{ "docId": "019dd923-622c-750b-8b9a-40e2965928db", "docSlug": "e5bffbaac707", "documentTitle": "TransMedics (TMDX)", "authorId": "58_Scorpion_Capital", "authorName": "Scorpion Capital", "documentKindSlug": "research-note", "documentKindLabel": "Research note", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-01-10 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 127, "pageCount": 342, "prevPage": 126, "nextPage": 128, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "The slide uses a combination of narrative summary and direct excerpts from a Feb 2024 letter to expose flaws in the OPTN allocation system.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-40e2965928db/127", "deckHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db#slide-127", "components": [ { "bbox": null, "kind": "callout", "text": "The growth in these types of workarounds (system violations, at present) strongly suggests that the current allocation system is not optimized to efficiently match organs with a patient", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-70f3-714d-84bf-fe3f4f5aa0c7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Transplant centers recognize that expedited placement has devolved into the Wild West, with OPTN now proposing reforms for “Expedited Placement Variance” – a euphemism for rampant out-of-sequence organ placement, favoritism, secrecy, and misuse.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3e43c499-d420-4875-9ac1-a5958fcab0f4", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.68 }, "kind": "paragraph", "text": "it takes for an OPO to progress through the match run to place a kidney. Recently, there has been an increase in out-of-sequence offers, “open offers,” and similar workarounds to the pilots are made permanent in various regions, a patchwork of opaque organ allocation practices that are not transparent to patients or the community at large could arise, exacerbating existing are at a transplant center that is not favored as an aggressive center worthy of being offered certain organs by the participating OPO. While aspects of this inequitable dynamic exist in our", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "60cf1c86-0e92-41bd-8f57-dc375e29edec", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "In Feb 2024, the American Society of Nephrology detailed its concerns in a 12-page letter to OPTN and HHS. The language is watered-down but spotlights the abuses: “systems violations”; “an increase in out-of-sequence offers, ‘open offers,’ and similar workarounds to the allocation system”; “a patchwork of opaque organ allocation practices”; patients are not “getting a fair opportunity” for an organ if they are at a center that is “not favored as an aggressive center by the participating OPO”; and that not a single OPO or transplant center has been “held accountable for any violation” of match rules.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8bfa1e13-2f55-4649-b629-a8474c8c6e89", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "paragraph", "text": "The growth in these types of workarounds (system violations, at present) strongly suggests that the current allocation system is not optimized to efficiently match organs with a patient and a consider expanding expedited placement practices. The current match-run algorithm, in apparently a growing number of cases, does not make match suggestions that the dedicated professionals at OPOs or transplant centers have confidence in.", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f9f86a20-b444-444b-a372-296bab9e6ee8", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“systems violations”; “an increase in out-of-sequence offers, ‘open offers,’ and similar workarounds to the allocation system”; “a patchwork of opaque organ allocation practices”; patients are not “getting a fair opportunity” for an organ if they are at a center that is “not favored as an aggressive center by the participating OPO”; and that not a single OPO or transplant center has been “held accountable for any violation” of match rules. — American Society of Nephrology letter to OPTN/HHS, Feb 2024", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-70f3-714d-84c0-0211475ac1a0", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c427064f-f5db-414d-985e-55cce5bb0f81", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.07, "y": 0.48 }, "kind": "title", "text": "American Society of Nephrology letter to OPTN/HSS, Feb 2024 - excerpts", "attrs": null, "subkind": "subtitle", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d0b99036-8223-489a-9bba-2036f447ecfe", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }