{ "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": 177, "pageCount": 342, "prevPage": 176, "nextPage": 178, "slideType": "preempt_rebuttal", "function": "preempt_rebuttal", "density": "dense", "nDataPoints": 0, "notes": "Includes a Q&A transcript excerpt highlighting the risks of off-label use beyond the 30-minute window.", "elementsJson": [ "paragraph", "callout_box", "footnote" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-40e2965928db/177", "deckHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db#slide-177", "components": [ { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.59 }, "kind": "callout", "text": "Most DCD's have excessive warm ischemic time; organs deteriorate rapidly after 30 minutes and unrecoverable", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "413325d2-6199-4876-9d7e-00fa22d86753", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "paragraph", "text": "Q: “As far as somebody like Mark Ghobrial and these heavy TransMedics users, how much off-label use is there? The label says less than 55 years old. How much of the use is more than 55 years old? It says less than 30 minutes of warm ischemic time. By the way, what does that mean—30 minutes of warm ischemic time?”\nA: “This is an interesting area because this relates to DCD's, donation after cardiac death. There's a period of time when after the life support is removed and before the heart stops; that period is called “donor warm ischemia time.” From the time of withdrawal from life support to the heart-stopping, it's variable and depends on a number of things. If that period of time exceeds 30 minutes, generally, we just walk away from the donor, at least for that organ. What happens is two out of three DCD's never die in time. So, that 30 minutes relates to that period of time we call “donor warm ischemia time” in DCD's. What we're seeing is the expansion of the pump's use - certainly, older than 55, for sure, and pushing the 30 minutes to longer, we don't know. I've heard people doing it, but I also don't think it's going to be pushed much more than 35 to 40 minutes because the organ deteriorates very quickly, almost exponentially, once you get past a certain point, and that point being 30 minutes. If you try to get an organ out and use it for 50 minutes, it'll never work. It doesn't matter what you put into it.” - One of the top liver transplant surgeons in the world, based at a leading Midwest academic center", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3250103d-6107-4225-983e-3f0948912725", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "The duration is of paramount importance, as prolonging it causes cellular injury and higher complications such as liver failure or ischemic cholangiopathy. One of the world's top liver transplant surgeons - who is sharply critical of and refuses to use TransMedics - told us that “two out of three DCD's never die in time” – meaning that the warm ischemic period exceeds 30 minutes, a key reason why DCD organs were rarely used prior to TransMedics: “if that period of time exceeds 30 minutes...we just walk away from the donor.” He stated that the organ “deteriorates very quickly, almost exponentially” at 30 minutes...if you try to get an organ our and use it for 50 minutes, it’ll never work...it doesn’t matter what you put into it.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7a464226-b084-4dbf-bd7a-68390f30fc6d", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“two out of three DCD's never die in time”... “if that period of time exceeds 30 minutes...we just walk away from the donor.”... “deteriorates very quickly, almost exponentially” at 30 minutes...if you try to get an organ our and use it for 50 minutes, it’ll never work...it doesn’t matter what you put into it.” — One of the top liver transplant surgeons in the world, based at a leading Midwest academic center", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-5373-719d-a97f-64b6e06c88ad", "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": "cf58d002-4431-4033-8e1e-f949d465d13b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The second indication on the label - ≤30 minutes of warm ischemic time - is a critical concept in donors after circulatory death (DCD)", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e7ab8959-d125-403b-bd0d-4cc5511281b3", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }