The following are a few notes I took from the webcast. Waleed seemed to be very upbeat compared to his Q3 earnings call. It sounds like the Investor Day (Dec 10th) will be very encouraging to investors.
Transition to new CFO. Why now? - First wave of growth completed, and the second wave coming is potentially bigger. We need new pair of eyes looking not just at the top line but maximising efficiency and putting in infrastructure to support. Also, the business is much more complex, Gerardo brings in expertise. Stephen Gordon’s abilities are still critical and he will work strategic initiatives, helping to educate stakeholders in Washington, DC. There are only 3 people that can do this: Waleed, Stephen, and Kamer (Chief Commercial Officer).
National Initiative. What is it? - Educating bipartison congressional leadership. Been at this for 4 years and in the past year and a half have been able to grow heart and liver in double digits. Didn’t catch all the acronyms mentioned here (CMF? Persa?).
Q3, how should we think about it? - Referred to Q3 as an “air pocket”. Q4 guide down is only $5M. Flat or slight increase. Flight data is so good for Oct/Nov, so shouldn’t we be trending up? What are we missing? Answer: Flight info is incomplete. There are cases in Q3 not on our planes. Only 4 weeks left in the Q, should have dealt with this back in Q3, don’t want to come up short. FY guide adjustment is about being more conservative.
Next year. How should we think about the growth trajectory? - Early on step-up function as we unlock things clinically (heart and lung mainly, eliminate discussion of >4 hrs, < 4 hrs re heart, DBD, DCD, shifting lexicon to “Do you want morning heart transplants?” You need to use OCS. 10K by 2028 not changing, 20K target thereafter, long path of growth. 3rd wave (20K) kidney, international markets, more share on the DBD front. More details at Investor Day.
What about liver side? DCD only penetrated 55%. - Seeing significant uptake of DCD this year over last year. Expect it to continue. Significant dataset in publication as we speak, will catalyse liver even further. DBD liver we have not really flexed that yet. How do you do that? By showing impacts and outcomes. Publications will be in public domain 1H next year.
We are in low 20% range penetration for DBD, we expect (all organs, not just liver) high 60% / low 70%. Top utilisers in liver penetration are at 85/90%, so we expect 70% across the board.
Heart market in Q3? What are we missing? - Nothing! Impacted by seasonality of summer vacations. No other dynamics, no other tech, no market share loss. We are becoming a critical mass in the US. Expect this to be a blip going forward. Going to take the heart and lung market by storm.
Ex Vivo study finishing up in Q3, any impact? - Been out there since last fall, 140 patients, don’t believe it had any impact at all.
Cliinical programs for next year. How impactful? - These are one piece of the growth catalyst. Will share plans to 10K and beyond, international market growth opportunity, and where do we expect to be when we’re at 10K in the US. We’ll end with detailing the growth catalysts next year. Will detail how clinical programs will translate to adoption (referring to Investor Day next week).
Pricing in clinical programs. Historically been at a discount? - Everything is run through NOP so pricing should be the same.
Congressional letter (referring to Paul Gosar)? Any further action? - Our compliance program is very high. We responded to that letter publicly. This is the price of success. (Sounds like no further action taken).
Pushback on cost? How to justify cost of $100K for a liver? - We save insurance companies $300K in complication costs and $1M re-transplant costs, which happens 30-35% of the time. With OCS it is less than 2%.
Warm perfusion competitor. Do you run into them much? No major impact on our business. They work direct with OPOs; we respect that. Cold perfusion there is no impact. Our goal is to make cold perfusion results obsolete before they are published.
Warm perfusion competitor results published recently. Any impact? - Read the FDA letter. There is no approval for transportation. The device is not portable; it cannot be put into a plane. Some organisations had to buy special vans to move it.
Aviation plans - 61% of plans used for NOP. Can all 18 be on NOP? Capacity is only 80%. We’ll get there over time. Stop at 22-23 jets. 20 operational at all times, 2-3 in maintenance at any given time.
What percentage of NOP is plane vs. ground? - NOP about 70% are planes, 30% ground.
Price discipline. Can we maintain this level of pricing. Yes, we are delivering significant value. We believe it’s fair pricing, not gouging. We are sharing significant costs savings with transplant centres. e.g. For DCD donor, a hospital not using TMDX logistics have to fund round trip cost with 50% risk to come back empty-handed. With TMDX they get 50% discount if donor doesn’t progress. No competitor can offer that. Sharing cost savings and value of network effect in NOP.
Margin affected by clinical programs next year? - I don’t know. If we are right re our momentum / uptake, that might take care of it. We’ll have to wait and see.
Final comment and what seems to be the new tagline:
We are going to change the lexicon on heart and lung next year. Details next week.