{ "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": 334, "pageCount": 342, "prevPage": 333, "nextPage": 335, "slideType": "villain_critique", "function": "name_villain", "density": "dense", "nDataPoints": 0, "notes": "The slide uses a combination of narrative summary and direct Q&A excerpts to build a case against the company's product claims.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-40e2965928db/334", "deckHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-40e2965928db#slide-334", "components": [ { "bbox": { "h": 0.03, "w": 0.5, "x": 0.07, "y": 0.51 }, "kind": "callout", "text": "Injury to livers accelerates rapidly after long duration on the pump", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "143d84c5-1492-4ef6-a595-5621801623bf", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.35, "x": 0.07, "y": 0.82 }, "kind": "callout", "text": "Infection risk from extended perfusion time", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d949bea1-9526-4eef-8f73-e9f11653fd9b", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "callout", "text": "The risk is exacerbated as livers are kept on the pump for 10-40 hours – far longer than the few hours in the pivotal trial – while surgeons “get their beauty sleep.”", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-5374-767b-b3be-dec0554859d5", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.85 }, "kind": "paragraph", "text": "“Infection risk increases the longer this thing is not transplanted. For example, if you’re going to transplant something from Nevada to Seattle or vice versa or a very long distance, that’s when these kinds of limitations come into play where transporting it becomes a bit of a logistical nightmare. Purely from a surgical point of view, there are some concerns there...The liver itself is more sensitive to that than other organ systems.” – Medical director at at OrganOx", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "cc578b7b-3772-480a-8e05-2674c6ad6f2b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The risk is exacerbated as livers are kept on the pump for 10-40 hours – far longer than the few hours in the pivotal trial – while surgeons “get their beauty sleep.” TransMedics recklessly appears to promote the device as capable of keeping livers going for days, with an ex-employee even making claims akin to quackery, suggesting organs are regenerating and “healing.” A medical director at OrganOx expressed alarm at the risk of extended perfusion times – similar to various surgeons we interviewed who have declined to use the device: “to put it mildly, a lot of different things are going to happen clinically to that organ...if you have blood doing through very, very small tubing...that is not healthy...these plastic tubes...red blood cells lyse and cause hemolysis...enzymes will leak out of the liver...all of these markers are essentially early markers of liver failure...increasing at a very high rate if the liver is on for an extend period”; “infection risk increases the longer this thing is not transplanted....”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "d2a96f13-be38-423f-8d07-4a17b8b7d785", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.55 }, "kind": "paragraph", "text": "Q: “I’ve heard they’re keeping livers on this for a really long time. What risk is there in keeping it for 10-11 hours versus 4 hours?” A: “To put it mildly, a lot of different things are going to happen clinically to that organ. Number one is blood. If you have blood going through very, very small tubing, that is not healthy in the long term. Our own blood vessels are slightly elastic in that they kind of move a little bit. These plastic tubes, which these PRVCs have to move through are more rigid. Because of that, blood, these red blood cells lyse and cause hemolysis and not carry enough oxygen to the organ itself. So, that’s a very real thing that happens with these organ care systems. That’s number one. Then, there is the performance of the liver itself. I talked about transaminase being high. These enzymes will leak out of the liver if it’s sick, and this is a very traumatic thing for a liver to go through. So, it will periodically increase its own transaminase levels and it will show you that it’s not performing well. Similarly, with another biomarker called lactate, that will also increase. All of these are essentially early markers of liver failure...transaminase and lactase are going to start increasing at a very high rate if the liver is on for an extended period of time.” – Medical director at OrganOx", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f1769301-3ca2-405a-b161-40c013be1c4f", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“to put it mildly, a lot of different things are going to happen clinically to that organ...if you have blood doing through very, very small tubing...that is not healthy...these plastic tubes...red blood cells lyse and cause hemolysis...enzymes will leak out of the liver...all of these markers are essentially early markers of liver failure...increasing at a very high rate if the liver is on for an extend period”; “infection risk increases the longer this thing is not transplanted....” — Medical director at OrganOx", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-5374-767b-b3be-e027d8a0570b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fd557fe7-b068-4e13-8f61-13f4fa99344c", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }