Okay, thanks everyone for joining us today. My name's Alan Gong. I am on the Medical Supplies and Devices team here at J.P. Morgan. It's my pleasure to introduce some members of the TransMedics management team. We're gonna start off with prepared remarks from Waleed Hassanein, CEO, and then we'll be joined by Stephen Gordon, CFO, for the Q&A. Waleed?
Thanks, Alan. Thank you all for being here. It's exciting to be here at J.P. Morgan to talk to you about a great company called TransMedics, where we're transforming a very important area of medicine called organ transplant. This is our cautionary statement. But let's dive in. Transplantation is the gold standard of treatment of end-stage organ failure.
It's also the most cost-effective treatment of a very complicated, very expensive end-of-life disease condition called end-stage organ failure. But what are the problems? The problems and the most rate-limiting factor of the expansion of this therapy has always been donor organ utilization for transplant. So, this is data from 2022.
In the United States, we had 10,000 donors after brain death in red, all the way to the far right of the slide. And we had nearly 5,000 DCD donors, so donor after cardiac death. So, you'd say, "Well, there's about 15,000 donors. That's a pretty healthy number. What is the problem?"
The problem is we utilized only 2,300 DBD lungs, 3,200 DBD hearts, and 7,400 DBD livers, leaving the vast majority of the donor pool in the DBD side unutilized. More importantly, we barely utilized any of the DCD organs or donor after cardiac death for lungs, heart, and livers. The vast majority of the nearly 5,000 donors went unutilized. That leaves a huge, significant opportunity to grow organ transplant numbers and transplant volumes in the United States that's been untapped.
So why this amount of these organs haven't been used? It's been because the main reason is due to historical ways of preserving organs, using very rudimentary technology, basically an Igloo box filled with ice, where organs used to sit in, and that limits the distance between donor and recipients to get these organs from a donor to a recipient. But more importantly, these organs sitting on ice have no way of being viable or allowing a physician to evaluate organ viability for transplant.
That's why we lose, on an annual basis, the vast majority of the donor pool completely not used for organ transplant and leaves a huge, huge gap. TransMedics was developed from day one to address these limitations in a comprehensive fashion.
We've done three very transformative things in our life as a company. First, we developed the first and only portable, FDA-approved breakthrough technology called the Organ Care System or OCS. It's the only system that is portable that is capable of keeping human organs alive. Heart is beating, lung is breathing, liver is making bile, kidney making urine from donor to recipient. And we did this for three major market segments.
Heart, lung, and liver is fully FDA approved to overcome all these historical limitations cold storage that we talked about. Second, 18 months ago or literally 6 months after or less than 6 months after...
Well, before we get there, to get FDA approval, we had to build the largest body of global clinical evidence to support the notion that using the OCS can, in fact, grow the number of organ transplants and improve post-transplant clinical outcomes. We did that using global, large volume, large scale trials that led us to get the FDA approval. Second, or third, we developed first in class.
Six months after FDA approval, we shifted our business model completely from selling medical technology to selling medical technology, service, and more recently, added logistics into this integrated model of business model called National OCS Program, or NOP for short, which is designed to drive significant growth of our utilization of our core business, which is medical technology and OCS.
So let's share with you some of the evidence of why are we excited about this opportunity. First, this is our core business. This is the technology that without it, we couldn't do anything else that we're gonna talk about for the rest of the presentation. This technology is the only portable technology, and I keep stressing portability, because without portability, you cannot do NOP.
Without portability, you cannot be engaged in logistics. You cannot maximize logistics for organ transplant. You cannot increase the supply of organ transplants. You cannot reduce the injury that the organ gets subjected to cold storage. and we did it not just for one organ, we did it for three organs, i.e., three markets: heart, lung, and liver.
This is just an example of the number of trials that we were engaged with to get FDA approval. We've done the largest number and the largest size clinical trials in the history of organ transplant to support all the claims that you heard from me and will hear from me for the rest of this presentation.
