TMDX Q1 Earnings

TMDX just crushed it!

Q1 revenues of $96.9M (up +133% YoY) vs estimates of $81.1M
Q1 net income of $12M vs estimates of $0.4M
Q1 net income margins of 12.5% vs estimates of 0.5%
Q1 GAAP EPS of $0.35 beats by $0.36

QoQ revenue has risen by 32%, 27%, 27%, 23%, and now 19.5%!

They also raised the top line FY24 forecast by 30M!

-TransMedics is raising its full year 2024 revenue guidance to be in the range of $390 million to $400 million vs $366.94M consensus, which represents 61% to 66% growth compared to the company’s prior year revenue. TransMedics’ prior 2024 revenue guidance was $360 million to $370 million.

Full Release: TransMedics Reports First Quarter 2024 Financial Results | TransMedics


Did you see that Service Revenue? It’s growing much faster than product revenue. If that doesn’t tell you the Plane service was a good idea I don’t know what will.



Looks like promising results here, especially on their net income. Transmedics earned adj EPS of 0.35/share, and Robinhood has the consensus analyst estimate as -0.05! Koyfin shows the consensus analyst estimate of 0.01

To put it another way, Koyfin is showing analysts expected net income of $0, and it came in at 12.2M!

Just a reminder on some of the terms and acronyms as this earnings call was hard to parse on the research aspect.

NOP = National OCS program (their program)
OCS = Organ Care System (their proprietary system)
OHP = Organ heart profusion (the profusion technique they use)
NRP = Normothermic Regional Perfusion (old technique, used by competitors)
DCD = Donation after circulatory death (heart related)
DBD = Donation after brain death (heart related)

Some notes from the conference call,

CEO - Waleed Hassanein

  • Focused on three verticals: 1) build out of aviation fleet and logistics 2) three new major clinical trials 3) growing transplant volumes through NOP
  • Very strong momentum towards achieving these three goals
  • Q1 revenue 96.9M, +133% yoy, 19% qoq
  • “We fully expect our future growth to be driven by both increased product and transplant logistics adoption”
  • Services revenue 14.5M up from 9.2M previous Q, +58% qoq (services was running for full quarter last Q, so apples to apples comparison)
  • Gross margin 62%, up from 59% last quarter and in line with expectations
  • Extremely confident we will be able to further improve the gross margin over the next 12 to 18 months
  • GAAP operating profit of 12.4M (interesting they say GAAP, i thought this was the non-GAAP number?)
  • Net income was 12.2M
  • “Remain laser focused” on delivering sustainable positive operating cash flow over the next several quarters
  • Set a new high water mark for case volume across all three organ markets in Q1
  • 14 owned aircraft, daily average number of active Transmedics planes were 9 planes (each plane is used about every 1.5 days)
  • Expect 15-20 operational aircraft by year end
  • Owned aircraft covered about 49% of NOP flight missions in Q1 compared to Q4 (lots of room to expand here)
  • “Potential long runway to drive additional growth and maximizing efficiency across our transplant logistics operations”
  • Fully expect to cover 80%+ of NOP missions with own aircraft
  • 105 transplant programs used TransMedics logistics, up from 97 in Q4
  • Lots of promising research results
  • OCS Heart was used in 75% of all DCD heart transplants at the OHP registries (basically their heart system is preferred for circulatory death transplants)
  • OCS DCD had superior survival outcomes in studies compared to NRP DCD (NRP is legacy competitor method)
  • Overall OCS NOP cost is more favorable than NRP costs
  • OCS DCD hearts were transported nearly double the distance from donor to recipients and had doubled the “cross-plant” time
  • Broader access to DCD donors because of NOP
  • DBD hearts had excellent post transplant clinical outcomes (hearts recovered from brain dead donors)
  • “Huge clinical potential” of increasing donor lung utilization
  • Three new major clinical programs in progress in Lung and Heart, designed to grow adoption
  • Pending FDA approval, expect all three programs to initiate enrollment within next year
  • Clinical stakeholders need to be reintroduced to the potential positive clinical value of the OCS Lung perfusion system (Lung requires more eduction of doctors and clinics)
  • OCS Liver is now performing 62% of operations in morning work hours (supports better outcomes when doctor focused in morning)
  • Optimizing work hours for transplant staff
  • Two clinical programs are in heart, OCS hear therapeutic warm perfusion (DBD hearts, increases utilization)
  • Other is new proprietary metabolic enhancing therapeutic agents to maximize protection of the donor heart - ready in end of 2024
  • Last clinical trail is for “OCS Heart cold oxygenated perfusion” - “easy to use system” (DBD hearts)
  • Continue to invest heavily into next gen OCS technology for all three organs that will be highly automated and optimized for NOP

