TransMedics (TMDX) 10-K 27 Feb 23 2022 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Feb. 15, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Registrant Name	TransMedics Group, Inc.
Entity Central Index Key	0001756262
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Shell Company	false
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Public Float			$ 841.3
Entity Common Stock, Shares Outstanding		32,196,219
Entity File Number	001-38891
Entity Incorporation, State or Country Code	MA
Entity Tax Identification Number	83-2181531
Entity Address, Address Line One	200 Minuteman Road
Entity Address, City or Town	Andover
Entity Address, State or Province	MA
Entity Address, Postal Zip Code	01810
City Area Code	978
Local Phone Number	552-0900
ICFR Auditor Attestation Flag	true
Document Annual Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock, No Par Value
Trading Symbol	TMDX
Security Exchange Name	NASDAQ
Auditor Name	PricewaterhouseCoopers LLP
Auditor Firm ID	238
Auditor Location	Boston, Massachusetts
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement for its 2023 Annual Meeting of Stockholders scheduled to be held on May 25, 2023, which Definitive Proxy will be filed with the Securities and Exchange Commission not later than 120 days after the registrant’s fiscal year end of December 31, 2022, are incorporated by reference into Part II and Part III of this Form 10-K.

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 201,182	$ 25,580
Marketable securities		66,872
Accounts receivable	27,611	5,934
Inventory	20,605	14,859
Prepaid expenses and other current assets	2,896	5,460
Total current assets	252,294	118,705
Property and equipment, net	19,223	9,841
Restricted cash	500	500
Operating lease right-of-use assets	5,130	5,847
Total assets	277,147	134,893
Current liabilities:
Accounts payable	3,341	6,651
Accrued expenses and other current liabilities	18,635	16,337
Deferred revenue	241	250
Operating lease liabilities	1,444
Total current liabilities	23,661	23,238
Long-term debt, net of discount and current portion	58,696	35,197
Operating lease liabilities, net of current portion	7,415	8,604
Total liabilities	89,772	67,039
Commitments and contingencies (Note 13)
Stockholders’ equity:
Preferred stock, no par value; 25,000,000 shares authorized; no shares issued or outstanding
Common stock, no par value; 150,000,000 shares authorized; 32,141,368 shares and 27,791,615 shares issued and outstanding at December 31, 2022 and 2021, respectively	666,277	510,488
Accumulated other comprehensive loss	(225)	(188)
Accumulated deficit	(478,677)	(442,446)
Total stockholders’ equity	187,375	67,854
Total liabilities and stockholders’ equity	$ 277,147	$ 134,893

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred Stock, No Par Value
Preferred Stock, Shares Authorized	25,000,000	25,000,000
Preferred Stock, Shares Issued	0	0
Preferred Stock, Shares Outstanding	0	0
Common Stock, No Par Value
Common Stock, Shares Authorized	150,000,000	150,000,000
Common Stock, Shares, Issued	32,141,368	27,791,615
Common Stock, Shares, Outstanding	32,141,368	27,791,615

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Total revenue	$ 93,459	$ 30,262	$ 25,639
Total cost of revenue	28,187	9,103	9,004
Gross profit	65,272	21,159	16,635
Operating expenses:
Research, development and clinical trials	26,812	22,304	18,831
Selling, general and administrative	69,897	38,283	24,188
Total operating expenses	96,709	60,587	43,019
Loss from operations	(31,437)	(39,428)	(26,384)
Other income (expense):
Interest expense	(3,726)	(3,874)	(3,985)
Other income (expense), net	(1,002)	(877)	1,653
Total other expense, net	(4,728)	(4,751)	(2,332)
Loss before income taxes	(36,165)	(44,179)	(28,716)
Provision for income taxes	(66)	(36)	(32)
Net loss	$ (36,231)	$ (44,215)	$ (28,748)
Net loss per share attributable to common stockholders, basic	$ (1.23)	$ (1.60)	$ (1.16)
Net loss per share attributable to common stockholders, diluted	$ (1.23)	$ (1.60)	$ (1.16)
Weighted average common shares outstanding, basic	29,556,633	27,616,839	24,702,764
Weighted average common shares outstanding, diluted	29,556,633	27,616,839	24,702,764
Net product revenue [Member]
Total revenue	$ 79,234	$ 29,657	$ 25,092
Total cost of revenue	16,970	9,031	8,961
Service Revenue [Member]
Total revenue	14,225	605	547
Total cost of revenue	$ 11,217	$ 72	$ 43

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Statement of Comprehensive Income [Abstract]
Net loss	$ (36,231)	$ (44,215)	$ (28,748)
Other comprehensive loss:
Foreign currency translation adjustment	(73)	(46)	(49)
Unrealized gains (losses) on marketable securities, net of tax of $0	36	(47)	(44)
Total other comprehensive loss	(37)	(93)	(93)
Comprehensive loss	$ (36,268)	$ (44,308)	$ (28,841)

CONSOLIDATED STATEMENTS OF CO_2

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Statement of Comprehensive Income [Abstract]
Other Comprehensive Income (Loss), Securities, Available-for-Sale, Unrealized Holding Gain (Loss) Arising During Period, Tax	$ 0	$ 0	$ 0

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Accumulated Other Comprehensive Loss	Accumulated Deficit
Balance at Dec. 28, 2019	$ 54,649	$ 424,134	$ (2)	$ (369,483)
Balance, Shares at Dec. 28, 2019		21,184,524
Issuance of common stock upon the exercise of common stock options	227	$ 227
Issuance of common stock upon the exercise of common stock options, Shares		218,084
Issuance of common stock in connection with employee stock purchase plan	357	$ 357
Issuance of common stock in connection with employee stock purchase plan, Shares		22,697
Issuance of common stock in public offering, net of discounts and issuance costs	75,085	$ 75,085
Issuance of common stock in public offering, net of discounts and issuance costs, Shares		5,750,000
Stock-based compensation expense	2,414	$ 2,414
Foreign currency translation adjustment	(49)		(49)
Unrealized gains (losses) on marketable securities	(44)		(44)
Net loss	(28,748)			(28,748)
Balance at Dec. 31, 2020	103,891	$ 502,217	(95)	(398,231)
Balance, Shares at Dec. 31, 2020		27,175,305
Issuance of common stock upon the exercise of common stock options	974	$ 974
Issuance of common stock upon the exercise of common stock options, Shares		588,461
Issuance of common stock in connection with employee stock purchase plan	419	$ 419
Issuance of common stock in connection with employee stock purchase plan, Shares		27,849
Stock-based compensation expense	6,878	$ 6,878
Foreign currency translation adjustment	(46)		(46)
Unrealized gains (losses) on marketable securities	(47)		(47)
Net loss	(44,215)			(44,215)
Balance at Dec. 31, 2021	67,854	$ 510,488	(188)	(442,446)
Balance, Shares at Dec. 31, 2021		27,791,615
Issuance of common stock upon the exercise of common stock options	$ 4,667	$ 4,667
Issuance of common stock upon the exercise of common stock options, Shares	507,795	507,795
Issuance of common stock in connection with employee stock purchase plan	$ 509	$ 509
Issuance of common stock in connection with employee stock purchase plan, Shares		30,143
Issuance of common stock in public offering, net of discounts and issuance costs	139,854	$ 139,854
Issuance of common stock in public offering, net of discounts and issuance costs, Shares		3,737,500
Issuance of restricted common stock, Shares		26,093
Restricted common stock forfeitures, Shares		(1,778)
Issuance of common stock in connection with exercise of warrants	438	$ 438
Issuance of common stock in connection with exercise of warrants, Shares		50,000
Stock-based compensation expense	10,321	$ 10,321
Foreign currency translation adjustment	(73)		(73)
Unrealized gains (losses) on marketable securities	36		36
Net loss	(36,231)			(36,231)
Balance at Dec. 31, 2022	$ 187,375	$ 666,277	$ (225)	$ (478,677)
Balance, Shares at Dec. 31, 2022		32,141,368

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2020
Statement of Stockholders' Equity [Abstract]
Discounts and issuance costs	$ 676	$ 585

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net loss	$ (36,231)	$ (44,215)	$ (28,748)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization expense	3,478	1,817	1,577
Stock-based compensation expense	10,321	6,878	2,414
Loss on extinguishment of debt	575
Loss on sale of marketable securities	107
Non-cash interest and end of term accretion expense	465	540	511
Non-cash lease expense	717	829
Net amortization of premiums on marketable securities	381	1,356	634
Unrealized foreign currency transaction (gains) losses	1,129	928	(1,065)
Changes in operating assets and liabilities:
Accounts receivable	(21,678)	840	(218)
Inventory	(8,024)	(4,894)	(1,740)
Prepaid expenses and other current assets	2,521	(3,151)	(769)
Accounts payable	(3,270)	5,090	(5,802)
Accrued expenses and other current liabilities	3,437	4,875	1,948
Deferred revenue		7	60
Operating lease liabilities	255	236
Deferred rent			933
Net cash used in operating activities	(45,817)	(28,864)	(30,265)
Cash flows from investing activities:
Purchases of property and equipment	(11,907)	(3,519)	(455)
Purchases of marketable securities	(10,496)	(72,024)	(121,793)
Proceeds from sales and maturities of marketable securities	76,916	104,810	80,650
Net cash provided by (used) in investing activities	54,513	29,267	(41,598)
Cash flows from financing activities:
Proceeds from issuance of long-term debt, net of issuance costs	58,509
Repayments of long-term debt	(36,050)
Proceeds from issuance of common stock in public offering, net of underwriting discounts and commissions and issuance costs paid	139,854		74,965
Proceeds from issuance of common stock upon exercise of stock options	4,667	974	227
Proceeds from issuance of warrants	438
Proceeds from issuance of common stock in connection with employee stock purchase plan	509	419	357
Proceeds from Paycheck Protection Program loan			2,249
Repayment of Paycheck Protection Program loan			(2,249)
Net cash provided by financing activities	167,927	1,393	75,549
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(1,021)	(797)	803
Net increase in cash, cash equivalents and restricted cash	175,602	999	4,489
Cash, cash equivalents and restricted cash, beginning of period	26,080	25,081	20,592
Cash, cash equivalents and restricted cash, end of period	201,682	26,080	25,081
Supplemental disclosure of cash flow information:
Cash paid for interest	3,260	3,334	3,475
Supplemental disclosure of non-cash investing and financing activities:
Transfers of inventory to property and equipment	2,135	1,823	1,191
Purchases of property and equipment included in accounts payable and accrued expenses	62	1,200
Reconciliation of cash, cash equivalents and restricted cash:
Cash and cash equivalents	201,182	25,580	24,581
Restricted cash	500	500	500
Total cash, cash equivalents and restricted cash shown in the statement of cash flows	$ 201,682	$ 26,080	$ 25,081

