{ "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": 162, "pageCount": 342, "prevPage": 161, "nextPage": 163, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "overcrowded", "nDataPoints": 2, "notes": "The slide uses a Q&A format to present expert testimony regarding potential misuse of medical devices.", "elementsJson": [ "paragraph", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-40e2965928db/162", "deckHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db#slide-162", "components": [ { "bbox": null, "kind": "callout", "text": "Surgeons freely admit that the only use case is convenience, to which the executive replied “100%...they told me first-hand...I’ll sleep overnight...TransMedics can go and get it...but TransMedics won’t let you just hire their surgeon to go...not something they will permit...you’ve got to use the cartridge...”", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-5373-719d-a97e-308e87428d14", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "list", "text": "Highest-volume users allegedly “do crazy things” like using device when donor and recipient are in the same hospital", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "21d682a7-3c81-44e6-80cc-2bebd088ae91", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.7 }, "kind": "list", "text": "Surgeons admit the use case is convenience, but can’t only use TMDX surgeon – have to pay for device", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "654da4ed-7a5a-4a0e-a2c4-fff83044828c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "“I’ve heard they do crazy things...sometimes the organ donor will be in the hospital and the liver is going to a patient next door and they’ll still put it on that machine...that’s just crazy...there’s no clinical benefit to that liver going on that machine to go from one room to another.” We noted that surgeons freely admit that the only use case is convenience, to which the executive replied “100%...they told me first-hand...I’ll sleep overnight...TransMedics can go and get it...but TransMedics won’t let you just hire their surgeon to go...not something they will permit...you’ve got to use the cartridge...”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "268dfa74-9e0b-47e5-a928-31ce2d3b64fd", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.2, "w": 0.86, "x": 0.07, "y": 0.49 }, "kind": "paragraph", "text": "Q: “There’s a very insular circle of Egyptians at the top: the CEO, Tamer, Magdy, Waleed’s sister, runs the lung business. It seems to be a similar Egyptian circle among their highest-volume users, this guy at Houston Methodist, Mark Ghobrial is Egyptian. There’s a guy at Henry Ford in Michigan; one of their highest-volume users is Lebanese. So, I noticed a lot of their highest-volume implanters share some similarity in background. I’ve heard Houston Methodist is using 170 of their devices. That could be $20-30 million of revenue to this company once you add in all the airfare and all that stuff. One guy.”\nA: “I’ve heard they do crazy things, too. That’s a big hospital. Sometimes, the organ donor will be in the hospital, and the liver is going to a patient next door, and they’ll still put it on that machine. That’s just crazy. There’s no clinical benefit to that liver going on that machine to go from one room to another.” – Executive at a West Coast OPO, longtime industry veteran", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "35447a97-c4d1-4882-8b56-82210878a19c", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.74 }, "kind": "paragraph", "text": "Q: “I’m hearing that most usage is off-label - it doesn’t actually need to be used because the organs are perfectly fine; there’s no issue with cold storage. Some surgeons that have been candid - they’re using it for convenience because they don’t want to get up at 2 am.”\nA: “Oh, 100%. I’ve got that first-hand. They told me first-hand. I’ve been operating all day. I can’t travel to Reno to go do a donor. If TransMedics is available, I’ll take it. I’ll sleep overnight. TransMedics can go and get it. But TransMedics won’t let you just hire their surgeon to go and get it and bring it back. That is not something that they will permit. You’ve got to use the cartridge.”\nQ: “One West Coast center, they have one OR, even though they’re a high-volume center, so they want to stack the cases, so they just stick them on the machine. If Medicare or the few private payors that cover this that are paying $100,000-200,000 to help with the logistics and scheduling, I mean, they would hit the roof. Nobody’s paying six figures so you can do it when it’s convenient for you.”\nA: “You’re 100% spot on.” – Executive at a West Coast OPO, longtime industry veteran", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "4dd7e28f-1915-4e0f-9d3a-b66253898f89", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“There’s a very insular circle of Egyptians at the top: the CEO, Tamer, Magdy, Waleed’s sister, runs the lung business. It seems to be a similar Egyptian circle among their highest-volume users, this guy at Houston Methodist, Mark Ghobrial is Egyptian.” — Executive at a West Coast OPO, longtime industry veteran", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-5373-719d-a97e-3769f7d9777b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts; https://www.accessdata.fda.gov/cdrh_docs/pdf20/P200031B.pdf", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "2a34e29a-a4a6-45a2-ad88-2a466b97c1b0", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The same OPO executive – one of the highest-volume in the country as far as organs placed – expressed shock at the off-label practices, using Houston Methodist as example, who we think is a top 2 or 3 “super user”", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d883f275-16c7-4c6e-893f-4ed6b0d9ca26", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }