Munster Value Investor

Liver (76% of revenue, 36% share): This is the core engine and it's still accelerating. They went from 26% share to 36% share in one year. Registry data coming soon will show "clear statistical superiority" for OCS Liver. If that data hits, 50% share by CY2028 is very realistic. And here's a fun fact -- Terumo just paid $1.5 billion to acquire OrganOx, a liver-only competitor whose device is too big and battery-limited for air transport. On the conference call, Hassanein basically said that this acquisition validates the multi-billion dollar market that TransMedics created. And OrganOx can't even compete in the NOP model because their box doesn't fit on an airplane. Heart (21% of revenue, 18% share): This is where it gets exciting. In February 2026, FDA granted FULL unconditional IDE approval for the ENHANCE Heart trial -- upgraded from the previous conditional approval. This is a big deal. Part A is designed to prove OCS can preserve hearts beyond the current 4-hour cold storage limit, which would be a historic first for the cardiothoracic transplant field. Hassanein said on the Q4 call that "these advancements stand to enable morning-hours heart and lung transplants for the first time in history." Part B is a head-to-head randomized trial against cold storage. The competitors making fancy cooler boxes with phase-change materials are literally refusing to let their devices be used as the control arm. They're scared of a direct comparison. When asked how he'd deal with this, Hassanein said "stay tuned" and then added they have a plan to "provide an appropriate control arm acceptable to the FDA." I love the confidence. Early clinical feedback has been positive, and we should get more meaningful data at the ISHLT symposium at the end of April 2026. Lung (2.5% of revenue, 2% share): This is the wild card. The De Novo lung trial got full FDA IDE approval in January 2026. This is a 450+ patient randomized trial -- the largest lung perfusion trial in history. Hassanein called it "the last real opportunity for the US lung transplant community to experience machine perfusion." He also took a not-so-subtle shot at the competition, criticizing "non-portable and non-blood-based perfusion technologies" with "poor and ambiguous clinical outcomes" for contributing to the low adoption of lung perfusion in the US. He's talking about XVIVO. If the De Novo trial works, lung goes from 2% share to potentially 20%+ over 3-4 years. That's a massive revenue upswing from a segment generating only $15M today. I also want to mention the NOP Connect 2.0 digital platform that launched this year. Most of their cases now run through this system, and management is already seeing efficiency gains in case management and billing. This is one of those behind-the-scenes operational improvements that compounds over time -- better data, faster turnaround, less administrative friction. It also deepens the switching cost moat because transplant centers are integrating their workflows into this platform. Kidney (0% of revenue today): There are over 20,000 deceased-donor kidney transplants per year in the US and another 8,000-9,000 kidneys get thrown away because of extended ischemia time. OCS Kidney on the Gen 3.0 platform is targeting FDA clinical trials in early 2027. This is a TAM that dwarfs everything else TMDX does today. Europe (TAM doubling): Europe accounts for 45% of global transplants. They're building NOP infrastructure in Italy first, with several other countries actively evaluating the model. They're even building a European air and ground logistics network. If Europe works, TMDX's addressable market nearly doubles overnight. The revenue contribution will be small in CY2026, but this is a CY2027-2029 story that could be huge.

Who to follow

sophia

The day which we fear our last is but the birthdate of eternity. Social Anxiety Syndrome. Adonitologist. Texas Native. Alief Native. @ToroBreedCo

Andy

@andy1820me

Real attorney at the intersections of competition law and workers' rights and of civil rights and public health. Fake epidemiologist.

Munster Value Investor

@uTech87

3 months ago

$TMDX remains one of my highest conviction positions. I've been adding at $100-105 and I have limit orders set at $90 and $85 in case the market gives me a gift during the CY2026 Q2-Q3 period when European investment costs ramp and Q3 seasonality hits. If you don't own $TMDX, start a position here at $100. Seriously. I can't think of another medtech on the planet that is as undervalued right now relative to its growth profile, competitive position. The last time the stock was this cheap relative to fundamentals was during the Summit Aviation panic, and you know how that turned out -- +249% from the October 2023 lows. If you already own it, add on any pullback below $95. The $80-90 range, if we get there, would be a generational buying opportunity. The market is giving you a chance to buy the only company on Earth with FDA-approved multi-organ perfusion technology, a vertically integrated aviation logistics network that nobody can replicate, 26% of all US heart/lung/liver transplants and climbing, five independent growth vectors that haven't even started contributing yet, and $489M in cash with zero debt -- all for 20x forward EBITDA. We're in the 5th inning and the bats are just getting hot. The liver franchise is a machine. Heart and lung trials are about to unlock enormous new markets. Kidney could be the biggest opportunity of all. And Europe doubles the TAM. The bottom line is that TransMedics is accelerating in every aspect of its business, and it's still relatively early. Expect this company to surprise you again and again. Can TMDX become a $500 stock? I don't know. But I know the setup has never looked this good, and I'm not selling a single share.