Nature of the Business and Basi

Nature of the Business and Basis of Presentation	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Nature of the Business and Basis of Presentation	1. Nature of the Business and Basis of Presentation TransMedics Group, Inc. (“TransMedics Group” and together with its consolidated subsidiaries, the “Company”) was incorporated in the Commonwealth of Massachusetts in October 2018. TransMedics, Inc. (“TransMedics”), an operating company and wholly owned subsidiary of TransMedics Group was incorporated in the State of Delaware in August 1998. The Company is a commercial-stage medical technology company transforming organ transplant therapy for end-stage organ failure patients across multiple disease states. The Company developed the Organ Care System (“OCS”) to replace a decades-old standard of care. The OCS represents a paradigm shift that transforms organ preservation for transplantation from a static state to a dynamic environment that enables new capabilities, including organ optimization and assessment. The Company’s OCS technology replicates many aspects of the organ’s natural living and functioning environment outside of the human body. The Company also developed its National OCS Program (“NOP”), an innovative turnkey solution to provide outsourced organ retrieval and OCS organ management, to provide transplant programs in the United States with a more efficient process to procure donor organs with the OCS. The accompanying consolidated financial statements have been prepared on the basis of continuity of operations, realization of assets and the satisfaction of liabilities and commitments in the ordinary course of business. The Company has incurred recurring losses since inception, including a net loss of $ 36.2 million for the year ended December 31, 2022. As of December 31, 2022, the Company had an accumulated deficit of $ 478.7 million. The Company expects to continue to generate operating losses in the foreseeable future. The Company believes that its existing cash of $ 201.2 million as of December 31, 2022 will be sufficient to fund its operations, capital expenditures, and debt service payments for at least the next 12 months following the filing of this Annual Report on Form 10-K. The Company may need to seek additional funding through equity financings, debt financings or strategic alliances. The Company may not be able to obtain financing on acceptable terms, or at all, and the terms of any financing may adversely affect the holdings or the rights of the Company’s shareholders. If the Company is unable to obtain funding, the Company will be required to delay, reduce or eliminate some or all of its research and development programs, product expansion or commercialization efforts, or the Company may be unable to continue operations. The Company is subject to risks and uncertainties common to companies in the medical device industry and of similar size, including, but not limited to, development by competitors of new technological innovations, dependence on key personnel, protection of proprietary technology, compliance with government regulations, uncertainty of market acceptance of products, and the need to obtain additional financing to fund operations. Products currently under development will require additional research and development efforts, including additional clinical testing and regulatory approval, prior to commercialization. These efforts require additional capital, adequate personnel, infrastructure and extensive compliance-reporting capabilities. The Company’s research and development may not be successfully completed, adequate protection for the Company’s technology may not be obtained, the Company may not obtain necessary government regulatory approval on its expected timeline or at all, and approved products may not prove commercially viable. The Company operates in an environment of rapid change in technology and competition. The impact of the COVID-19 pandemic has been and may continue to be extensive in many aspects of society, which has resulted in and may continue to result in significant disruptions to the global economy, as well as businesses and capital markets around the world. Continued impacts to the Company’s business as a result of COVID-19 may include disruptions to the Company’s manufacturing operations and supply chain; labor shortages; decreased productivity and unavailability of materials or components; limitations on its employees’ and customers’ ability to travel, and delays in product installations, trainings or shipments to and from other affected countries and within the United States. While the Company maintains an inventory of finished products and raw materials used in its OCS products, a further prolonged pandemic could lead to shortages in the raw materials necessary to manufacture its products. The Company’s consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”). Any reference in these notes to applicable guidance is meant to refer to the authoritative GAAP as found in the Accounting Standards Codification (“ASC”) and Accounting Standards Update (“ASU”) of the Financial Accounting Standards Board (“FASB”). The accompanying consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements, and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions reflected in these consolidated financial statements include, but are not limited to, revenue recognition, the valuation of inventory and the valuation of stock-based awards. The Company bases its estimates on historical experience, known trends and other market-specific or other relevant factors that it believes to be reasonable under the circumstances. On an ongoing basis, management evaluates its estimates as there are changes in circumstances, facts and experience. Changes in estimates are recorded in the period in which they become known. As of the date of issuance of these consolidated financial statements, the Company is not aware of any specific event or circumstance that would require the Company to update estimates, judgments or revise the carrying value of any assets or liabilities. Actual results may differ from those estimates or assumptions. Risk of Concentrations of Credit, Significant Customers and Significant Suppliers Financial instruments that potentially expose the Company to concentrations of credit risk consist primarily of cash, cash equivalents, marketable securities and accounts receivable. The Company does not believe that it is subject to unusual credit risk beyond the normal credit risk associated with commercial banking relationships. As of December 31, 2022 and 2021, the Company had no allowance for credit losses. Significant customers are those that accounted for 10 % or more of the Company’s revenue or accounts receivable. For the year ended December 31, 2022, one customer accounted for 14 % of revenue. For the year ended December 31, 2021, one customer accounted for 11 % of revenue. For the year ended December 31, 2020, two customers accounted for 14 % and 10 % of revenue, respectively. As of December 31, 2022, no customer accounted for 10 % or more of accounts receivable. As of December 31, 2021, two customers accounted for 21 % and 15 % of accounts receivable, respectively. Certain of the components and subassemblies included in the Company’s products are obtained from a sole source, a single source or a limited group of suppliers, as are sterilization services. Although the Company seeks to reduce dependence on those limited sources of suppliers, manufacturers and service providers, the partial or complete loss of certain of these sources could have a material adverse effect on the Company’s operating results, financial condition and cash flows and damage its customer relationships. Deferred Financing Costs Deferred financing costs related to a recognized debt liability are recorded as a reduction of the carrying amount of the debt liability and amortized to interest expense using the effective interest method over the repayment term of the debt. Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents. Restricted Cash As of December 31, 2022 and 2021, the Company maintained two letters of credit totaling $ 0.5 million for the benefit of the landlord of its leased property. The Company was required to maintain a separate cash balance of $ 0.5 million to secure the letters of credit. Related to this separate cash balance, the Company classified $ 0.5 million as restricted cash (non-current) on its consolidated balance sheets as of December 31, 2022 and 2021. Accounts Receivable Accounts receivable are presented net of an allowance for credit losses, which is an estimate of amounts that may not be collectible. The Company performs ongoing credit evaluations of its customers and monitors economic conditions to identify facts and circumstances that may indicate its receivables are at risk of collection. The Company provides reserves against accounts receivable for estimated credit losses, if any, that may result from a customer’s inability to pay based on the composition of its accounts receivable, current economic conditions and historical credit loss activity. Amounts deemed uncollectible are charged or written-off against the reserve. As of December 31, 2022 and 2021, the Company had no allowance for credit losses. During the years ended December 31, 2022, 2021 and 2020, the Company did no t record any provisions for credit losses. During the year ended December 31, 2022, the Company wrote off less than $ 0.1 million of accounts receivable balances. During the years ended December 31, 2021 and 2020, the Company did no t write off any accounts receivable balances. Property and Equipment Property and equipment are stated at cost less accumulated depreciation and amortization. Depreciation and amortization expense is recognized using the straight-line method over the estimated useful life of each asset as follows: Estimated Useful Life Manufacturing equipment 5 years OCS Consoles 5 years Computer equipment and software 3 years Laboratory equipment 3 years Office and trade show equipment 5 years Leasehold improvements Shorter of term of lease or 15 years Costs incurred for OCS Consoles are recorded as inventory unless and until the Company determines that an OCS Console will either be used for the NOP or loaned to a customer for its use, at which time the Company reclassifies the cost of the OCS Console from inventory to property and equipment and begins to depreciate the OCS Console over its estimated useful life. Such depreciation expense is classified as a cost of revenue. The Company retains title to all OCS Consoles loaned to customers. Costs for capital assets not yet placed into service are capitalized as construction-in-progress and depreciated once placed into service. Upon retirement or sale, the cost of assets disposed of and the related accumulated depreciation and amortization are removed from the accounts and any resulting gain or loss is included in loss from operations. Expenditures for repairs and maintenance are charged to expense as incurred. Impairment of Long-Lived Assets Long-lived assets consist of property and equipment and right-of-use assets. Long-lived assets to be held and used are tested for recoverability whenever events or changes in business circumstances indicate that the carrying amount of the assets may not be fully recoverable. Factors that the Company considers in deciding when to perform an impairment review include significant underperformance of the business in relation to expectations, significant negative industry or economic trends and significant changes or planned changes in the use of the assets. If an impairment review is performed to evaluate a long-lived asset group for recoverability, the Company compares forecasts of undiscounted cash flows expected to result from the use and eventual disposition of the long-lived asset group to its carrying value. An impairment loss would be recognized in loss from operations when estimated undiscounted future cash flows expected to result from the use of an asset group are less than its carrying amount. The impairment loss would be based on the excess of the carrying value of the impaired asset group over its fair value. The Company did no t record any impairment losses on long-lived assets during the years ended December 31, 2022, 2021 and 2020. Software Development Costs The Company incurs costs to develop computer software that is embedded in the hardware components of the Company’s OCS Console and OCS Perfusion Sets. Research and development costs related to this software are expensed as incurred, except for costs of internally developed or externally purchased software that qualify for capitalization. Software development costs incurred subsequent to the establishment of technological feasibility, but prior to the general release of the product, are capitalized and, upon general release, are amortized based upon the pattern in which economic benefits related to such assets are realized. Due to the short time period between achieving technological feasibility and product release and the insignificant amount of costs incurred during such periods, the Company did no t capitalize any software development costs during the years ended December 31, 2022, 2021 and 2020. Inventory Inventory is valued at the lower of cost or net realizable value. Cost is computed using the first-in, first-out method. The Company regularly reviews inventory quantities on-hand for excess and obsolete inventory and, when circumstances indicate, records charges to write down inventories to their estimated net realizable value, after evaluating historical sales, future demand, market conditions and expected product life cycles. Such charges are classified as cost of revenue in the consolidated statements of operations. Any write-down of inventory to net realizable value creates a new cost basis. At the end of each reporting period, the Company assesses whether losses should be accrued on long-term manufacturing purchase commitments in accordance with Accounting Standards Codification (“ASC”) 330, Inventory , which requires that losses that are expected to arise from firm, noncancelable and unhedged commitments for the future purchase of inventory, measured in the same way as inventory losses, should be recognized in the current period in the statements of operations unless they are deemed recoverable through firm sales contacts or when there are other circumstances that reasonably assure continuing sales without price decline. As of the end of each reporting period presented in the accompanying consolidated financial statements, the Company did not identify any potential losses arising from remaining future purchase commitments as compared to estimated future customer sales through the remainder of the term of the manufacturing purchase commitment and, as a result, did no t recognize any loss provision for future-period remaining purchase commitments for the year ended December 31, 2022. Leases Prior to January 1, 2021, the Company accounted for leases under ASC 840, Leases (“ASC 840”). Effective January 1, 2021 , the Company adopted ASC Topic 842, Leases (“ASC 842”), using the modified retrospective approach with no restatement of prior periods or cumulative adjustment to accumulated deficit. Therefore, for the year ended December 31, 2020, the Company’s financial statements continue to be presented in accordance with ASC 840, the accounting standard originally in effect for such period. As of and for the years ended December 31, 2022 and 2021, the Company’s consolidated financial statements are presented in accordance with ASC 842. In accordance with ASC 842, the Company accounts for a contract as a lease when it has the right to control the asset for a period of time while obtaining substantially all of the asset’s economic benefits. The Company determines if an arrangement is a lease or contains an embedded lease at inception. For arrangements that meet the definition of a lease, the Company determines the initial classification and measurement of its right-of-use asset and lease liability at the lease commencement date and thereafter if modified. The lease term includes any renewal options that the Company is reasonably assured to exercise. The present value of lease payments is determined by using the interest rate implicit in the lease, if that rate is readily determinable; otherwise, the Company uses its estimated secured incremental borrowing rate for that lease term. The Company’s policy is to not record leases with an original term of twelve months or less on its consolidated balance sheets and recognizes those lease payments in the income statement on a straight-line basis over the lease term. The Company’s existing leases are for office, laboratory and manufacturing space. In addition to rent, the leases may require the Company to pay additional costs, such as utilities, maintenance and other operating costs, which are generally referred to as non-lease components. The Company has elected to not separate lease and non-lease components. Only the fixed costs for lease components and their associated non-lease components are accounted for as a single lease component and recognized as part of a right-of-use asset and lease liability. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in operating expense in the consolidated statements of operations. Revenue from leasing arrangements is not subject to the revenue standard for contracts with customers and remains separately accounted for under ASC 842. In accordance with ASC 842, lessors should classify and account for a lease with variable lease payments that do not depend on a reference index or a rate as an operating lease if the lease would have been classified as a sales-type lease or a direct financing lease and the lessor would have otherwise recognized a day-one loss. The Company’s OCS Console implied rental agreements qualify as sales-type leases with certain variable payments that meet specified criteria such that a day-one loss would be recognized under ASC 842. Therefore, in accordance with ASC 842, such leases are accounted for as operating leases and the Company does not derecognize the leased asset (the OCS Console) at the time of the sale but depreciates the leased asset over the useful life of the asset. Fair Value Measurements Certain assets and liabilities are carried at fair value under GAAP. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs. Financial assets and liabilities carried at fair value are to be classified and disclosed in one of the following three levels of the fair value hierarchy, of which the first two are considered observable and the last is considered unobservable: • Level 1—Quoted prices in active markets for identical assets or liabilities. • Level 2—Observable inputs (other than Level 1 quoted prices), such as quoted prices in active markets for similar assets or liabilities, quoted prices in markets that are not active for identical or similar assets or liabilities, or other inputs that are observable or can be corroborated by observable market data. • Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to determining the fair value of the assets or liabilities, including pricing models, discounted cash flow methodologies and similar techniques. The Company’s cash equivalents and marketable securities are carried at fair value, determined according to the fair value hierarchy described above (see Note 4). The carrying values of the Company’s accounts receivable, accounts payable and accrued expenses approximate their fair values due to the short-term nature of these assets and liabilities. The carrying value of the Company’s long-term debt approximates its fair value (a level 2 measurement) at each balance sheet date due to its variable interest rate, which approximates a market interest rate. Marketable Securities The Company’s marketable securities (non-equity instruments) are classified as available-for-sale and are carried at fair value, with the unrealized gains and losses reported as a component of accumulated other comprehensive income (loss) in stockholders’ equity. Realized gains and losses are based on the specific identification method and are included as a component of other income (expense), net in the consolidated statements of operations. When the fair value is below the amortized cost of a marketable security, an estimate of expected credit losses is made. The credit-related impairment amount is recognized in the consolidated statements of operations. Credit losses are recognized through the use of an allowance for credit losses account in the consolidated balance sheet and subsequent improvements in expected credit losses are recognized as a reversal of an amount in the allowance account. If the Company has the intent to sell the security or it is more likely than not that the Company will be required to sell the security prior to recovery of its amortized cost basis, then the allowance for the credit loss is written-off and the excess of the amortized cost basis of the asset over its fair value is recorded in the consolidated statements of operations. There were no credit losses recorded during the years ended December 31, 2022, 2021 and 2020. Segment Information The Company manages its operations as a single segment for the purposes of assessing performance and making operating decisions. The Company has developed and is commercializing a proprietary system to preserve human organs for transplant in a near-physiologic condition to address the limitations of cold storage organ preservation. Operating segments are defined as components of an enterprise for which separate financial information is regularly evaluated by the Company’s chief operating decision maker, or decision-making group, in deciding how to allocate resources and assess performance. The Company has determined that its chief operating decision maker is its Chief Executive Officer. The Company’s chief operating decision maker reviews the Company’s financial information on a consolidated basis for purposes of allocating resources and assessing financial performance. Product Warranties The Company provides a one-year warranty on its OCS Consoles and disposable sets and replaces or repairs any OCS Console or disposable set that does not function in accordance with the product specifications . OCS Consoles returned to the Company may be refurbished and redeployed. Estimated warranty costs are recorded at the time of shipment of the OCS Console or disposable set. Warranty costs are estimated based on the current expected product replacement or repair cost and expected replacement or repair rates based on historical experience. The Company evaluates its warranty accrual at the end of each reporting period and makes adjustments as necessary. As of December 31, 2022 and 2021, the warranty accrual was less than $ 0.1 million. Revenue Recognition The Company generates net product revenue primarily from sales of its single-use, organ-specific disposable sets used on its organ-specific OCS Consoles. To a lesser extent, the Company also generates product revenue from the sale of OCS Consoles to customers and the implied rental of OCS Consoles loaned to customers at no charge. For each new transplant procedure, customers purchase an additional OCS disposable set for use on the customer’s existing organ-specific OCS Console. The Company also generates service revenue by providing outsourced organ retrieval and OCS organ management services under its National OCS Program in the United States. The Company recognizes revenue from sales to customers applying the following five steps: (1) identification of the contract, or contracts, with a customer, (2) identification of the performance obligations in the contract, (3) determination of the transaction price, (4) allocation of the transaction price to the performance obligations in the contract, and (5) recognition of revenue when, or as, performance obligations are satisfied. Substantially all of the Company’s customer contracts have multiple-performance obligations that contain deliverables consisting of OCS Perfusion Sets and OCS Solutions. Customer contract deliverables may also include organ retrieval and OCS organ management services under the Company's National OCS Program or an OCS Console, whether sold or loaned to the customer. The Company evaluates each promise within a multiple-performance obligation arrangement to determine whether it represents a distinct performance obligation. The primary performance obligations in the Company’s customer arrangements from which it derives revenue are the OCS Perfusion Sets, the OCS Solutions, the OCS Console, organ retrieval services and OCS organ management services. When a customer order includes an OCS Console, the Company has determined that customer training and the equipment set-up of the OCS Console, each performed by the Company, are not distinct because they are not sold on a standalone basis and can only be performed by the Company in conjunction with a sale or loan of its OCS Console. In addition, the Company has determined that the OCS Console itself is not distinct because the customer cannot benefit from the OCS Console without the training and equipment set-up having been completed. As a result, when the order includes an OCS Console, the Company has concluded that training, OCS Console equipment set-up, and the OCS Console itself are highly interdependent and represent a single, combined performance obligation. The Company recognizes revenue from the single, combined performance obligation only once the OCS Console has arrived at the customer site and the training and equipment set-up have been completed by the Company. Customer orders may include the loan of an OCS Console as well as OCS disposable sets used in each transplant procedure. When the Company loans the OCS Console to the customer, it retains title to the console at all times and does not require minimum purchase commitments from the customer related to any OCS products. In such cases, the Company invoices the customer for OCS disposable sets based on customer orders received for each new transplant procedure and the prices set forth in the customer agreement. Over time, the Company typically recovers the cost of the loaned OCS Console through the customer’s continued purchasing and use of additional OCS disposable sets. For these reasons, the Company has determined that part of the arrangement consideration for the disposable set is an implied rental payment for use of the OCS Console. Therefore, the Company allocates the arrangement consideration between the lease deliverables (i.e., the OCS Console) and non-lease deliverables (i.e., the OCS disposable sets) based on the relative estimated standalone selling price of each distinct performance obligation. To date, the amounts allocated to lease deliverables have been insignificant. Revenue from sales to customers of OCS Perfusion Sets, OCS Solutions and OCS Consoles is classified as net product revenue in the Company's consolidated statements of operations. Revenue from sales to customers of organ retrieval and OCS organ management services is classified as service revenue in the Company’s consolidated statements of operations. Revenue is recognized when control is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled to in exchange for the product or services. When a customer order includes disposable sets and organ retrieval or OCS organ management services, the Company has determined that the disposable sets and services constitute separate performance obligations and recognizes revenue as the disposable sets and services are each delivered to the customer. Payments Made to Customers Under some of the Company’s customer clinical trial agreements, the Company makes payments to its customers for reimbursements of clinical trial materials and for specified clinical documentation related to the customer’s use of its OCS products. The Company also makes payments to customers involved in post-approval studies for information related to the transplant procedures performed. The Company determines the appropriate accounting treatments for these payments depending on the nature of the payment and whether they are for distinct goods or services. Contract Assets and Liabilities The Company recognizes a receivable at the point in time at which it has an unconditional right to payment. Such receivables are not contract assets. Contract assets arise from unbilled amounts in customer arrangements when revenue recognized exceeds the amount billed to the customer and the Company’s right to payment is not just subject to the passage of time. The Company had no contract assets as of December 31, 2022 and 2021. Contract liabilities represent the Company’s obligation to transfer goods or services to a customer for which it has received consideration (or the amount is due) from the customer. The Company has determined that its only contract liabilities are deferred revenue, which consists of amounts that have been invoiced but that have not been recognized as revenue. Remaining Performance Obligations The Company generally satisfies performance obligations within one year of the contract inception date, which amounts are included in deferred revenue and are not material. Other Revenue Considerations Revenue is reported net of taxes. The Company does not consider shipping to be a contract performance obligation, therefore shipping costs incurred and billed to customers are recorded as revenue and cost of revenue. The Company only includes estimated variable amounts in the transaction price to the extent it is probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The Company does not assess whether promised goods or services are performance obligations if they are deemed immaterial in the context of the contract with the customer. Additionally, the Company does not assess whether a contract has a significant financing component if the expectation at contract inception is that the period between payment by the customer and the transfer of the promised goods or services to the customer will be one year or less. Distributors The Company markets and sells its products primarily through its direct sales force, which sells its products to end customers globally. A small portion of the Company’s revenue is generated by sales to a limited number of distributors in Europe and Asia-Pacific. When the Company transacts with a distributor, its contractual arrangement is with the distributor and not with the end customer. Whether the Company transacts business with and receives the order from a distributor or directly from an end customer, its revenue recognition policy and resulting pattern of revenue recognition for the order are the same. Research, Development and Clinical Trials Costs Research, development and clinical trials expenses consist of costs incurred for research activities, product development, hardware and software engineering and clinical trial activities, including salaries and bonuses, stock-based compensation, employee benefits, facilities costs, laboratory supplies, depreciation, testing, regulatory, data management and consulting costs. Research, development and clinical trials costs are expensed as incurred. Advance payments for goods or services to be received in the future for use in research, development and clinical trials activities are recorded as prepaid expenses. Such prepaid expenses are recognized as an expense when the related goods have been delivered or the related services have been performed, or when it is no longer expected that the goods will be delivered or the services rendered. Patent Costs All patent-related costs incurred in connection with filing and prosecuting patent applications are expensed as incurred due to the uncertainty about the recovery of the expenditure. Amounts incurred are classified as general and administrative expenses. Foreign Currency Translation The functional currency of each of the Company’s foreign subsidiaries is the currency of the local country. Assets and liabilities of the Company’s foreign subsidiaries are translated into U.S. dollars using the period-end exchange rates, and income and expense items are translated into U.S. dollars using average exchange rates in effect during each period. The effects of these foreign currency translation adjustments are included in accumulated other comprehensive loss, a separate component of stockholders’ equity. The Company also incurs transaction gains and losses resulting from intercompany transactions as well as transactions with customers or vendors denominated in currencies other than the functional currency of the legal entity in which the transaction is recorded. Realized and unrealized foreign currency transaction gains (losses) are included in the consolidated statements of operations as a component of other income (expense) and totaled ($ 1.3 million), ($ 1.0 million) and $ 1.0 million for the years ended December 31, 2022, 2021 and 2020, respectively. Stock-Based Compensation The Company accounts for stock-based awards granted to employees, non-employees and directors based on the fair value of the award on the date of grant. The fair value of option awards is measured using the Black-Scholes option-pricing model. The fair value of restricted common stock awards is measured based on the difference between market value of the Company’s common stock on date of grant and the purchase price (if any). Generally, the Company issues awards with only service-based vesting conditions. Compensation expense for those awards is recognized over the vesting period of the respective award using the straight-line method. The Company accounts for forfeitures as they occur and records compensation cost assuming all option holders will complete the requisite service period. When the unvested portion of an award is forfeited, the Company reverses compensation expense previously recognized in the period of the forfeiture. The Company classifies stock-based compensation expense in its consolidated statements of operations in the same manner in which the award recipient’s payroll costs are classified or in which the award recipient’s service payments are classified. Comprehensive Loss and Accumulated Other Comprehensive Loss Comprehensive loss includes net loss as well as other changes in stockholders’ equity that result from transactions and economic events other than those with stockholders. The Company’s only elements of other comprehensive loss are foreign currency translation adjustments and unrealized gains (losses) on marketable securities. Accumulated other comprehensive gains (losses) on the consolidated balance sheets consists primarily of foreign currency translation adjustments. Accumulated other comprehensive loss attributable to unrealized gains (losses) on marketable securities has not been significant. Net Income (Loss) per Share Basic net income (loss) per common share is computed by dividing the net income (loss) by the weighted average number of shares of common stock outstanding for the period. Diluted net income (loss) per common share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding for the period, including potential dilutive common shares assuming the dilutive effect of outstanding stock awards. For periods in which the Company reports a net loss, diluted net loss per common share is the same as basic net loss per common share, since dilutive common shares are not assumed to have been issued if their effect is anti-dilutive. The Company reported a net loss attributable to common stockholders for each of the years ended December 31, 2022, 2021 and 2020. The Company’s potential dilutive securities have been excluded from the computation of diluted net loss per share as the effect would be to reduce the net loss per share. The Company excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to common stockholders for the periods indicated above because including them would have had an anti-dilutive effect: As of December 31, 2022 2021 Warrants to purchase common stock 14,440 64,440 Options to purchase common stock 3,288,791 2,797,550 Employee stock purchase plan 14,135 12,465 Restricted stock awards 24,315 — 3,341,681 2,874,455 Income Taxes The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and

Marketable Securities

Marketable Securities	12 Months Ended
	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Marketable Securities	3. Marketable Securities The Company did no t have marketable securities as of December 31, 2022. Marketable securities by security type as of December 31, 2021 consisted of the following (in thousands): December 31, 2021 Amortized Gross Gross Credit Losses Fair Value U.S. Treasury securities (due within one year) $ 63,907 $ — $ ( 33 ) $ — $ 63,874 U.S. government agency bonds (due within 3,001 — ( 3 ) — 2,998 $ 66,908 $ — $ ( 36 ) $ — $ 66,872

Fair Value of Financial Assets

Fair Value of Financial Assets and Liabilities	12 Months Ended
	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Fair Value of Financial Assets and Liabilities	4. Fair Value of Financial Assets The Company did no t have assets measured at fair value on a recurring basis as of December 31, 2022. The following table presents the Company’s fair value hierarchy for its assets that were measured at fair value on a recurring basis as of December 31, 2021 (in thousands): Fair Value Measurements at December 31, 2021 Using: Level 1 Level 2 Level 3 Total Assets: Cash equivalents: Money market funds $ 11,169 $ — $ — $ 11,169 Marketable securities: U.S. Treasury securities — 63,874 — 63,874 U.S. government agency bonds — 2,998 — 2,998 $ 11,169 $ 66,872 $ — $ 78,041 Money market funds were valued by the Company based on quoted market prices, which represent a Level 1 measurement within the fair value hierarchy. U.S. Treasury securities and U.S. government agency bonds were valued by the Company using quoted prices in active markets for similar securities, which represent a Level 2 measurement within the fair value hierarchy.

Inventory

Inventory	12 Months Ended
	Dec. 31, 2022
Inventory Disclosure [Abstract]
Inventory	5. Inventory Inventory consisted of the following (in thousands): December 31, 2022 2021 Raw materials $ 10,939 $ 7,274 Work-in-process 1,876 1,932 Finished goods 7,790 5,653 $ 20,605 $ 14,859

Property and Equipment, Net

Property and Equipment, Net	12 Months Ended
	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	6. Property and Equipment, Net Property and equipment, net consisted of the following (in thousands): December 31, 2022 2021 Manufacturing equipment $ 3,721 $ 1,769 OCS Consoles 10,878 8,865 Computer equipment and software 2,064 1,511 Laboratory equipment 671 668 Office and trade show equipment 2,121 177 Leasehold improvements 12,415 1,319 Construction-in-progress 482 5,267 32,352 19,576 Less: Accumulated depreciation and amortization ( 13,129 ) ( 9,735 ) $ 19,223 $ 9,841 During the years ended December 31, 2022, 2021 and 2020, total depreciation and amortization expense was $ 3.5 million, $ 1.8 million and $ 1.6 million, respectively. Of those amounts, $ 1.7 million, $ 1.4 million and $ 1.3 million, respectively, was recorded as expense in cost of revenue related to the depreciation of OCS Consoles.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	12 Months Ended
	Dec. 31, 2022
Accrued Expenses And Other Current Liabilities [Abstract]
Accrued Expenses and Other Current Liabilities	7. Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consisted of the following (in thousands): December 31, 2022 2021 Accrued payroll and related expenses $ 9,812 $ 5,173 Accrued logistics costs 2,581 — Accrued professional fees 965 1,973 Accrued research, development and clinical trial expenses 1,876 4,567 Accrued other 3,401 4,624 $ 18,635 $ 16,337

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2022
Debt Disclosure [Abstract]
Long-Term Debt	8. Long-Term Debt Long-term debt consisted of the following (in thousands): December 31, 2022 2021 Principal amount of long-term debt $ 60,000 $ 35,000 Less: Current portion of long-term debt — — Long-term debt, net of current portion 60,000 35,000 Debt discount, net of accretion ( 1,304 ) ( 511 ) Accrued end-of-term payments — 708 Long-term debt, net of discount and current portion $ 58,696 $ 35,197 OrbiMed Credit Agreement The Company entered into a credit agreement with OrbiMed Royalty Opportunities II, LP (the “OrbiMed Credit Agreement”) in June 2018, pursuant to which TransMedics borrowed $ 35.0 million. Borrowings under the OrbiMed Credit Agreement bore interest at an annual rate equal to the London Interbank Offered Rate (“LIBOR”), subject to a minimum of 1.0 % and a maximum of 4.0 % , plus 8.5 % (the “Applicable Margin”), subject in the aggregate to a maximum interest rate of 11.5 %. In addition, borrowings under the OrbiMed Credit Agreement bore paid-in-kind (“PIK”) interest at an annual rate equal to the amount by which LIBOR plus the Applicable Margin exceeded 11.5 %, but not to exceed 12.5 %. The PIK interest was added to the principal amount of the borrowings outstanding at the end of each quarter until the repayment of the borrowings in July 2022 . Borrowings under the OrbiMed Credit Agreement were repayable in quarterly interest-only payments until the maturity date, at which time all principal and accrued interest was due and payable. At its option, the company could prepay outstanding borrowings under the OrbiMed Credit Agreement. The Company was required to make a final payment in an amount equal to 3.0 % of the principal amount of any prepayment or repayment. The final payment and debt discount amounts were being accreted to interest expense over the term of the OrbiMed Credit Agreement using the effective interest method. In July 2022, the Company repaid amounts due under the OrbiMed Credit Agreement, including $ 35.0 million of principal repayments and a $ 1.1 million end of term payment, as well as accrued interest, and the OrbiMed Credit Agreement was terminated. Upon repayment of the outstanding amounts, the Company recorded a loss on extinguishment of debt of $ 0.6 million, which was classified as other expense in the consolidated statements of operations. Canadian Imperial Bank of Commerce Credit Agreement In July 2022, the Company entered into a credit agreement with Canadian Imperial Bank of Commerce (“CIBC”), pursuant to which the Company borrowed $ 60.0 million (the “CIBC Credit Agreement”). Borrowings under the CIBC Credit Agreement bear interest at an annual rate equal to either, at the Company’s option, (i) the secured overnight financing rate for an interest period selected by the Company, subject to a minimum of 1.5 %, plus 2.0 % or (ii) 1.0 % plus the higher of a) the prime rate subject to a minimum of 4.0 % or b) the Federal Funds Effective Rate, plus 0.5 %. Borrowings under the CIBC Credit Agreement are payable in monthly interest-only payments for the first 24 months , and then payable in equal monthly principal payments plus accrued interest until the maturity date of the CIBC Credit Agreement in July 2027 . If certain revenue milestones are met after the first 24 months, the Company may extend the interest-only repayment period by one additional year. At the Company’s option, the Company may prepay borrowings outstanding under the CIBC Credit Agreement, subject to a prepayment fee of 2.0 % of outstanding borrowings if paid prior to 12 months after the closing date, and 1.0 % if paid on or after 12 months after the closing date but prior to 24 months after the closing date. In connection with entering into the CIBC Credit Agreement, the Company paid upfront fees and other costs of $ 1.5 million, which were recorded by the Company as a debt discount. The debt discount is reflected as a reduction of the carrying value of long-term debt on the Company’s consolidated balance sheet and is being accreted to interest expense over the term of the CIBC Credit Agreement using the effective interest method. All obligations under the CIBC Credit Agreement are guaranteed by the Company and each of its material subsidiaries. All obligations of the Company and each guarantor are secured by substantially all of the Company’s and each guarantor’s assets, including their intellectual property, subject to certain exceptions. Under the CIBC Credit Agreement, the Company has agreed to customary representations and warranties, events of default and certain affirmative and negative covenants to which it will remain subject until maturity. The financial covenants include, among other covenants, (x) a requirement to maintain a minimum liquidity amount of the greater of either (i) the consolidated adjusted EBITDA loss (or gain) for the trailing four month period (only if EBITDA is negative) and (ii) $ 10.0 million, and (y) a requirement to maintain total net revenue of at least 75 % of the level set forth in the total revenue plan presented to CIBC. The obligations under the CIBC Credit Agreement are subject to acceleration upon the occurrence of specified events of default, including payment default, change in control, bankruptcy, insolvency, certain defaults under other material debt, certain events with respect to governmental approvals (if such events could cause a material adverse change in the Company’s business), failure to comply with certain covenants and a material adverse change in the Company’s business, operations or financial condition. As of December 31, 2022, the Company was in compliance with all financial covenants of the CIBC Credit Agreement. During the continuance of an event of default, the interest rate per annum will be equal to the rate that would have otherwise been applicable at the time of the event of default plus 2.0 %. If an event of default (other than certain events of bankruptcy or insolvency) occurs and is continuing, CIBC may declare all or any portion of the outstanding principal amount of the borrowings plus accrued and unpaid interest to be due and payable. Upon the occurrence of certain events of bankruptcy or insolvency, all of the outstanding principal amount of the borrowings plus accrued and unpaid interest will automatically become due and payable. In addition, the Company may be required to prepay outstanding borrowings, subject to certain exceptions, with portions of net cash proceeds of certain asset sales and certain casualty and condemnation events. The Company assessed all terms and features of the CIBC Credit Agreement in order to identify any potential embedded features that would require bifurcation. As part of this analysis, the Company assessed the economic characteristics and risks of the debt. The Company determined that all features of the CIBC Credit Agreement are either clearly and closely associated with a debt host or have a de minimis fair value and, as such, do not require separate accounting as a derivative liability. As of December 31, 2022, the interest rate applicable to borrowings under the CIBC Credit Agreement was 6.1 %. During each of the years ended December 31, 2022, 2021 and 2020, the weighted average effective interest rate on outstanding borrowings was approximately 6.6 %, 11.2 %, and 11.2 %, respectively.

