Good afternoon, everyone. Suraj Kalia, Senior Medical Device Analyst at Oppenheimer. This afternoon, we're pleased to have Blade Air Mobility with us. You might think, how does Blade Air fit within the medical device landscape? We have Seth Bacon, CEO; Will Heyburn, CFO; and Scott Wunsch, COO, with us today. It's a very active space, folks, and I think you want to hear the story. And where Blade fits into the whole organ transport landscape. Seth, I'll let you take the floor. I'll resurface probably a few minutes towards the end for Q&A.
That sounds great, Suraj. Thank you, everybody, for the opportunity to discuss this further. Seth Bacon, Chief Executive Officer for Trinity. We are the MediMobility of Blade, so the healthcare component of Blade. Our organization was founded in 2013, and in 2015, we began full transition to working with transplant centers and organ procurement organizations, OPOs, across the country as our sole focus. So from 2015 to present day, Trinity is solely focused on the transplant industry and how we can support our partners, meaning the transplant centers and OPO partners throughout the country. We're very, very fortunate over the last 8+ years to now become the largest organ transportation logistics provider in the country.
It's come with a lot of ebbs and flows and difficult days and good days, but we're proud of where we sit today and our mission of always trying to help facilitate getting people off the list. Anything we can do to diminish the amount of people waiting on the list and increase organ transplantation, that's our sole focus every single day when we come to work. Joining me is an individual that joined our organization in 2018, Mr. Wunsch.
Hi. I'm Scott Wunsch. As Seth said, I'm the Chief Operating Officer here at Trinity. Started here in 2018. Spent 13 years working for an OPO, an organ procurement organization, before coming to Trinity. I was the Vice President of Operations when I left LifeCenter Northwest in Seattle. So I was a customer, and I came to Trinity, and we've been doing customer-focused work in this transplant logistics space for the last many years and continuing to grow to where we are today. And going there, doing exciting work, and we love this space and love the work that we're doing. Like Seth said, we have a pinpoint focus on helping get people transplanted off the transplant waiting list through our work.
Scott, I think it might be a little helpful if we just go ahead and walk through the organ transplantation process real quickly, and then how our service lines of transportation logistics and also our organ placement services fit into that model today.
Yeah. So I'll quickly just talk about what happens today in this space when a person becomes an organ donor and then when we get involved. Ultimately, a patient goes to the hospital, has some type of catastrophic injury. The hospital has determined that the patient's not going to survive the injury. They pass it along. They make a referral to the organ procurement organizations. The organ procurement organization determines if the patient is a criteria for donation, gets authorization to move forward with donation, and then makes offers to the transplant centers. Transplant centers accept that organ that's been offered through the OPO through a variety of different systems that's managed by the federal government. And then at that point, the transplant center contacts us for transportation.
And that could be moving their teams, could be moving just the organ, could be moving perfusion devices with teams, a variety of different things that play out that keep us very busy. And all this work is as soon as possible, most often kind of work that we're doing. And this is through ground and air transportation every single day, 365, 24/7, no holidays. And so we're staying busy in regards to this work and doing it very efficiently. And I'll let Seth kind of expand on some of those efficiencies, but from coast to coast, this is what we do every single day.
In that organ donation process, you heard Scott talk about that there are organ offers that are being made to the transplant centers. Uniquely in Q4 last year, due to the request of many of our contracted customers, they asked us to look into doing more for them than just transportation and logistics, even though that was a significant portion of our business growth and development for year after year. We also felt that expanding our service lines while staying solely focused on transplantation, that there was opportunity there. In Q4, we opened up organ placement services, or we refer to as TOPS, Trinity Organ Placement Services. We're working directly on behalf of the transplant center and helping them source and sort through the various organ offers that are being offered to the transplant centers.
So for us and our future business development, it gets us further upstream. It allows us to work more closely with the transplant center partners, more upstream, more on the front end of these organs being offered, and assisting them in whether they are going to be accepted or declined to other hospitals that might be more accepting of that organ. So that's a new service line for us. We work with two programs currently. We have several more in our pipeline, our sales pipeline. We anticipate that growing very rapidly here as we are halfway through Q1, or excuse me, almost ready through Q1 and into Q2. So we're right on track with where we expected our TOPS program to be and excited to continue to build on that new service line for us.
That is in conjunction with our transportation and logistics model that we've had, as I mentioned, since 2015. The transportation logistics is what supported the business development and growth all the way up to today. We're excited to be able to offer the TOPS line services that are taking place as well in congruence. We're able to reach out to our current contracted customers and offer and have discussions around these new service lines. Why do they pick us? How has Trinity expanded so greatly across the country and in such large volume, and why are we the number one provider of these services in the U.S. today? I think our value proposition is a few things. Number one is we reach out with these or we communicate with these transplant centers and OPO partners with long-term contracts.
We hold ourselves accountable to the things that are difficult. We hold ourselves accountable to response times. We hold ourselves accountable to always saying yes. In the transportation world, those are two things that are extremely difficult to perform on a day-in, day-out basis, as Scott mentioned, 24/7, 365. So even if it's Christmas morning, we always have to be able to say yes and do so with an appropriate response time. Those are things that we thrive upon. So that's what gets us in the door and provides us a ramp to provide a long-term contract with these transplant centers. As you know, healthcare contracts are difficult to achieve, especially long-term ones. We've been successful in doing so.
We're also able to customize our programming, meaning that depending on types of ground transportation that is specific for them, those are the things that we'll put in place. If we're moving medical teams, we'll put in large full-size SUVs with all the amenities. If we're moving just tissue, organs, boxes, equipment, then we'll put in hybrid type of apparatus because that's what's important or necessary. There might be a combination of apparatus depending upon what the needs are with that particular customer. And then also equally as important is the aviation aspect. There are some transplant centers across the country that are very cost-conscious, or they are most familiar with turboprop aircraft. And they like the utilization of turboprop aircraft. We have the ability to customize that response, place dedicated aircraft that is to their request in that specific geography at a set fee schedule.
So whether a transplant center is requesting perhaps a turboprop, more efficient, they know their distances, it fits within their model of how far out they're willing to go to do organ recoveries, we can customize that. If they want to go something a little bit more towards light jet, they're going a little bit further out, they've got less equipment, less people than normal, then a light jet would be a great solution for them. And then what we have found is that midsize jet is also the evolution of what's taking place within transplant. There are more people going with more equipment further. And then we also have additional resources of heavy jet. You may or may not know the longest nautical mile transplant of an organ was Alaska to Boston. That was us that coordinated that trip.
There is no mid or light jet that can perform that trip non-stop without stopping for fuel or worrying about pilots dutying out. So you have to have heavy jet resources to which we do, and we can provide those solutions as well. So it is the right aircraft for the right mission at the right time for the right outcome. And that's one of the value propositions that we afford all of our customers across the country. And that's a little of our value proposition. Our customer service is very transparent. We have a strong customer success-driven team that communicates with our transplant center partners on a weekly and monthly basis. We provide data analytics back to them so they can see exactly how far they're going, how many organs they recovered, how many times maybe they came back empty-handed.
Each one of these requests, we're providing them a door-to-door time that our coordinators provide on a day-to-day basis. We also self-report on how well we did on those door-to-door times. These are analytics that we give back to our transplant center partners on a monthly basis. We provide a competitive fee schedule. We do these negotiations in advance. These are fixed fees so they know exactly how to budget based off of the transportation costs associated with particular organs going particular distances. We feel that's a strong value add as all of these transplant centers have a budget. They have to fit everything within a particular P&L for their hospital. We feel that we do a great job of working those fee schedules out with them in a competitive scale ahead of time.
It's those types of things, just the black-and-white operational side of it that we feel we bring a strong value to this space and have been able to allow us to grow fairly significantly. As we move forward with organ placement services, we're hoping to be able to do something similar, customized fee schedules that are based upon whether they are a mega facility performing hundreds of transplants a month or maybe a smaller, perhaps a children's hospital that is doing maybe 10 or 12 a year. We can customize the fee schedule that makes the most sense for them. We're doing it at an extremely high level that they are accustomed to receiving from us. We believe that we are the best. We're not trying to be the biggest. That's just a side product of trying to work so hard to become the best at what we do. And so, Scott, I would just ask that maybe we close before we open up with Q&A of just what's next, how we are continuing to grow, what additional opportunities, and what the pipeline looks like currently.
Okay. Just continuing to grow by building exceptional relationships with our transplant centers and working with new transplant centers to continue to see where we're going next. But as Seth mentioned, our TOPS program, our logistics program, continuing to be pinpoint focused on the transplant community and having those trusting relationships are everything. We're really proud of what we've done and where we're going and how we're getting there.
And then Suraj, if I may, I'll just say one more thing before we open it up for Q&A. And that is this: as we continue to evolve as an organization, obviously, it's important for businesses to do so, critically important. And we have recently acquired 8 aircraft. And what I would tie that into is an exciting moment because we know who we are. We know who we are. We know the value that we bring to our transplant centers today. And the great thing about these aircraft is that these are proven platforms. We've been using these platforms for a long period of time. They have extended range. They are midsize jets that we spoke about earlier, the different types of aircraft that we have for our different customers. We can plug and play these aircraft into the spaces that we need them acutely.
We know that they can take all the necessary equipment that we experienced in them taking, all the different technology modalities we can perform with these aircraft. We know that some of our centers are going further distances with more people, and that allows us to plug and play with these aircraft a little bit more. And then also on the financial side, us being the owners of these aircraft, we'll hopefully change that profit model for us as well to increase those margins instead of having somebody else that is also the owner of the aircraft. It gives us more autonomy, more operational ability. We're familiar with the capabilities of this aircraft. We're excited about this opportunity. It continues to give us just another modality to be able to perform. So we've got owned aircraft.
We've got dedicated contracted aircraft that only move when we call them a nd then we've got third-party providers. And all of those are governed by our Chief of Safety. Again, a value proposition that we have and no one else does as a safety division that evaluates all of our aviation providers on a quarterly basis. And so with that, I just wanted to provide, that's one recent evolution of our business model that we're excited about and more than happy for the Q&A opportunity.
Sure. So Seth, Scott, well, I'll let anyone take it in any order, the questions. So how would you all characterize, and again, just given the interest for this conference in terms of the medical device or the medtech component, I'll keep my questions just relegated to the organ transportation part, right, for obvious reasons. So I guess, gentlemen, how would you characterize the price elasticity of demand in the organ transport aviation business or logistics part? If I, one of the things Seth, you said, if I remember correctly, you said there is a fixed fee, you'll quote, I don't know, pick a number, $50,000, right? Does it mean if Suraj comes in and offers Dr. Heyburn $40,000 for transport, you could potentially lose that? Just help us understand the price elasticity part of the equation?
It's really the transplant centers are the ones that can answer this question best. But certainly, we try to stay educated with the processes and the capabilities that they have. That's part of our negotiation. And the value that we bring to the table is we understand a little bit on the financial side that they're facing as an organization. They're running a business. These transplant centers are also running a business, Suraj. And they need to make sure that their expenses associated with a transplant that they can't grossly overpay for something they're not going to be reimbursed on. And I believe that the cost associated with the transportation of each organ is going to vary somewhat because you're talking about various types of distances, various types of modalities.
It might be a ground transportation just going right across town, or they're going transcontinental to go recover an organ. And I can tell you that our experience is that when those fees do increase, it does require an administrator to get involved to look at it from the top down and decide whether this is still a worthwhile proposition for them to get involved with because the costs are perhaps significantly higher than "normal." And I think that what we are experiencing now, Suraj, is that each of these surgeons and administrators is looking at these organ recoveries on almost a case-by-case basis because costs have increased so much.
There's not a lot of elasticity with regards to reimbursements that I think that they're evaluating on a case-by-case basis to do what's best not only medically for their patient, but also, unfortunately, they've got a cost efficiency model that they've got to evaluate as well with each one of these cases. I think that the cost of not only transportation, but the technology themselves, the cost of technology varies quite a bit in this space, as I know you're savvy to. These are all components that factor into the total cost of transplantation that are being evaluated, like I mentioned, on a case-by-case basis. I don't know that there's that level of elasticity that we might think that there is. I think it's actually pretty focused on what transplant centers can ask for reimbursement.
If I can add, we do all this on the front side. We very rarely have to compete against a quote because we've done this on the very front side in the contractual process. And so to think that we lose a trip because of $10,000, to your example, is a very rare occasion that somebody's calling us and saying, "Hey, give us a quote," and then we go back and forth. It's really our contractual customers are set from the beginning.
So Scott, Seth, you brought up a very interesting point, at least in your remarks, Seth, and I hope I got this right. So you go to, let's say, a transplant site and you say, I don't know, pick a number. You do 10 transplants this month. I'll give you a contractual fixed rate of, pick a number, $40,000 per run, right? Fine. But at the end of the day, like you also said later on, you don't know if you're going to need ground transportation or you're going to need a wide-body jet for long distances. If every of those 10 transplants is ground transportation, you guys are going to make a killing on that rate. I get it. But if you don't, right?
But if it's a wide body, how do you make that determination and say, is it just purely by competition, or you have enough statistical basis from the past where you say, "I have a reasonably good idea where the organs are going to come, what are going to come, and that's the rate we are going to keep it this way"? And is it yearly, or is it quarter-by-quarter fluctuations? Sorry, too many questions in that.
No, it's okay. I'll try to remember them all. First of all, the latter part of that is we do a lot of deep dives with our customers throughout the contractual and onboarding process. So we know the different types of programs they have, how many organ recoveries they're performing, and we get a general idea of how many are in-state versus out-of-state, which are within their region, etc. So we do get a barometer on that, but that's really just to understand the volumes and the level of expectation. Our fee schedule is actually based, Suraj, based on the different types of modality. So as much to your point of, is we maybe budget that we're going to do 10 trips, and then those 10 trips happen to be ground, and we make a killing. Unfortunately, that's not how it works.
It's very much individualized, meaning that if it is a trip that is a ground-only trip, we have a specific ground rate that is utilized by the hour. I see the light bulb came on. So the invoice is just for the ground. And so that particular trip generated its own invoice based upon the type of transportation modality that was utilized. If it was a King Air, if it was an organ-only, so it was just a light jet that came in cross-country and it was a one-way. However, whatever modality of transportation is performed, we have an hourly rate based on that type of transportation. So each invoice per transplant is individualized.
Got it. Got it.
That's what's best for the transplant center is having a midsize jet or, like Seth said, we own jets, we dedicate jets, we third-party jets. So an organ going 300 nautical miles doesn't need a wide-body jet. It needs a King Air to move that organ. This is where we can best serve the customer and best provide the best modality as Seth shares for that customer. We've had a lot of success making sure we do the right thing, the right aircraft at the right time for the customer.
Got it. That I do see from the aviation side, putting Trinity and Blade together, our experience is in aviation and knowing what's the right equipment for the mission. We've probably got 90%+ market share here in New York. And a lot of the time, these hospitals want to use rotorcraft because it takes a long time to get to an airport, and it's much faster and much more cost-effective to use a rotorcraft. So we really try to think about the specific geography, where our customer is located. And that dictates, to a large part, what kind of aircraft asset we're going to dedicate to that area. If you're in a hot environment, you need an aircraft with an APU so the air conditioning is running. Little stuff like that, that delights our customers. And so we're always thinking about it. And aviation, unfortunately, is not one-size-fits-all.
We're very much thinking about the unique requirements of the customers. A big one of those is often cost. That's where some of the rotorcraft come in and the turboprops come in because they can be much more cost-effective for centers that are focused on that aspect of it. You're looking at two guys, Seth and Scott, that have built a business into $130 million over almost a decade. They've been doing it by winning RFPs. Part of that is by providing a cost-effective solution where you always pick up the phone. So it's certainly been a part of the journey.
Fair point. So Seth, going back to some of the comments you made in terms of the composition of the aircraft and the air transport assets, Seth, as more DCD organs, donation after cardiac death organs, become available, some of the regulations, I should say regulations, even the regulations are changing in terms of continuous distribution for lungs. They're going to spill over into hearts and livers also. So what I'm curious is, fast forward 2 years down the line, would your asset model also or the composition of your assets also change for longer distance versus what you all have? How are you thinking about what's changing on the ground from the demand side of the equation?
Yeah, great question, Suraj. And I think you hit on organ allocation regulations. Organ allocation rules are changing. And what we also have a great experience with is more teams are going further distances with more people, more equipment. When I got started in this line of work, turboprops and light jets were the workhorses of the industry. And what we've seen evolve is that we're going, to your point, we're going further. Organ allocation rules are changing. Organs are no longer staying within their specific DSA, their specific area, their specific region. They're going across country. They're going transcontinental. They're going to the patient who's most in need, which is, I think, what we all want as far as our true north. And so how we facilitate that. And I do think that you have to have that myriad of resources at your disposal.
You have to have ground resources that can run lights and sirens as well as transport teams as well as just do equipment. You have to have a variety of ground resources, not one-size-fits-all on the ground. And I think, similarly, the same rules apply for air. You've got to have a heavy jet that can do the transcontinental without stopping, your wide-body example. You've got to have that rotor aircraft that can do your metropolitan stuff, rooftop to rooftop in a high metropolitan area such as New York, San Francisco, L.A. And then you've got your more cost-effective aircraft for some of your transplant centers that are ultimately extremely cost-conscious.