So let me share with you the evidence that we created, and this is obviously this evidence has been published in several major high-impact peer-reviewed journals, so I'm trying to condense it into one slide. So what you will see per organ, and this is older data, this is the data that helped us get FDA approval, that for each organ, we have proven two critical things.
We've proven that we can dramatically increase the utilization of organs that are currently not being utilized for organ transplant from both DBD and DCD organs, which is huge. This, this means we could double heart and lung transplant. We could increase liver transplant by nearly 50% in this country, which will be a huge, huge, impact in the therapy.
But we did this with outcomes that are far superior to cold storage technique, and that's in the lower half of these categories, where we reduced significant complications in lung transplant by 50%. We reduced significant complications in heart transplant by 65%.
We developed a whole new therapy called DCD heart transplant, where we took hearts that have died, that stopped beating for 30-35 minutes, and we revived them in the OCS, and we preserved them in the OCS, and we transplanted them in healthy recipient and had outcomes at 1 and 2 years better than a standard heart transplant therapy in the United States. So that's a huge impact. To give you an example of that, 3 years ago, there were zero heart transplants in the United States from DCD donors.
Today, it's the fastest-growing segment of heart transplant, and it's single-handedly responsible of growing heart transplant double digits for the last 2 years, and TransMedics has the lion share of these organs.
And for liver, we not only proved that we can reduce short-term complication by 43%, but also long-term complications by 84%. The long-term complications are the Achilles heel of liver transplantation therapy, meaning those are the number one reason why a patient that got a liver transplant requires a second liver transplant within the first year. It's really based on complications due to biliary strictures that kills the graft and requires a second transplant, another $1 million, higher risk to the recipient. So this is the data that we built around the OCS to support our ability to move forward from there, and we got the FDA approval.
Now, let's talk about the most exciting thing that we did after FDA approval, was to completely revamp the business model from selling medical technology to integrating a whole new business model for the business, which we call the NOP or the National OCS Program. What is the NOP? The NOP is the first in its class, way to provide an integrated end-to-end technology, clinical, surgical solution to the transplant program, by which TransMedics will be responsible for the entire chain of command of the organ from donor to recipient.
The concept there is to, one, enable the program to grow their volume, transplant volume significantly without the historical limitations that are imposed in organ transplantation. Time and distance is a primary one. Second, benefit for TransMedics is we reduce the learning curve. The burden of the learning curves used to cripple us.
A transplant program that sends one of their junior surgeons to go out and get an organ, and the organ doesn't do well, it's not, they're not gonna point to their junior surgeon that has two left hands to do the surgery. They're gonna point at the technology. So that was a huge, huge thing for us to minimize learning curves and really deliver the highest standard of clinical care for that organ to maintain or improve the post-transplant clinical outcomes.
But more importantly, we were hoping to demonstrate that using the NOP could remove or alleviate the burden on work-life balance, on hospital resources, whether surgeons, nurses, anesthesiologists, and maximize their transplant volume. The concept is to use the NOP to increase the adoption of OCS technology.
That is really the basic concept, while maintaining high clinical outcomes for the recipient. How do we run the National OCS Program for the last two years? Through these 16 launch points across the United States, which gives us broad geographical coverage in areas where it heavily dense in transplant surgery and gives us coast-to-coast coverage.
Every one of these launch points has surgeons, cardiothoracic and abdominal, to do heart and lung procurement and liver procurement, has technologies, all three organs, heart, lung, and liver. In addition, have clinical specialists that do the entire management of the organ from the donor to recipient. We weren't satisfied with that.
When we started this, we saw significant growth of utilization, but also it brought us closer to becoming an integrated partner or integral part of the workflow of organ transplant from donor to recipient. We highlighted a major, major opportunity for the business, which is the logistics, managing the logistics around NOP. We didn't stop. We moved on, and last year we launched TransMedics Aviation and Logistics, which is really an air and ground logistics that is dedicated primarily to organ transplantation.
One important piece of data that you may not be aware of: 100% of movement of organs, heart, lung, and liver, happens in a charter flight. 100%. You cannot fly an organ on a commercial airplane. You have to fly it in a charter flight.
80%-85% of heart, lung, and liver transplant require a charter flight. Today, there's no unified logistical network that is broad enough to get organ from San Francisco to Boston or from New York to Southern California. They rely heavily on these fragmented mom-and-pop operators with 30-year-old airplanes and a couple of national brokers that add significant cost to the logistics cost of an organ transplant. When we analyzed the first, say, 4,000 donor-to-recipient missions in the NOP model, we came up with these facts that transplants are highly concentrated, and we expected that because transplant is a very concentrated market.
So 80% of the U.S. transplant is performed around nine states, which, as you may have guessed, they are within the 16 areas that we are launching from. But donors are very fragmented. They're across the United States, and that's why we're not only in nine launching point, but we're in 16, to capture more and more donors.
But in operating the NOP model in the early days, when we're relying on the current model or the fragmented model of organ logistics or transplant logistics, we found out there are some major challenges that we could help improve. First, plane availability.
If you have a championship game like tonight, or you're in the Kentucky Derby weekend or in a, you know, the March Madness, you cannot find a plane to go to get an organ. We lose cases, and patients don't get transplanted because the charter operators are heavily involved in these national events.
So plane availability is a huge variable, and none of the two major brokers that do this for transplant own a single jet, so they rely heavily on these very small mom-and-pop operators across the United States.
Another thing, because they don't control the logistics, pilots, they time out in the middle of the case, so they take a team from Stanford, they go to Seattle, and mid-flight, they say, "Oh, we need to scramble another jet with a whole new crew because the pilot is gonna time out," which adds double the cost to the transplant program. And there's significant inefficiencies, multiple layers of margins. There's significant inefficiencies about charging a transplant program a round trip for a trip that should be only one way.
So we decided to do something about it, in the way TransMedics does things about solving problems in organ transplant. So we wanted to revamp the entire logistics around organ transplant. So first, we wanted to modernize the way transplant logistics work from donor to recipient to maximize efficiency.
And everything I'm gonna talk about here is to maximize efficiency for these NOP cases that now we're opening and facilitating hearts coming from Anchorage, Alaska, to be transplanted in New York City or in Boston or in Florida. Historically, with the current model or the historical model of organ transplant logistics, you could not even envision doing that because you don't have the infrastructure, you don't have the planes, you don't have the time to do that. We can do that, and we've been doing that quite routinely over the last six months.
So that's number one, modernizing the entire way of thinking about organ transplant logistics. Second, we have to manage and control organ transplant logistics, air and ground. If we are going to be the standard of care in organ transplant management in the United States, we have to own the entire logistical piece, and mainly for all NOP cases.
From that, we developed TransMedics Aviation was born, and the concept of what I'm talking about here is envision the Amazon delivery model in organ transplant, where you - when you call TransMedics, for a case, you know when is it gonna come, how is it gonna come. You have full visibility to the organ en route, so you have high degree of predictability on this particular case. So how are we operating it? How are we building it? We're building a dedicated fleet of modern jets.
You know, our, our fleet right now has an average vintage of almost, you know, little bit more than 2 years. This is the youngest fleet in the entire industry. All same type, so it easier to operate, easier to service, and efficient from a margin standpoint. And the concept here is to cover only all NOP cases. We're not becoming a logistical company. We're a medical technology company that developed a great model to maximize the use of our technology called NOP, and now we're adding another opportunity for the business to grow our revenue, grow our—improve our margin through logistics for NOP cases, and gives us huge leverage on that entire business.
We acquired a company, an operator, and we're maintaining that Part 135 license with the highest safety rating in the industry, which is ARGUS Platinum Elite. This is something that we feel very strongly about, as we are focusing on the quality of everything we do in TransMedics. And from a medical technology standpoint, we have to continue to keep that highest quality in mind, even in our logistical arm... We have our own dedicated pilot crew.
Our crew does nothing but organ transplant missions, and they're highly motivated by the mission, and frankly, you know, shout out to our entire logistical team. They believe in the mission, and you know, many of our team and logistics were working New Year's Eve, Christmas Eve, Christmas Day. You know, the way we positioned it is you guys are delivering Santa's best gifts to patients who are in need for organ transplant in the form of a new organ. You know, we couldn't be here without these guys.
They're doing a phenomenal job. Ultimately, we're aiming to provide a 24/7/365 operational availability. We're not gonna lose an organ transplant because we can't find a plane because the operator is in the Kentucky Derby. That's not gonna happen for NOP. You know, this is an example of our active operating fleet. To date, we have acquired 11 jets, all the same brand, same plane type, Phenom 300E, and we've been operating this model since late August, early September. We didn't stop here.
To manage these logistical, logistics movement efficiently, we also talked about developing a digital command and control center. As you can see here, we just opened that center last week in Andover, Massachusetts. What you see there is our logistical team, watching every movement, every organ. We have a status update on every organ. Where is it going? Where is it coming from? Where the donor is, what's the ETA time?
That gets communicated to the transplant program. They have the same visibility we have, and we're constantly updating the status. But we're also... What you don't see, it's in the, it's in a, you know, it's in fine, it, it's not so visible, is we, our team, our dispatching team, our logistics team, can see where every resource we have in every hub.
So when we're mobilizing, we're mobilizing with maximum efficiency in place. If Stanford or UCSF wants to go get an organ from Seattle, it doesn't make sense to fly a team from our hub in San Francisco. We have a team in Seattle. The team in Seattle will go procure the organ, and we can ship it to San Francisco.
Maximum efficiency and maximum leverage. Just to give you an example of how successful the aviation and logistics model is for TransMedics, this is just an example of the missions completed since September. As you can see, there's a significant momentum, and it's driving significant excitement in the field. Again, I cannot thank our logistics team and NOP team enough for the effort they do to make these visions reality.
I know they're listening to me when I'm talking, so thank you, guys, and kudos to you that you're able to achieve this success in such a short period of time. Let's move on and talk about the overall business, you know, from a financial highlight standpoint. As you can see, we've been able to deliver seven quarters of growth with beat and raise results. As you can see, we're, you know, we ended Q3 with about a little bit north of $400 million in cash. So we're, we're fully funded, and we're fully stocked to be able to deliver on our short and long-term growth. Speaking of which, you know, our near-term growth strategy, we're not stopping here.
I mean, this is, this is a great, this is a great result, but obviously, many of you know that I've stated publicly that our goal is to do 10,000 transplants by 2028 in the U.S. from heart, lung, and liver alone, not including kidneys. Twenty twenty-two, we did about 1,000. Twenty-three, we did north of 2,000 transplants. So we still have a long way of growth to go, and we're, we're planning to fully maximize on that. How are we gonna do it?
Here's how we're gonna do it. Near term, we're expanding our TransMedics logistical business. So we acquired 11 planes, of which 7-8 are operational right now. We're just in the process of getting the other planes active. We are targeting by the end of this year to be operational with 20 planes in the U.S. and a dedicated fleet of SUVs to support the car transport. We want to expand our NOP resources to make sure that as the demand is not slowing down, the demand is actually increasing, that we are not gonna be bottlenecked by availability of our clinical support staff.
The lung program is a very important program for us, and we know it's been lagging a little bit behind the momentum behind liver and heart. We have plans for second half of this year to really put that lung program back on the map and have it contributing to our growth, at least at the level of heart or very close to it, and that's gonna significantly improve our financial performance for the near term. Long term, our growth strategy is, has been articulated many times. You know, the key for us is to growing the overall U.S. transplant volume.