Equity

Equity	12 Months Ended
	Dec. 31, 2022
Equity [Abstract]
Equity	9. Equity Preferred Stock As of December 31, 2022, the Company’s articles of organization authorized the Company to issue up to 25,000,000 shares of preferred stock, no par value per share, all of which is undesignated. The preferred stock will have such rights, preferences, privileges and restrictions, including voting rights, dividend rights, conversion rights, redemption privileges and liquidation preferences, as shall be determined by the Company’s boards of directors upon issuance. Common Stock As of December 31, 2022, the Company’s articles of organization authorized the Company to issue up to 150,000,000 shares of common stock, no par value per share. Each share of common stock is entitled to one vote on all matters submitted to a vote of the Company’s stockholders. The holders of common stock are entitled to receive dividends, if any, as may be declared by the board of directors, as described above. Through December 31, 2022, no dividends had been declared or paid. Warrants As of December 31, 2022, the Company had outstanding warrants to purchase 14,440 shares of common stock at an exercise price of $ 17.47 per share with an expiration date of May 6, 2024 . In November 2022, warrants were exercised to purchase 50,000 shares of common stock at an exercise price of $ 8.75 per share for total proceeds of $ 0.4 million.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2022
Stockholders' Equity Note [Abstract]
Stock-Based Compensation	10. Stock-Based Compensation 2019 Stock Incentive Plan The 2019 Stock Incentive Plan (the “2019 Plan”) provides for the grant of incentive stock options, nonqualified stock options, stock appreciation rights, restricted stock, restricted stock units, unrestricted stock, unrestricted stock units, and other stock-based awards to employees, directors, and consultants of the Company and its subsidiaries. The number of shares of common stock of TransMedics Group initially available for issuance under the 2019 Plan was 3,428,571 shares, plus the number of shares underlying awards under the previously outstanding 2014 Stock Incentive Plan (the “2014 Plan”), not to exceed 1,595,189 shares, that expire or are terminated, surrendered, or cancelled without the delivery of shares, are forfeited to or repurchased by TransMedics Group or otherwise become available again for grant. Since the effectiveness of the Company’s 2019 Plan in April 2019, no awards have been made or will be made under the 2014 Plan. Shares withheld in payment of the exercise or purchase price of an award or in satisfaction of tax withholding requirements, and the shares covered by a stock appreciation right for which any portion is settled in stock, will reduce the number of shares available for issuance under the 2019 Plan. In addition, the number of shares available for issuance under the 2019 Plan (i) will not be increased by any shares delivered under the 2019 Plan that are subsequently repurchased using proceeds directly attributable to stock option exercises and (ii) will not be reduced by any awards that are settled in cash or that expire, become unexercisable, terminate or are forfeited to or repurchased by TransMedics Group without the issuance of stock under the 2019 Plan. As of December 31, 2022, 820,336 shares of common stock were available for issuance under the 2019 Plan. 2019 Employee Stock Purchase Plan Pursuant to the Company’s 2019 Employee Stock Purchase Plan (the “2019 ESPP”), certain employees of the Company are eligible to purchase common stock of the Company at a reduced price during offering periods. The 2019 ESPP permits participants to purchase common stock using funds contributed through payroll deductions, subject to the limitations set forth in the Internal Revenue Code, at a purchase price of 85 % of the lower of the closing price of the Company’s common stock on the first trading day of the offering period or the closing price on the applicable purchase date, which is the final trading day of the applicable offering period. A total of 371,142 shares of common stock of TransMedics Group were initially reserved for issuance under the 2019 ESPP. During the year ended December 31, 2022, 30,143 shares were issued under the 2019 ESPP and as of December 31, 2022, 290,453 shares remained available for issuance. 2021 Inducement Plan In August 2021, the Company’s board of directors approved the TransMedics Group, Inc. Inducement Plan (the “Inducement Plan”). Pursuant to the terms of the Inducement Plan, the Company may grant nonqualified stock options, stock appreciation rights, restricted stock, unrestricted stock, restricted stock unit awards and performance awards to individuals who were not previously employees or directors of the Company or individuals returning to employment after a bona fide period of non-employment with the Company. A total of 1,000,000 shares of the Company’s common stock were initially available for issuance under the Inducement Plan. As of December 31, 2022, 478,938 shares of common stock remained available for issuance under the Inducement Plan. Stock Option Valuation The fair value of stock option grants is estimated using the Black-Scholes option-pricing model. Because there had been no public market for the Company's common stock prior to the Company's initial public offering, there is limited Company-specific historical and implied volatility data. Accordingly, the Company bases its estimates of expected volatility on a combination of the Company's own historical volatility and historical volatility of a group of publicly-traded companies with similar characteristics to itself. For options with service-based vesting conditions, the expected term of the Company’s stock options has been determined utilizing the “simplified” method for awards that qualify as “plain-vanilla” options. The risk-free interest rate is determined by reference to the U.S. Treasury yield curve in effect at the time of grant of the award for time periods approximately equal to the expected term of the award. Expected dividend yield is based on the fact that the Company has never paid cash dividends and does not expect to pay any cash dividends in the foreseeable future. The following table presents, on a weighted average basis, the assumptions used in the Black-Scholes option-pricing model to determine the grant-date fair value of stock options granted to employees and directors: Year Ended December 31, 2022 2021 2020 Risk-free interest rate 2.33 % 0.90 % 0.91 % Expected term (in years) 6.03 6.03 5.97 Expected volatility 59 % 58 % 54 % Expected dividend yield 0 % 0 % 0 % The following table summarizes the Company’s option activity since December 31, 2021: Number Weighted Weighted Aggregate (in years) (in thousands) Outstanding as of December 31, 2021 2,797,550 $ 20.64 7.54 $ 14,625 Granted 1,195,910 19.48 Exercised ( 507,795 ) 9.19 Forfeited ( 186,586 ) 27.45 Expired ( 10,288 ) 31.89 Outstanding as of December 31, 2022 3,288,791 $ 21.56 7.86 $ 132,076 Vested and expected to vest as of December 31, 2022 3,288,791 $ 21.56 7.86 $ 132,076 Options exercisable as of December 31, 2022 1,603,499 $ 17.86 6.92 $ 70,331 The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the fair value of the Company’s common stock for those stock options that had exercise prices lower than the fair value of the Company’s common stock. The aggregate intrinsic value of stock options exercised during the years ended December 31, 2022, 2021 and 2020, was $ 15.0 million, $ 16.3 million and $ 2.9 million, respectively. The weighted average grant-date fair value of stock options granted during the years ended December 31, 2022, 2021 and 2020 was $ 11.32 per share, $ 18.63 per share and $ 7.91 per share, respectively. The Company has no t granted any stock-based awards with performance-based vesting conditions. Restricted Common Stock During the year ended December 31, 2022, the Company granted shares of restricted common stock to certain non-employee service providers. The Company did no t grant restricted common stock in either of the years ended December 31, 2021 and 2020. Shares of unvested restricted common stock may not be sold or transferred by the holder. If the holder’s service to the Company and its affiliates ceases for any reason, unvested shares of restricted common stock held by these individuals will immediately be forfeited for no consideration, as provided in the individual restricted stock agreements. The following table summarizes the Company's restricted common stock activity since December 31, 2021: Shares Weighted Average Grant Date Fair Value Unvested restricted common stock as of December 31, 2021 — $ — Issued 26,093 28.74 Vested — — Forfeited ( 1,778 ) 28.12 Unvested restricted common stock as of December 31, 2022 24,315 $ 28.79 Stock-Based Compensation The Company recorded stock-based compensation expense in the following expense categories of its consolidated statements of operations (in thousands): Year Ended December 31, 2022 2021 2020 Cost of revenue $ 125 $ 72 $ 27 Research, development and clinical trials expenses 1,465 1,114 396 Selling, general and administrative expenses 8,731 5,692 1,991 $ 10,321 $ 6,878 $ 2,414 As of December 31, 2022, total unrecognized compensation cost related to unvested share-based awards was $ 22.3 million, which is expected to be recognized over a weighted-average period of 2.5 years.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	11. Income Taxes Tax Provision Components During the years ended December 31, 2022, 2021 and 202 0 , the Company recorded no income tax benefits for the net operating losses incurred or for the research and development tax credits generated in each year in the United States, due to the uncertainty regarding the realizability of these respective deferred tax assets. The Company generated income in the Netherlands for the years ended December 31, 2022, 2021 and 2020 and, accordingly, recorded a foreign income tax provision of $ 0.1 million, less than $ 0.1 million and less than $ 0.1 million for the years ended December 31, 2022, 2021 and 2020, respectively. Loss Before Income Taxes The domestic and foreign components of loss before income taxes were as follows (in thousands): Year Ended December 31, 2022 2021 2020 United States $ ( 36,416 ) $ ( 44,321 ) $ ( 28,803 ) Foreign 251 142 87 $ ( 36,165 ) $ ( 44,179 ) $ ( 28,716 ) A reconciliation of the U.S. federal statutory income tax rate to the Company’s effective income tax rate is as follows: Year Ended December 31, 2022 2021 2020 Federal statutory income tax rate ( 21.0 )% ( 21.0 )% ( 21.0 )% State taxes, net of federal benefit ( 5.4 )% ( 6.9 )% ( 5.7 )% Federal and state research and development tax ( 5.4 )% ( 2.4 )% ( 3.6 )% Nondeductible items ( 2.8 )% ( 3.2 )% ( 0.2 )% Deferred tax effect of change in state blended rate 16.2 % ( 1.7 )% 7.8 % Return to provision 2.6 % 1.1 % 1.7 % Other 0.1 % ( 0.2 )% 0.0 % Change in deferred tax asset valuation allowance 15.8 % 34.3 % 20.9 % Effective income tax rate 0.1 % 0.0 % ( 0.1 )% Net deferred tax assets consisted of the following (in thousands): December 31, 2022 2021 Deferred tax assets: Net operating loss carryforwards $ 92,445 $ 94,672 Capitalized research and development expense 8,109 4,291 Research and development tax credit carryforwards 13,565 12,186 Accrued expenses 2,994 2,528 Stock-based compensation expense 3,492 2,254 Lease liability 2,218 2,299 Section 163(j) interest 754 — Other 483 170 Total deferred tax assets 124,060 118,400 Deferred tax liabilities: Other ( 885 ) ( 674 ) Right-of-use assets ( 1,284 ) ( 1,562 ) Total deferred tax liabilities ( 2,169 ) ( 2,236 ) Valuation allowance ( 121,891 ) ( 116,164 ) Net deferred tax assets $ — $ — As of December 31, 2022, the Company had federal net operating loss carryforwards of $ 378.5 million, which may be available to offset future taxable income, of which $ 209.5 million of the total net operating loss carryforwards expire at various dates beginning in 2023 , while the remaining $ 169.0 million do not expire but are limited in their usage to an annual deduction equal to 80 % of annual taxable income. As of December 31, 2022, the Company had state net operating loss carryforwards of $ 321.2 million, which may be available to offset future taxable income and expire at various dates beginning in 2030 . As of December 31, 2022, the Company also had U.S. federal and state research and development tax credit carryforwards of $ 9.0 million and $ 5.5 million, respectively, which may be available to offset future tax liabilities and begin to expire in 2023 and 2024 , respectively. As of December 31, 2022, the Company had no foreign net operating loss carryforwards. Utilization of the U.S. federal and state net operating loss carryforwards and research and development tax credit carryforwards may be subject to a substantial annual limitation under Sections 382 and 383 of the Internal Revenue Code of 1986, and corresponding provisions of state law, due to ownership changes that have occurred previously or that could occur in the future. These ownership changes may limit the amount of carryforwards that can be utilized annually to offset future taxable income or tax liabilities. In general, an ownership change, as defined by Section 382, results from transactions increasing the ownership of certain stockholders or public groups in the stock of a corporation by more than 50% over a three-year period. The Company has not conducted a study to assess whether a change of control has occurred or whether there have been multiple changes of control since inception due to the significant complexity and cost associated with such a study. If the Company has experienced a change of control, as defined by Section 382, at any time since inception, utilization of the net operating loss carryforwards or research and development tax credit carryforwards would be subject to an annual limitation under Section 382, which is determined by first multiplying the value of the Company’s stock at the time of the ownership change by the applicable long-term tax-exempt rate, and then could be subject to additional adjustments, as required. Any limitation may result in expiration of a portion of the net operating loss carryforwards or research and development tax credit carryforwards before utilization. Further, until a study is completed by the Company and any limitation is known, no amounts are being presented as an uncertain tax position. As required by Accounting Standard Codification 740, management of the Company has evaluated the positive and negative evidence bearing upon the realizability of its deferred tax assets, which are comprised principally of net operating loss carryforwards. Management has determined that it is more likely than not that the Company will not recognize the benefits of federal and state deferred tax assets and, as a result, a valuation allowance has been recorded. The Company had no unrecognized tax benefits or related interest and penalties accrued for the years ended December 31, 2022 and 2021. The Company's policy is to record any interest or penalties related to income taxes as part of the income tax provision. The Company generated research credits for the tax years ending after December 31, 2001 but has not conducted a study to document qualified activities. This study may result in an adjustment to the Company's research and development carryforwards; however, until a study is completed and any adjustment is known, no amounts are being presented as an unrecognized tax benefit for the year ended December 31, 2022. A full valuation allowance has been provided against the Company's research and development credits and, if an adjustment is required, this adjustment would be offset by an adjustment to the deferred tax asset established for the research credit carryforward and the valuation allowance. The Company files income tax returns as prescribed by the tax laws of the jurisdictions in which it operates. In the normal course of business, the Company is subject to examination by federal and state jurisdictions, where applicable. There are currently no pending federal or state tax examinations. The Company has open tax years subject to examination from fiscal year 2019 to present. To the extent that the Company has carryforward attributes, the tax years in which the attribute was generated may still be adjusted upon examination by federal, state or local tax authorities if they either have been or will be used in the future. Changes in the valuation allowance for deferred tax assets during the year ended December 31, 2022 related primarily to the capitalization of research and development costs required under Section 174 and current year federal and net operating losses generated, partially offset by a decrease in deferred tax assets related to state net operating loss carryforwards due to a change in the state effective tax rate. Changes in the valuation allowance for deferred tax assets during the years ended December 31, 2021 and 2020 related primarily to the increase in net operating loss carryforwards in 2021 and 2020. The changes in the valuation allowance were as follows (in thousands): Year Ended December 31, 2022 2021 2020 Valuation allowance as of beginning of year $ ( 116,164 ) $ ( 101,029 ) $ ( 95,024 ) Decreases recorded as benefit to income tax provision — — — Increases recorded to income tax provision ( 5,727 ) ( 15,135 ) ( 6,005 ) Valuation allowance as of end of year $ ( 121,891 ) $ ( 116,164 ) $ ( 101,029 ) As of December 31, 2022 and 2021, the Company had no accrued interest or penalties related to uncertain tax positions and no amounts had been recognized in the Company’s consolidated statements of operations.

