TMDX - possible future TAM expansion

This puts a human face on the need for more organs for transplants. The article also provides some insight into issues with the current Organ Procurement Organizations in the US. In the future (far in the future) TMDX could conceivably take over the role that the OPOs currently fulfill. This has been mentioned in various conference presentations and the CEO always kind of ducks the question. I don’t know how much TAM this would add, but it would certainly widen their moat.


TMDX is a 27% position for me, making it #2 (#1 is an auto company that also makes batteries). Yes, that’s irresponsible. Yes, I’m up 40% since I bottomed out the first week of January.

TMDX is currently losing money but has some good things going for it:

  • Triple digit revenue growth
  • Razor and blade model (sound familiar?)
  • May turn profitable this year… the numbers are swinging quickly
  • There are potential competitors on the horizon, but TMDX has a substantial lead in organ transplant… with tech that WILL broadly increase the organ transplant market
  • Approved for heart (go to their website to see a beating heart being transported with their system!), lungs, liver. Going for approval for kidney… it WILL happen.

IMO, this is the next big medical tech investment opportunity, as revolutionary (and profitable for investors) as Intuitive Surgical has been.

Yeah, it sounds like I write marketing copy for the Fool…LOL. I invite folks to go to their website and check it out for yourselves.

As for AnalogKid’s statement that TMDX could conceivably take over the role that the OPOs fill… that certainly appears to be in the cards.

Yes, I’m short on detail in this post. Go check out the detail for yourselves… something you would likely do even if I did an exhaustive (and IMO unnecessary) analysis here. :slight_smile:

He is no fool who gives what he cannot keep to gain what he cannot lose.


Just some numbers



Thanks for posting those numbers. I haven’t followed TMDX super closely, but it does seem like an interesting company based on the regulatory / logistics moat that they’re building, combined with positive value props for all the stakeholders (hospitals, patients, insurance). That being said, does anyone have any idea if that kind of cash burn will continue for the foreseeable future as they build out their manufacturing and logistics network? That’s a lot of cash burn given they’d have less than a year of net cash if you annualize last quarter’s FCF, and that’s including what looks like a recent raise.

It seems like a very unique company / opportunity, but having to raise a lot of cash in the current environment, coupled with a NTM P/S multiple that’s 1.5x a lot of the SaaS companies discussed on our board (most who are +FCF and ~3x a company like S who also has high growth and is unprofitable, but has better net cash position) gives me a bit of pause at the moment.

I’d be curious to hear any more detailed thoughts.

EDIT: I’m not sure if the FCF numbers posted above are correct? I looked at Yahoo Finance numbers and it appears TTM FCF is -$60M, with the most recent quarter at -$17M. That definitely seems much more reasonable/sustainable than -$50M in the most recent quarter.


I agree - the FCF # from Buynhold does not look accurate. I am seeing -$17.21M in the latest Q here - Transmedics Financial Statements: Income Statement, Balance Sheet & Cash Flow | CapEdge.

However, I do expect them to do another raise this year. If they report great numbers, I would not be surprised to see them do it after this ER. They got stuck having to do a horrible raise during COVID, and I think the CEO is scarred from that experience. I think he is going to raise as soon as he can.

The last raise was done in the heat of the downturn last year, it was oversubscribed, and the stock went from $40 to $50 shortly after the raise. (It later came back to $40 in October.) My point is, if they keep executing, I think the capital will be there.


Your right Dsnerd and AnalogKid70 thanks for the help. I forgot to breakout the quarterly reports, for Cashflow they report them as 3 months, 6 months, 9 months and full year. I have revised it except for Q420 that is the full year.



Yep, I would generally agree that another potential raise doesn’t seem unreasonable when considering it will support massive growth to fulfill currently unmet demand (not to mention the continued moat building).

My initial reaction was mostly to a -200% FCF margin and 3 quarters of runway, which worried me a lot more than a -65% FCF margin and 8-9 quarters of runway at current burn rate.

The huge run-up over the past 9 months and higher valuation still give me some pause as someone who would be buying in fresh (trying to learn from 2021-22 mistakes!), but I’ll just need to dig in further to better understand the future growth rates and profit margin profile.