Having that pool of all different types of resources, and the one thing I'll add to your question is eVTOL or EVA aircraft, eventually, those will enter into this space as well, moving organ-onlies, perhaps teams via electric vehicle aircraft or electric vertical takeoff and landing aircraft. I believe that we provide a unique value proposition for them to enter into this space and utilize them right away as a proof of concept doing something that is critically important to healthcare.
Interesting. Seth, this might be an unfair question, but who better to ask, at least get some idea, than you guys? So if I were to ask you for a pie chart, Seth, let's say I give you three variables. One is the donor-recipient match, mismatch criteria. Let's assume that. The second would be the actual technology on which the organ transport is done, whether it's perfusion-based, whether it's cold static storage. And the third would be the logistics, time, whether you have to go from point A to point B through the screws and the time it takes. So if an organ becomes unutilized or has to be thrown away, if I were to tell you, "Scott, based on your view of the landscape, what would be the pie chart? Is 70% of the organs that are being discarded because of the organ transport technologies? Are they because of logistics, or how?" I'll let anyone take it. Not specific to Blade, just in general, how do you see the space?
Well, organ allocation is a big topic. This is a policy within the industry that's driving some of these things. Over time, and we're not going to sit here and say we're the experts at organ allocation, but kidney discard rates continue to increase. Now, is that some due to transportation? Sure. There's probably a few things that a commercial flight doesn't take off on time and the cold time increases and stuff. But the majority of organs not getting transplanted after recovery is not because of transportation. There's a small percentage that sometimes get to the forefront of the conversation because it was an unfortunate scenario, as in a kidney. We moved very few kidneys. But at the end of the day, transportation is not that. I think the system within transportation is efficient, does great work.
And as we've talked about today, there are lots of different ways of moving an organ and a team to make sure it gets transplanted within the time frames that we have. There's a lot of other factors that play into why an organ doesn't get transplanted post-recovery. And I think that's a whole nother conversation. And as I'm sure you're aware, there's a lot of conversation on the federal level and the OPOs and transplant centers how to get more organs transplanted. And perfusion is part of that. There's no doubts about that. There's timing. There's lots of different factors that play into why an organ gets transplanted or not.
Fair point. Fair point. Seth, we are almost up on time. Two final questions your way. So one is, do you think the industry, aviation business, the organ logistics aviation business, do you think that is right for M&A? Question number one. Question number two is, from your vantage point, how do you see the business model changing over time with competition, with the changing landscape, everything going on?
Yeah. First question, is the organ transportation business right for M&A? This is coming from the organization that was acquired two years ago. I would say yes. And I think it's worked out well for both organizations. Our organization in performing what we do has grown over 100% in the last two years. And that's because of our partnership and the resources that we now share alongside Blade. So it has been strong. What uniquely, though, I think you understand, Suraj, is there are strong players in this industry, and then there's just smaller operators. And so that separation is becoming larger and larger. The second question was. I'm sorry. Could you repeat it real quick?
Just in terms of your vantage point, right, as you see the business, how do you think about the business has got to change this way for a variety of reasons, and this is what we got to do from point A to point B over the next few years?
I think there's a lot of scrutiny on transplantation. Kidney dialysis is a huge spend by the federal government, billions of dollars. I think there's a lot of scrutiny towards transplantation and increasing the opportunity to perform more transplantation. That's coming from the community, from federal government. And so we are going to be expected to perform at a high level. I think the organizations that can continue to do that with a high level of transparency and customer service and partnering with the transplant centers, those are the ones that are going to be most successful because those are the ones who are under the most scrutiny to get it right, the OPOs and the transplant centers. And so we need to be supportive to understanding how they meet their goals and objectives.
But in all, Suraj, the entire industry is currently going through a lot of scrutiny. It will continue to be. There's a lot of reorganization that's taking place at a federal level that we are watching acutely. I think this is just all part of the evolution. This is not a bad thing. This is actually a great thing. Those that can evolve and do it alongside our partners and understand the expectations of the federal government are the ones that are going to survive the most or survive the best, rather.
Got it. Gentlemen, fascinating conversation. As you guys know, you guys are in the thick of discussions on organ transplantation and very active space in medtech. I do appreciate you coming this afternoon. A lot of good things and insights learned. Hope to continue this conversation. Thank you so much.