Leases

Leases	12 Months Ended
	Dec. 31, 2022
Leases [Abstract]
Leases	12. Leases The Company leases its office, laboratory and manufacturing space under two noncancelable leases (the “Leases”) that expire in December 2027 and include a lease incentive, fixed payment escalations, and rent holidays. The Leases include an option to renew for an additional five years . The option to extend the lease term was not included in the right-of-use asset and the lease liability as it was not reasonably certain of being exercised. The Company classified the Leases as operating leases under ASC 842. Annual base rent increases at an average rate of 2.5 % each year until the end of the term. The Company is also obligated to pay the landlord certain costs, taxes, and operating expenses, subject to certain exclusions. As these costs are generally variable in nature, they are not included in the measurement of the right-of-use asset and related lease liability. Under the Leases, the landlord contributed $ 3.4 million towards the Company’s leasehold improvements. The Company determined that it owns the leasehold improvements related to the Leases and, as such, reflected the $ 3.4 million lease incentive as a reduction of rental payments used to measure the operating lease liability, and, in turn, the operating lease right-of-use asset upon adoption of ASC 842. The components of the Company’s lease expense under ASC 842 are as follows: Year Ended December 31, 2022 2021 Operating lease cost $ 1,353 $ 1,353 Short-term lease cost 806 159 Variable lease cost 718 640 $ 2,877 $ 2,152 Supplemental disclosure of cash flow information related to the leases were as follows (in thousands): Year Ended December 31, 2022 2021 Cash paid for amounts included in the measurement of operating $ 1,948 $ 1,901 The weighted-average remaining lease term as of December 31, 2022 was 5.0 years. The weighted-average remaining lease term as of December 31, 2021 was 6.0 years. The weighted-average discount rate as of December 31, 2022 and 2021 was 6.7 %. Because the interest rate implicit in the lease was not readily determinable, the Company’s estimated incremental borrowing rate was used to calculate the present value of the Leases. In determining its incremental borrowing rate, the Company considered its credit quality and assessed interest rates available in the market for similar borrowings, adjusted for the impact of collateral over the term of the lease. Future annual lease payments under the Company’s Leases as of December 31, 2022 are as follows (in thousands): Year Ending December 31, 2023 $ 1,997 2024 2,047 2025 2,098 2026 2,150 2027 2,204 Total future minimum lease payments 10,496 Less: imputed interest ( 1,637 ) Total operating lease liabilities $ 8,859 The following table represents lease liabilities on the consolidated balance sheet (in thousands): December 31, 2022 Current operating lease liabilities $ 1,444 Operating lease liabilities, net of current portion 7,415 Total operating lease liabilities $ 8,859

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	13. Commitments and Contingencies 401(k) Savings Plan The Company has a defined-contribution savings plan under Section 401(k) of the Internal Revenue Code. This plan covers substantially all employees who meet minimum age and service requirements and allows participants to defer a portion of their annual compensation on a pre-tax basis. Company contributions to the plan may be made at the discretion of the board of directors. For the years ended December 31, 2022, 2021 and 2020, the Company did no t make any contributions to the plan. Indemnification Agreements In the ordinary course of business, the Company has agreed to defend and indemnify its customers against third-party claims asserting infringement of certain intellectual property rights, which may include patents, copyrights, trademarks or trade secrets. The Company’s exposure under these indemnification provisions is generally limited to the total amount paid by the end-customer under the agreement. However, certain agreements include indemnification provisions that could potentially expose the Company to losses in excess of the amount received under the agreement. In the ordinary course of business, the Company may provide indemnification of varying scope and terms to vendors, lessors, business partners and other parties with respect to certain matters including, but not limited to, losses arising out of breach of such agreements or from intellectual property infringement claims made by third parties. In addition, the Company has entered into indemnification agreements with members of its board of directors that will require the Company, among other things, to indemnify them against certain liabilities that may arise by reason of their status or services as directors or officers. The maximum potential amount of future payments the Company could be required to make under these indemnification agreements is, in many cases, unlimited. To date, the Company has not incurred any material costs as a result of such indemnifications. The Company is not currently aware of any indemnification claims and had not accrued any liabilities related to such obligations in its consolidated financial statements as of December 31, 2022 and 2021. Unconditional Purchase Commitment In January 2021, the Company entered into an unconditional $ 9.5 million purchase commitment, in the ordinary course of business, for goods with specified annual minimum quantities to be purchased through December 2029 . The contract is not cancellable without penalty. The remaining purchase commitment as of December 31, 2022 was $ 7.0 million. Legal Proceedings The Company is not currently party to any material legal proceedings. At each reporting date, the Company evaluates whether or not a potential loss amount or a potential range of loss is probable and reasonably estimable under the provisions of the authoritative guidance that addresses accounting for contingencies. The Company expenses as incurred the costs related to such legal proceedings.

Segment Reporting and Geographi

Segment Reporting and Geographic Data	12 Months Ended
	Dec. 31, 2022
Segment Reporting [Abstract]
Segment Reporting and Geographic Data	14. Segment Reporting and Geographic Data The Company has determined that it operates in one segment (see Note 2). See Note 15 for revenue by country. Long-lived assets by geography are summarized as follows (in thousands): December 31, 2022 2021 Long-lived assets by country (1) : United States $ 18,568 $ 9,085 All other countries 655 756 Total long-lived assets $ 19,223 $ 9,841 (1) The Company’s only long-lived assets consist of property and equipment, net of depreciation, which are categorized based on their location of domicile.

Revenue

Revenue	12 Months Ended
	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Revenue	15. Revenue The Company has determined that the payments made to the customer for reimbursement of clinical trial materials and customer’s costs incurred to execute specific clinical trial protocols related to the Company’s OCS products do not provide the Company with a distinct good or service transferred by the customer, and therefore such payments are recorded as a reduction of revenue from the customer in the Company’s consolidated statements of operations. Reductions of revenue related to such payments made to customers for reimbursements are recognized when the Company recognizes the revenue for the sale of its OCS disposable sets. The reconciliation of gross product revenue to net product revenue for these certain payments is shown below (in thousands): Year Ended December 31, 2022 2021 2020 Gross product revenue from sales to customers $ 77,854 $ 30,780 $ 27,809 Less: Clinical trial payments ( 1,380 ) 1,123 2,717 Total net product revenue $ 79,234 $ 29,657 $ 25,092 Clinical trial payments for the year ended December 31, 2022 include adjustments for certain clinical trial accrual estimates. As clinical trials reach the end of their follow up period, the Company updates its accrual estimates. The Company will continue to update its clinical trial accrual estimates as all information related to clinical trial payments is received. The Company determined that payments made to customers to obtain information related to post-approval studies or existing standard-of-care protocols (i.e., unrelated to the Company’s OCS products) meet the criteria to be classified as a cost because the Company receives a distinct good or service transferred by the customer separate from the customer’s purchase of the Company’s OCS products and the consideration paid to the customer represents the fair value of the distinct good or service received. As a result, such payments made to the customers are recorded as operating expenses. The Company recorded payments made to customers related to post-approval studies and for documentation related to existing standard-of-care protocols of $ 1.0 million, $ 2.1 million and $ 1.6 million for the years ended December 31, 2022, 2021 and 2020, respectively, as operating expenses. Disaggregated Revenue The Company disaggregates revenue from contracts with customers by organ type and geographical area as it believes this presentation best depicts how the nature, amount, timing and uncertainty of the Company’s revenue and cash flows are affected by economic factors, as shown below (in thousands): Year Ended December 31, 2022 2021 2020 Revenue by country by organ(1): United States Lung total revenue $ 7,967 $ 9,843 $ 5,392 Heart total revenue 29,902 10,103 8,599 Liver total revenue 46,169 1,915 5,248 Total United States revenue 84,038 21,861 19,239 All other countries Lung revenue 880 822 802 Heart revenue 8,451 7,579 5,598 Liver revenue 90 — — Total all other countries revenue 9,421 8,401 6,400 Total revenue $ 93,459 $ 30,262 $ 25,639 (1) Revenue by country is categorized based on the location of the end customer. Total revenue includes product and service revenue. Net revenue includes product revenue only. When a customer order includes disposable sets and organ retrieval or OCS organ management services in the United States, the Company has determined that the disposable sets and services constitute separate performance obligations and recognizes revenue as the disposable sets and services are each delivered to the customer.