TransMedics is not here to cannibalize the old historical numbers. We're here to grow the transplant volume, and we know we have an opportunity to double lung transplant and double heart transplant, and that's what we're gonna be doing. In fact, I've already told this to the International Society for Heart and Lung Transplantation meeting in front of 400 heart and lung transplant surgeons, and we got their attention, and that's exactly what we're planning to do. It's not gonna happen overnight. It's gonna happen over the next 4 or 5 years.
And, you know, if you don't believe me, look at the annual growth of heart and lung transplant over the last 2 years. It's been growing high single double digits almost close to 20%, 15%-20%, and it's primarily due to NOP and OCS. So that is materializing in front of us. Next gen OCS is very important for us because that is when we really, you know, move beyond the 10,000 transplants that we talked about.
It gives us the ability to go from 10,000 to 15 or maybe even higher number of organ transplant per year. Of course, securing OUS reimbursement is a key driver to growing our OUS revenue and allowing us to drive additional revenue from OUS across all three organs. We're in a very unique, competitive place.
You know, historically, you know, IP, technology, and the FDA indication, PMA, the global presence, the clinical evidence is an important you know barriers to entry. But, with NOP and with the logistics integration, we have just added the biggest, the deepest, the widest moat around TransMedics business. There is nobody, and I mean nobody, out there that can match TransMedics' ability to execute in that field in the United States, period, full stop. We are planning to continue to maintain that leadership position. It's not by words, it's by us doing more work, focusing on the quality, making sure that we have new clinical programs to expand indication. You know, when you're transforming standard of care, when you're the pioneer in that area, you have to continue to be at the lead, or you're gonna be falling behind pretty quickly, and we don't like to be second in anything we do.
Finally, we see TransMedics as a significant growth opportunity. I think they, again, we like to lead with our results and track record. We see, we see our, our justification for that is, we have disruptive technology with significant clinical evidence. It's not just me here talking about it, it's we have the evidence to back it. It's a multibillion-dollar annual opportunity that we are just barely starting to penetrate and really take a hold of. We have already established U.S. reimbursement.
We don't have any issues with CMS or commercial payers in the United States for organ transplant. It's one of the highest most coveted therapy because of the cost efficiency for managing these very expensive patients. We have a robust FDA indication and a pipeline with a PMA you know barrier. The NOP and logistics integration just gives us a very unique position, and we're becoming, ultimately, we're becoming an integral part of the workflow for transplant cases in the United States.
So we're very, very excited about where we are, and I look forward to addressing your question. Allen, thank you for the opportunity to be here today.
Thanks, Waleed. So just to kick us off, you know, you're coming off a year where you grew revenues, you know, or you haven't pre-announced, but based on your guidance, you're set to grow revenues around 140%, so really strong growth. And when we think about kind of the drivers you have going into 2024 with, you know, the aviation transition, with continued momentum across your organs, how should we think about your ability to kind of continue to grow your underlying organ volumes at that same level?
And how should we think about the progress you've made on building out aviation, with the addition of more jets, with the build-out of the Andover hub? How does that all factor into 2024?
Sure. So, Alan, as you know, I can't, I can't address the question directly, but as much as I wish, because we haven't pre-announced, and we're looking forward to announcing year-end results. But, you know, as I stated earlier, our target goal is to do a minimum of 10,000 transplants by 2028. We have just done north of 2,000 in 2023, so we have a long way to go, and we are not planning to slow down. We don't see it slowing down. Our focus mainly is on executing.
We're focusing on making sure that we have the resources to meet the demand. We're not concerned about the demand slowing down. We're concerned about our ability to meet the demand. We're concerned about our ability to stand up the logistics service and get the additional planes operational as soon as we can. We're focusing on making sure that we are opening up new hubs. We're focusing on getting the lung program on its feet, because that program alone could add significant growth near term for us in the United States.
We're focusing on making sure that we have enough clinical support staff to meet the growing needs of the NOP. So, you know, all of that is very exciting for us. It's what we-- That's what we do. But we... You know, I think I addressed that question. You know, I can't talk about granularity until we announce the year-end result in end of February.
When we think about that 10,000 number that you're talking about, right, I think that, you know, there's probably going to be an element of share capture away from kind of, you know, the, the ice boxes that are standard of care today, but also a bit of market expansion, right? Especially, you know, when we think about organs like heart, where you've really developed this kind of DCD market. So when we think about that 10,000, you know, to the extent that you can talk about it, to the extent that, you know, you're kind of thinking about it, how should we think about the mix of share capture and market expansion to kind of get to that target?
I think for us, we think, you know, we think about it in two different dimensions. The first dimension is: What kind of organ mix we think of those 10,000? First of all, 10,000, guys, is for us, you know, you need to understand that 10,000 represents about 60%, 65% of the volume of heart and lung and liver transplant in the United States from 2022. That's when we established the 10,000. So it's not like the full market opportunity. This is just what we set as a bogey. First is the case mix.
We think that liver will always lead because just there's more liver cases done in the United States than heart and lung combined. So we expect to see liver still in the lead, but we expect to see heart and lung equally represented in 2028. So that's what we expect. As far as the share, the mix of what's existing market versus new market? The name of the game for us is to growing the overall market, so we're always gonna be focusing on that. But definitely, there is obviously an organic growth of cannibalizing the existing market.
We don't look at that as a weakness, we look at that as to become the standard of care. You need to be doing, in our humble opinion, you know, 75%-85% of the total volume, which will include existing organs plus additional organs. So.
So kind of have to loop you in a little bit here, Stephen. I think, you know, one of the dynamics of this, you know, the service and aviation build-out, is that it is a bit lower gross margin, right? So I think that's something that I think some investors are worried about for the long-term outlook. But I think there's also, you know, some kind of interesting benefits, especially when it comes to things like, you know, dry runs, where you can leverage having that in-house. So, could you kind of explain the kind of leverage that-
Yeah.
Having in-house gives you?
No, it's absolutely true that, you know, we have more service component of the business that's gonna naturally, you know, bring down the mix. And so the overall margin of the company is gonna be lower as an integrated business than it was, it's just as product, you know, product business. But the revenue opportunity is much greater, and the pace of revenue attainment is much faster by, you know, surrounding the device sales with these services. So that's what we're really doing. And then you mentioned about efficiency, which is very true.
So the ability for us to use our own logistics network and not rely on others means the clinical service business is gonna have a higher margin than it did before. Because when we were relying on others, not only were, you know, hospitals, the brokers were charging the hospitals directly, but if there was extra legs that we had to do, we had to eat that cost, because we wanted to meet every transplant.
But we don't have to do that anymore because we're using our planes in the most efficient way. So there's really a great opportunity, I think, in the service margin to really improve from what it was prior to the aviation addition.
Continuing on the cost discussion for a bit. I think, some investors are pretty surprised, in recent quarters, where you've kind of talked about what I think they kind of viewed as pretty ambitious targets for profitability. You know, kind of flirting with profitability through 2024, and then kind of approaching what could be your, your end-stage profitability in 2025.
Mm-hmm.
Given that you still have to, you know, build out aviation, you still want to be investing into growing the end market and the penetrating end market, while also developing your technology, what gives you the confidence that you can kind of balance growth and also leverage over the next two years?
Yeah. No, it's, it's a great question. I mean, the, the real question is around, like, what level are we seeing maturity? And if we're on this pace to 10,000 in five years, and we're, you know, halfway there in 2.5 years, like, that really should be a business that can throw off mature margins. And that's really what, you know, I've addressed, I think, in those questions where... Yeah, 2024, for sure, we have, still more investment to make. But as we get into 2025 and exit 2025 to 2026, you know, the revenue growth should be well ahead of any investment.
Just kind of going back to you, Waleed. I think, you know, this being such a large, untapped opportunity, you know, one does have to worry about kind of competition, right? And there are competitors in the market and, you know, in a general sense, who do have their own solutions for organ transplant.
So given kind of the success that you're clearly having, how should we frame, you know, some competitors who are maybe trying to come into the market with their own devices, aimed at maybe, you know, taking some piece of the market, maybe not competing directly in terms of warm perfusion, but looking to carve out a piece of the market kind of for their own, and how you think about the competitive landscape, let's say, like, in a couple of years when those products maybe hit the market?
Thanks, Allen. I think, you know, two things. One, we love, we love, to have competition in the space because it validates what we're doing. But if the competition doesn't have a portable, warm, physiologic, perfusion solution, they shouldn't call themselves competing with TransMedics, because what they're doing is just an extension of the cold storage. that's what's unique about the OCS. So that's number one.
Number two, TransMedics is not just basking in our glory and, and, enjoying the success we're, we're doing. We made an investment in newer technologies last year, and we're planning to fully capitalize on these two technologies exactly for that reason. Because we are again, we pioneered this space, this entire industry, from whole cloth, and we plan to stay as the leader of that space for a very long time. And for that, doesn't come by just us sticking to what we're doing.
We're constantly looking how to improve, building the next-gen technology, building new clinical indications, and we're continuing to be driving the market forward. They're just coming to the realization, to trying to catch up with us. We're moving the ball down the field and maybe even to a completely different ballgame. So And that's, that's how we plan to tackle this. But you know, we're keeping an eye on everything that's in the marketplace.
We believe very strongly that to be able to move the needle on expanding the market and improving the outcome, you need to have a portable, warm, physiologic, solution. Anything else on the margin is nothing but that. It's noise level. It doesn't impact us. Then you add to that the NOP. 2 years from now, maybe 18 months from now, it's not about technology, it's about a surgeon who wants a company to get them the organ to their doorstep so they can enjoy their daughter's birthday on one evening, and they don't have to fly to Seattle to get that organ and come back to San Francisco.
It's about the reliability of the logistical service to bring that organ to their doorstep with the most efficient cost structure. It's not just about the technology. The technology is the core of what we do, but it's what we build around the technology is key, and that's two years from now. We believe that's what's gonna make us the clear winner in this, in this space. But, you know, but we still have work to do.
...Then, I guess, just as kind of a final question, you know, I think for heart and liver especially, you've really started to develop relationships with kind of, you know, the major centers that represent the vast majority of kind of volumes in that space. So when we think about your confidence in really continuing to drive deeper penetration into those accounts, that, you know, up until now, have not fully converted, despite the fact that, you know, this is a very different technology, saves a lot of time for surgeons. How do you, like, what are the concerns, I guess, and how do you address them going forward?
For heart and liver?
Yeah.
Yeah. So for us, as I stated on the last earnings call, you know, we're already at more than 45 centers for heart and liver. 45 centers for heart and liver, the top 45 centers in heart and liver drive more than 85% of the national transplant volume. So for us, we are at a critical mass with the right centers. Any center that hasn't converted yet, it's only either a matter of time to either convert or a matter of time for them not to be involved in organ transplant, because we just don't see.
Those centers are the ones that are involved in less than 20 transplant per year, so it's less than one a week, so it becomes very difficult. You know, if you have two or three centers in a region, and two of the centers are already converted to NOP, and their volume is growing year-over-year, that third center is either gonna adopt or they're gonna have some very tough time competing in that environment. But, you know, the key is in education. The key is to lead with data. The key is to show the benefit of OCS, the benefit of NOP, the benefit of logistics. And, you know, we're just getting started here, guys.
I know, you know, some people might forget that this is only, you know, in our starting the third year of commercial execution. So there's a lot, there's a lot to be done, and there's a lot of great growth opportunity in front of us. And, you know, we're extremely fortunate to be sitting here with this, with this success in our track record, so.
Okay. I think that's all the time we have. Thank you.
Thank you. Thank you, Allen.
Thank you, Allen.