16 (as a policy item) the statement that the ORA, the IRB and the IO retain the authority to suspend research; added definition of ORA (section 3.5); clarified that the responsibility of the UNMC ORA and HRPP to ensure investigators are qualified includes investigators who are not medical staff (section 4.2.4); clarified responsibility for making determinations required by the HIPAA Privacy Rule (section 4.2.14); clarified policies related to CIRB review of Exempt Research (section 5.0), specifically that the Organization will accept the review and approval of an external IRB for exempt human subject research, but will not enter into reliance for those studies; deleted specific contraception language from addendum 1 (reference to text present on IRB website); removed redundancies; stylistic changes and correction of typographic errors.