K Number
K081997
Device Name
PERFADEX WITH THAM
Date Cleared
2008-10-09

(87 days)

Product Code
Regulation Number
876.5880
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Perfadex® with THAM is intended for flushing, storage and transportation of isolated lungs after removal from the donor in preparation for eventual transplantation into a recipient Perfadex® Solution for Lung Perfusion is indicated for the flushing, storage and transportation of isolated lungs after removal from the donor, in preparation for eventual transplantation into a recipient
Device Description
Perfadex® with THAM is a colloid based "extracellular" low potassium electrolyte solution for rapid cooling, perfusion and storage of lungs in connection with transplantation Perfadex® with THAM contains THAM at strength of 3.3 mmol in a sterile 50 ml glass bottle, while the predicate device (K022730) contains THAM at strength of 1.0 mmol in a 1.0 or 2.8 ml pre-filled syringe with THAM. Perfadex® with THAM is a clear, sterile, non-pyrogenic, colloid based, lightly buffered so called "extracellular" low potassium dextran solution primarily for rapid cooling, perfusion and storage of lungs in connection with transplantation. The solution is slightly acidic (pH 5.5) to permit long shelf life, and is adjusted shortly before use to pH 7.4 by the addition of THAM solution from the co-packed bottle, 1 mmol of THAM per liter of Perfadex®.
More Information

No
The device description focuses on the chemical composition and intended use of a solution for organ preservation, with no mention of AI or ML technologies.

No
The device is described as a solution for flushing, storage, and transportation of isolated organs for transplantation, which is a preservation function rather than directly treating a disease or condition in a living organism.

No
The device is described as a solution for flushing, storage, and transportation of isolated lungs, indicating a preservation and preparation function, not a diagnostic one.

No

The device description clearly indicates it is a solution (a liquid substance) intended for flushing, storage, and transportation of lungs, which is a physical product, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for "flushing, storage and transportation of isolated lungs after removal from the donor in preparation for eventual transplantation into a recipient." This describes a process performed on an organ outside of the body, not a test performed on a sample from the body to diagnose or monitor a condition.
  • Device Description: The description details a solution used for preserving organs, not for analyzing biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, providing diagnostic information, or being used in a laboratory setting for diagnostic purposes.

Therefore, Perfadex® with THAM is a medical device used for organ preservation, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Perfadex® with THAM is intended for flushing, storage and transportation of isolated lungs after removal from the donor in preparation for eventual transplantation into a recipient
Perfadex® Solution for Lung Perfusion is indicated for the flushing, storage and transportation of isolated lungs after removal from the donor, in preparation for eventual transplantation into a recipient

Product codes

MSB

Device Description

Perfadex® with THAM is a colloid based "extracellular" low potassium electrolyte solution for rapid cooling, perfusion and storage of lungs in connection with transplantation
The device Perfadex® with THAM contains THAM at strength of 3.3 mmol in a sterile 50 ml glass bottle, while the predicate device (K022730) contains THAM at strength of 1.0 mmol in a 1.0 or 2.8 ml pre-filled syringe with THAM.
Perfadex® with THAM is a clear, sterile, non-pyrogenic, colloid based, lightly buffered so called "extracellular" low potassium dextran solution primarily for rapid cooling, perfusion and storage of lungs in connection with transplantation. The solution is slightly acidic (pH 5.5) to permit long shelf life, and is adjusted shortly before use to pH 7.4 by the addition of THAM solution from the co-packed bottle, 1 mmol of THAM per liter of Perfadex®.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lungs

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K022730

Reference Device(s)

K000881

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5880 Isolated kidney perfusion and transport system and accessories.

(a)
Identification. An isolated kidney perfusion and transport system and accessories is a device that is used to support a donated or a cadaver kidney and to maintain the organ in a near-normal physiologic state until it is transplanted into a recipient patient. This generic type of device may include tubing, catheters, connectors, an ice storage or freezing container with or without bag or preservatives, pulsatile or nonpulsatile hypothermic isolated organ perfusion apparatus with or without oxygenator, and disposable perfusion set.(b)
Classification. Class II (performance standards).

0

XII. PREMARKET NOTIFICATION SUMMARY

Submitted by:Vitrolife Sweden AB
Faktorvägen 13
SE-434 37 Kungsbacka
SWEDEN
Contact Person:Mr Kjell Kjörk

Mr Kjell Kjörk Vitrolife Sweden AB Faktorvägen 13 SE-434 37 Kungsbacka SWEDEN Phone +46 31 721 80 77 Fax +46 31 721 80 90 Mail kkjork@vitrolife.com

Date Prepared:10 July 2008
Trade Name:Perfadex® with THAM
Common Name:Solution for lung preservation
Classification Name:Isolated kidney perfusion and transport system
and accessories (21 C.F.R. § 876.5880)
Predicate Device:Perfadex® (K022730)
Description of the Device:Perfadex® with THAM is a colloid based
"extracellular" low potassium electrolyte solution
for rapid cooling, perfusion and storage of lungs
in connection with transplantation
Intended Use:Perfadex® with THAM is intended for flushing,
storage and transportation of isolated lungs after
removal from the donor in preparation for
eventual transplantation into a recipient

1

Technological Characteristics:

The device Perfadex® with THAM contains THAM at strength of 3.3 mmol in a sterile 50 ml glass bottle, while the predicate device (K022730) contains THAM at strength of 1.0 mmol in a 1.0 or 2.8 ml pre-filled syringe with THAM.

Perfadex® is the only solution which has been specifically developed for lung preservation, and is today used in about 90% of the lung transplantations performed world-wide.

Perfadex® with THAM is a clear, sterile, non-pyrogenic, colloid based, lightly buffered so called "extracellular" low potassium dextran solution primarily for rapid cooling, perfusion and storage of lungs in connection with transplantation. The solution is slightly acidic (pH 5.5) to permit long shelf life, and is adjusted shortly before use to pH 7.4 by the addition of THAM solution from the co-packed bottle, 1 mmol of THAM per liter of Perfadex®.

Perfadex® was first 510(k) cleared by the FDA on 8 March 2001 (K000881). Perfadex® with co-packed THAM in a pre-filled syringe was then cleared on 27 October 2003 (K022730), and this clearance is used as predicate for the current submission.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an abstract symbol representing the human form, composed of three stylized figures facing to the right.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 0 9 2008

Mr. Kjell Kjörk Pharmacist, Regulatory Affairs Manager Vitrolife Sweden AB Faktorvagen 13 Kungsbacka SWEDEN SE-434 37

Re: K081997

Trade/Device Name: Perfadex® with THAM Regulation Number: 21 CFR §876.5880 Regulation Name: Isolated kidney perfusion and transport system and accessories Regulatory Class: II Product Code: MSB Dated: September 10, 2008 Received: September 12, 2008

Dear Mr. Kjörk:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

3

Page 2

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxx(Obstetrics/Gynecology)240-276-0115
21 CFR 894.xxx(Radiology)240-276-0120
Other240-276-0100

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometrics' (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Jorgu M. Zhang

Joyce M. Whang, Ph.D. Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

INDICATIONS FOR USE STATEMENT XI.

K081997 510(k) Number (if known):

Device Name:

Pcrfadex® with THAM

Indications for Use:

Perfadex® Solution for Lung Perfusion is indicated for the flushing, storage and transportation of isolated lungs after removal from the donor, in preparation for eventual transplantation into a recipient

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 C.F.R. § 801.109) Over-the Counter Use

f

Argu M. Khan

OR

(Division S Division of Reproductive, Abdominal, and Radiological Devi 510(k) Number