CFO - Stephan Gordon

  • Exited all legacy charter business
  • 67M liver, 20.2M heart, 4.7M lung
  • Product revenue was 61.3M, service revenue 35.5M (I’m trying to understand what the ~20M of service revenue that is not transport is? the software organizing transplants?)
  • Product margin was 77%, service margin 36%
  • Total operating expenses were 47.5M, +54% yoy (OpEx growing much slower than revenue)
  • Expense growth was driven by 94% growth in R&D, SG&A +45% yoy
  • GAAP operating profit 12.4M vs -2.6M last year, net income 12.2M vs -2.6M last year
  • “We grew our revenue both annually and sequentially, improved our gross margin and showed good top down profitability”


  • Analyst, “I think the beat in disposables that might be a little bit more surprising” (not sure what disposables these are?)
  • “A lot of things went right in the first quarter”
  • Outcomes being achieved across the board are now more transparent to clinical users
  • Lung outcomes getting better
  • Working very hard to educate the market
  • Outcomes in heart market especially are helping to drive OCS Heart
  • Will lean on outcomes story line
  • Investing in three major cardiothoracic programs
  • Continue to add transplant centers and will go deeper with existing ones
  • Growth in logistics was important to help us get access to the cases that we couldn’t get access
  • CFO says, “We don’t expect a down quarter sequentially”, we expect modest qoq growth, and that’s how they have modeled
  • Tremendous evidence supporting warm perfusion has good outcomes with fatty livers (many livers donated are fatty)
  • Will get to 25-30 planes by end of next year
  • On path to sustainable profit going forward, a little bit ahead of where we thought we’d be
  • Analyst asks about a cold perfusion competitor that can go longer in cold profusion, CEO Waleed replies “they failed a trial in Europe”, says warm perfusion better anyways when possible (anybody know who this competitor is?)
  • Analyst, “Gentlemen, congrats again on a blockbuster quarter”
  • Two years from now, every heart transplanted in this country should be preserved on a TransMedics technology
  • Two new heart clinical programs, one focuses therapeutic and optimization for DBD, and other is cold profusion
  • Cold profusion requires a “full-blown new system and full new circuitry” and will start beginning in 2025 (anybody know more about trade offs of warm vs cold profusion?)
  • Cold profusion will be “pulsatile”, which is a distinguishing factor that nobody else has
  • Planes cost depreciate over 10 years at 50% value, no change from original assumptions

I am very impressed with the report here and it sounds like TransMedics is firing on all cylinders. Their new clinical programs are set to come online soon, and they expect to be handling all heart transplants in the US in only two years from now.

The extent of their earnings beat can be seen that on 97M of revenue, analysts expected $0 net income and it came in at $12M+


wpr - Thanks for your typical great summary.

In answer to one of your questions - what are disposables - that is how they refer to the “kit” of items that is used and disposed of with each organ retrieval. The OCS machine is used over and over, but there is a kit of items that is used and thrown away. The money TMDX charges is for the “kit” or “disposable” + money for the service and transportation.

I have not yet listened to the ER call. I’m not sure what they are referring to with a competitor testing “cold perfusion”. I know of Paragonix who has an advanced form of cold storage - but to my knowledge they are not doing “perfusion” - just storing in a cold chamber with more precise temperature control. Organox has a warm perfusion device for livers and Ex-Vivo has a perfusion device for lungs (much different than TMDX). I have not kept up with competitors lately, so I don’t know if the reference is to one of these competitors or something completely different.

Did they break out the revenue by US vs ex-US? Do you happen to have those numbers (so I don’t have to listen to the call to get them)? Thanks


That’s the last 5 quarters (most recent quarter on the left, obv). The “flight school etc” line is stuff that had to do with the acquisition and will be gone going forward.

My understanding is that $14.5m was “Transmedics Logistics” and that is basically the same “49% of NOP missions” covered by owned aircraft. Service Revenue was $35.5m so I assume that means $21.0m of it was NOT covered by Transmedics Logistics. So that $21m includes flights for the other 51% of NOP missions (flights which they have to purchase from other carriers) and also other costs that are charged to customers as Service Revenue (such as labor costs I guess?) since they said: As a reminder, our service revenue includes the added amounts we charge for the NOP clinical service of surgical procurement and organ management and also includes the logistics revenue.

@stocknovice please correct me if that’s wrong.

Hope that helps,


Yes, “Service Revenue” is the amount TMDX is paid for the retrieval of the organs. As you said, it includes transportation, but it also includes the cost for surgeons and support staff who have to travel to the donor location, remove the organ, and maintain it in the OCS device during transport.

The Product and Service Rev. from the last 6 quarters is below. Service Rev. started being reported separately in 2022 Q4 - before they owned any planes.

Prod Rev - |25.1|34|42.5|47.7|51.9|61.3|

Service Rev - |6.3|7.6|10|18.7|29.3|35.5|


@AnalogKid70 nailed it, including the past breakouts for Product and Service Revenue.

Needless to say, I’m a big fan of the quarter.


Big fan of the quarter indeed. Today was one of my very few “spiffy pops”.


Following up on the competitive trial question - I believe it was referring to this:

X-vivo has a heart device for hypothermic (cold) perfusion.

I’m not an expert - but reading the results of the study, it seems like the Xvivo device was better than standard ice storage. But maybe TMDX is stating that the results are not as good as TMDX results (that is my guess).