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2022
Related Party Transactions [Abstract]
Related Party Transactions	16. Related Party Transactions Employment of Dr. Amira Hassanein Dr. Amira Hassanein, who serves as Product Director for the Company’s OCS Lung program, is the sister of Dr. Waleed Hassanein, the Company’s President, Chief Executive Officer and a member of the Company’s board of directors. The Company paid Dr. Amira Hassanein $ 0.4 million, $ 0.4 million and $ 0.3 million in total compensation in the years ended December 31, 2022, 2021 and 2020, respectively, for her services as an employee.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements, and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions reflected in these consolidated financial statements include, but are not limited to, revenue recognition, the valuation of inventory and the valuation of stock-based awards. The Company bases its estimates on historical experience, known trends and other market-specific or other relevant factors that it believes to be reasonable under the circumstances. On an ongoing basis, management evaluates its estimates as there are changes in circumstances, facts and experience. Changes in estimates are recorded in the period in which they become known. As of the date of issuance of these consolidated financial statements, the Company is not aware of any specific event or circumstance that would require the Company to update estimates, judgments or revise the carrying value of any assets or liabilities. Actual results may differ from those estimates or assumptions.
Risk of Concentrations of Credit, Significant Customers and Significant Suppliers	Risk of Concentrations of Credit, Significant Customers and Significant Suppliers Financial instruments that potentially expose the Company to concentrations of credit risk consist primarily of cash, cash equivalents, marketable securities and accounts receivable. The Company does not believe that it is subject to unusual credit risk beyond the normal credit risk associated with commercial banking relationships. As of December 31, 2022 and 2021, the Company had no allowance for credit losses. Significant customers are those that accounted for 10 % or more of the Company’s revenue or accounts receivable. For the year ended December 31, 2022, one customer accounted for 14 % of revenue. For the year ended December 31, 2021, one customer accounted for 11 % of revenue. For the year ended December 31, 2020, two customers accounted for 14 % and 10 % of revenue, respectively. As of December 31, 2022, no customer accounted for 10 % or more of accounts receivable. As of December 31, 2021, two customers accounted for 21 % and 15 % of accounts receivable, respectively. Certain of the components and subassemblies included in the Company’s products are obtained from a sole source, a single source or a limited group of suppliers, as are sterilization services. Although the Company seeks to reduce dependence on those limited sources of suppliers, manufacturers and service providers, the partial or complete loss of certain of these sources could have a material adverse effect on the Company’s operating results, financial condition and cash flows and damage its customer relationships.
Deferred Financing Costs	Deferred Financing Costs Deferred financing costs related to a recognized debt liability are recorded as a reduction of the carrying amount of the debt liability and amortized to interest expense using the effective interest method over the repayment term of the debt.
Cash Equivalents	Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents.
Restricted Cash	Restricted Cash As of December 31, 2022 and 2021, the Company maintained two letters of credit totaling $ 0.5 million for the benefit of the landlord of its leased property. The Company was required to maintain a separate cash balance of $ 0.5 million to secure the letters of credit. Related to this separate cash balance, the Company classified $ 0.5 million as restricted cash (non-current) on its consolidated balance sheets as of December 31, 2022 and 2021.
Accounts Receivable	Accounts Receivable Accounts receivable are presented net of an allowance for credit losses, which is an estimate of amounts that may not be collectible. The Company performs ongoing credit evaluations of its customers and monitors economic conditions to identify facts and circumstances that may indicate its receivables are at risk of collection. The Company provides reserves against accounts receivable for estimated credit losses, if any, that may result from a customer’s inability to pay based on the composition of its accounts receivable, current economic conditions and historical credit loss activity. Amounts deemed uncollectible are charged or written-off against the reserve. As of December 31, 2022 and 2021, the Company had no allowance for credit losses. During the years ended December 31, 2022, 2021 and 2020, the Company did no t record any provisions for credit losses. During the year ended December 31, 2022, the Company wrote off less than $ 0.1 million of accounts receivable balances. During the years ended December 31, 2021 and 2020, the Company did no t write off any accounts receivable balances.
Property and Equipment	Property and Equipment Property and equipment are stated at cost less accumulated depreciation and amortization. Depreciation and amortization expense is recognized using the straight-line method over the estimated useful life of each asset as follows: Estimated Useful Life Manufacturing equipment 5 years OCS Consoles 5 years Computer equipment and software 3 years Laboratory equipment 3 years Office and trade show equipment 5 years Leasehold improvements Shorter of term of lease or 15 years Costs incurred for OCS Consoles are recorded as inventory unless and until the Company determines that an OCS Console will either be used for the NOP or loaned to a customer for its use, at which time the Company reclassifies the cost of the OCS Console from inventory to property and equipment and begins to depreciate the OCS Console over its estimated useful life. Such depreciation expense is classified as a cost of revenue. The Company retains title to all OCS Consoles loaned to customers. Costs for capital assets not yet placed into service are capitalized as construction-in-progress and depreciated once placed into service. Upon retirement or sale, the cost of assets disposed of and the related accumulated depreciation and amortization are removed from the accounts and any resulting gain or loss is included in loss from operations. Expenditures for repairs and maintenance are charged to expense as incurred.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets Long-lived assets consist of property and equipment and right-of-use assets. Long-lived assets to be held and used are tested for recoverability whenever events or changes in business circumstances indicate that the carrying amount of the assets may not be fully recoverable. Factors that the Company considers in deciding when to perform an impairment review include significant underperformance of the business in relation to expectations, significant negative industry or economic trends and significant changes or planned changes in the use of the assets. If an impairment review is performed to evaluate a long-lived asset group for recoverability, the Company compares forecasts of undiscounted cash flows expected to result from the use and eventual disposition of the long-lived asset group to its carrying value. An impairment loss would be recognized in loss from operations when estimated undiscounted future cash flows expected to result from the use of an asset group are less than its carrying amount. The impairment loss would be based on the excess of the carrying value of the impaired asset group over its fair value. The Company did no t record any impairment losses on long-lived assets during the years ended December 31, 2022, 2021 and 2020.
Software Development Costs	Software Development Costs The Company incurs costs to develop computer software that is embedded in the hardware components of the Company’s OCS Console and OCS Perfusion Sets. Research and development costs related to this software are expensed as incurred, except for costs of internally developed or externally purchased software that qualify for capitalization. Software development costs incurred subsequent to the establishment of technological feasibility, but prior to the general release of the product, are capitalized and, upon general release, are amortized based upon the pattern in which economic benefits related to such assets are realized. Due to the short time period between achieving technological feasibility and product release and the insignificant amount of costs incurred during such periods, the Company did no t capitalize any software development costs during the years ended December 31, 2022, 2021 and 2020.
Inventory	Inventory Inventory is valued at the lower of cost or net realizable value. Cost is computed using the first-in, first-out method. The Company regularly reviews inventory quantities on-hand for excess and obsolete inventory and, when circumstances indicate, records charges to write down inventories to their estimated net realizable value, after evaluating historical sales, future demand, market conditions and expected product life cycles. Such charges are classified as cost of revenue in the consolidated statements of operations. Any write-down of inventory to net realizable value creates a new cost basis. At the end of each reporting period, the Company assesses whether losses should be accrued on long-term manufacturing purchase commitments in accordance with Accounting Standards Codification (“ASC”) 330, Inventory , which requires that losses that are expected to arise from firm, noncancelable and unhedged commitments for the future purchase of inventory, measured in the same way as inventory losses, should be recognized in the current period in the statements of operations unless they are deemed recoverable through firm sales contacts or when there are other circumstances that reasonably assure continuing sales without price decline. As of the end of each reporting period presented in the accompanying consolidated financial statements, the Company did not identify any potential losses arising from remaining future purchase commitments as compared to estimated future customer sales through the remainder of the term of the manufacturing purchase commitment and, as a result, did no t recognize any loss provision for future-period remaining purchase commitments for the year ended December 31, 2022.
Leases	Leases Prior to January 1, 2021, the Company accounted for leases under ASC 840, Leases (“ASC 840”). Effective January 1, 2021 , the Company adopted ASC Topic 842, Leases (“ASC 842”), using the modified retrospective approach with no restatement of prior periods or cumulative adjustment to accumulated deficit. Therefore, for the year ended December 31, 2020, the Company’s financial statements continue to be presented in accordance with ASC 840, the accounting standard originally in effect for such period. As of and for the years ended December 31, 2022 and 2021, the Company’s consolidated financial statements are presented in accordance with ASC 842. In accordance with ASC 842, the Company accounts for a contract as a lease when it has the right to control the asset for a period of time while obtaining substantially all of the asset’s economic benefits. The Company determines if an arrangement is a lease or contains an embedded lease at inception. For arrangements that meet the definition of a lease, the Company determines the initial classification and measurement of its right-of-use asset and lease liability at the lease commencement date and thereafter if modified. The lease term includes any renewal options that the Company is reasonably assured to exercise. The present value of lease payments is determined by using the interest rate implicit in the lease, if that rate is readily determinable; otherwise, the Company uses its estimated secured incremental borrowing rate for that lease term. The Company’s policy is to not record leases with an original term of twelve months or less on its consolidated balance sheets and recognizes those lease payments in the income statement on a straight-line basis over the lease term. The Company’s existing leases are for office, laboratory and manufacturing space. In addition to rent, the leases may require the Company to pay additional costs, such as utilities, maintenance and other operating costs, which are generally referred to as non-lease components. The Company has elected to not separate lease and non-lease components. Only the fixed costs for lease components and their associated non-lease components are accounted for as a single lease component and recognized as part of a right-of-use asset and lease liability. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in operating expense in the consolidated statements of operations. Revenue from leasing arrangements is not subject to the revenue standard for contracts with customers and remains separately accounted for under ASC 842. In accordance with ASC 842, lessors should classify and account for a lease with variable lease payments that do not depend on a reference index or a rate as an operating lease if the lease would have been classified as a sales-type lease or a direct financing lease and the lessor would have otherwise recognized a day-one loss. The Company’s OCS Console implied rental agreements qualify as sales-type leases with certain variable payments that meet specified criteria such that a day-one loss would be recognized under ASC 842. Therefore, in accordance with ASC 842, such leases are accounted for as operating leases and the Company does not derecognize the leased asset (the OCS Console) at the time of the sale but depreciates the leased asset over the useful life of the asset.
Fair Value Measurements	Fair Value Measurements Certain assets and liabilities are carried at fair value under GAAP. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs. Financial assets and liabilities carried at fair value are to be classified and disclosed in one of the following three levels of the fair value hierarchy, of which the first two are considered observable and the last is considered unobservable: • Level 1—Quoted prices in active markets for identical assets or liabilities. • Level 2—Observable inputs (other than Level 1 quoted prices), such as quoted prices in active markets for similar assets or liabilities, quoted prices in markets that are not active for identical or similar assets or liabilities, or other inputs that are observable or can be corroborated by observable market data. • Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to determining the fair value of the assets or liabilities, including pricing models, discounted cash flow methodologies and similar techniques. The Company’s cash equivalents and marketable securities are carried at fair value, determined according to the fair value hierarchy described above (see Note 4). The carrying values of the Company’s accounts receivable, accounts payable and accrued expenses approximate their fair values due to the short-term nature of these assets and liabilities. The carrying value of the Company’s long-term debt approximates its fair value (a level 2 measurement) at each balance sheet date due to its variable interest rate, which approximates a market interest rate.
Marketable Securities	Marketable Securities The Company’s marketable securities (non-equity instruments) are classified as available-for-sale and are carried at fair value, with the unrealized gains and losses reported as a component of accumulated other comprehensive income (loss) in stockholders’ equity. Realized gains and losses are based on the specific identification method and are included as a component of other income (expense), net in the consolidated statements of operations. When the fair value is below the amortized cost of a marketable security, an estimate of expected credit losses is made. The credit-related impairment amount is recognized in the consolidated statements of operations. Credit losses are recognized through the use of an allowance for credit losses account in the consolidated balance sheet and subsequent improvements in expected credit losses are recognized as a reversal of an amount in the allowance account. If the Company has the intent to sell the security or it is more likely than not that the Company will be required to sell the security prior to recovery of its amortized cost basis, then the allowance for the credit loss is written-off and the excess of the amortized cost basis of the asset over its fair value is recorded in the consolidated statements of operations. There were no credit losses recorded during the years ended December 31, 2022, 2021 and 2020.
Segment Information	Segment Information The Company manages its operations as a single segment for the purposes of assessing performance and making operating decisions. The Company has developed and is commercializing a proprietary system to preserve human organs for transplant in a near-physiologic condition to address the limitations of cold storage organ preservation. Operating segments are defined as components of an enterprise for which separate financial information is regularly evaluated by the Company’s chief operating decision maker, or decision-making group, in deciding how to allocate resources and assess performance. The Company has determined that its chief operating decision maker is its Chief Executive Officer. The Company’s chief operating decision maker reviews the Company’s financial information on a consolidated basis for purposes of allocating resources and assessing financial performance.
Product Warranties	Product Warranties The Company provides a one-year warranty on its OCS Consoles and disposable sets and replaces or repairs any OCS Console or disposable set that does not function in accordance with the product specifications . OCS Consoles returned to the Company may be refurbished and redeployed. Estimated warranty costs are recorded at the time of shipment of the OCS Console or disposable set. Warranty costs are estimated based on the current expected product replacement or repair cost and expected replacement or repair rates based on historical experience. The Company evaluates its warranty accrual at the end of each reporting period and makes adjustments as necessary. As of December 31, 2022 and 2021, the warranty accrual was less than $ 0.1 million.
Revenue Recognition	Revenue Recognition The Company generates net product revenue primarily from sales of its single-use, organ-specific disposable sets used on its organ-specific OCS Consoles. To a lesser extent, the Company also generates product revenue from the sale of OCS Consoles to customers and the implied rental of OCS Consoles loaned to customers at no charge. For each new transplant procedure, customers purchase an additional OCS disposable set for use on the customer’s existing organ-specific OCS Console. The Company also generates service revenue by providing outsourced organ retrieval and OCS organ management services under its National OCS Program in the United States. The Company recognizes revenue from sales to customers applying the following five steps: (1) identification of the contract, or contracts, with a customer, (2) identification of the performance obligations in the contract, (3) determination of the transaction price, (4) allocation of the transaction price to the performance obligations in the contract, and (5) recognition of revenue when, or as, performance obligations are satisfied. Substantially all of the Company’s customer contracts have multiple-performance obligations that contain deliverables consisting of OCS Perfusion Sets and OCS Solutions. Customer contract deliverables may also include organ retrieval and OCS organ management services under the Company's National OCS Program or an OCS Console, whether sold or loaned to the customer. The Company evaluates each promise within a multiple-performance obligation arrangement to determine whether it represents a distinct performance obligation. The primary performance obligations in the Company’s customer arrangements from which it derives revenue are the OCS Perfusion Sets, the OCS Solutions, the OCS Console, organ retrieval services and OCS organ management services. When a customer order includes an OCS Console, the Company has determined that customer training and the equipment set-up of the OCS Console, each performed by the Company, are not distinct because they are not sold on a standalone basis and can only be performed by the Company in conjunction with a sale or loan of its OCS Console. In addition, the Company has determined that the OCS Console itself is not distinct because the customer cannot benefit from the OCS Console without the training and equipment set-up having been completed. As a result, when the order includes an OCS Console, the Company has concluded that training, OCS Console equipment set-up, and the OCS Console itself are highly interdependent and represent a single, combined performance obligation. The Company recognizes revenue from the single, combined performance obligation only once the OCS Console has arrived at the customer site and the training and equipment set-up have been completed by the Company. Customer orders may include the loan of an OCS Console as well as OCS disposable sets used in each transplant procedure. When the Company loans the OCS Console to the customer, it retains title to the console at all times and does not require minimum purchase commitments from the customer related to any OCS products. In such cases, the Company invoices the customer for OCS disposable sets based on customer orders received for each new transplant procedure and the prices set forth in the customer agreement. Over time, the Company typically recovers the cost of the loaned OCS Console through the customer’s continued purchasing and use of additional OCS disposable sets. For these reasons, the Company has determined that part of the arrangement consideration for the disposable set is an implied rental payment for use of the OCS Console. Therefore, the Company allocates the arrangement consideration between the lease deliverables (i.e., the OCS Console) and non-lease deliverables (i.e., the OCS disposable sets) based on the relative estimated standalone selling price of each distinct performance obligation. To date, the amounts allocated to lease deliverables have been insignificant. Revenue from sales to customers of OCS Perfusion Sets, OCS Solutions and OCS Consoles is classified as net product revenue in the Company's consolidated statements of operations. Revenue from sales to customers of organ retrieval and OCS organ management services is classified as service revenue in the Company’s consolidated statements of operations. Revenue is recognized when control is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled to in exchange for the product or services. When a customer order includes disposable sets and organ retrieval or OCS organ management services, the Company has determined that the disposable sets and services constitute separate performance obligations and recognizes revenue as the disposable sets and services are each delivered to the customer. Payments Made to Customers Under some of the Company’s customer clinical trial agreements, the Company makes payments to its customers for reimbursements of clinical trial materials and for specified clinical documentation related to the customer’s use of its OCS products. The Company also makes payments to customers involved in post-approval studies for information related to the transplant procedures performed. The Company determines the appropriate accounting treatments for these payments depending on the nature of the payment and whether they are for distinct goods or services. Contract Assets and Liabilities The Company recognizes a receivable at the point in time at which it has an unconditional right to payment. Such receivables are not contract assets. Contract assets arise from unbilled amounts in customer arrangements when revenue recognized exceeds the amount billed to the customer and the Company’s right to payment is not just subject to the passage of time. The Company had no contract assets as of December 31, 2022 and 2021. Contract liabilities represent the Company’s obligation to transfer goods or services to a customer for which it has received consideration (or the amount is due) from the customer. The Company has determined that its only contract liabilities are deferred revenue, which consists of amounts that have been invoiced but that have not been recognized as revenue. Remaining Performance Obligations The Company generally satisfies performance obligations within one year of the contract inception date, which amounts are included in deferred revenue and are not material. Other Revenue Considerations Revenue is reported net of taxes. The Company does not consider shipping to be a contract performance obligation, therefore shipping costs incurred and billed to customers are recorded as revenue and cost of revenue. The Company only includes estimated variable amounts in the transaction price to the extent it is probable that a significant reversal of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is resolved. The Company does not assess whether promised goods or services are performance obligations if they are deemed immaterial in the context of the contract with the customer. Additionally, the Company does not assess whether a contract has a significant financing component if the expectation at contract inception is that the period between payment by the customer and the transfer of the promised goods or services to the customer will be one year or less. Distributors The Company markets and sells its products primarily through its direct sales force, which sells its products to end customers globally. A small portion of the Company’s revenue is generated by sales to a limited number of distributors in Europe and Asia-Pacific. When the Company transacts with a distributor, its contractual arrangement is with the distributor and not with the end customer. Whether the Company transacts business with and receives the order from a distributor or directly from an end customer, its revenue recognition policy and resulting pattern of revenue recognition for the order are the same.
Research, Development and Clinical Trials Costs	Research, Development and Clinical Trials Costs Research, development and clinical trials expenses consist of costs incurred for research activities, product development, hardware and software engineering and clinical trial activities, including salaries and bonuses, stock-based compensation, employee benefits, facilities costs, laboratory supplies, depreciation, testing, regulatory, data management and consulting costs. Research, development and clinical trials costs are expensed as incurred. Advance payments for goods or services to be received in the future for use in research, development and clinical trials activities are recorded as prepaid expenses. Such prepaid expenses are recognized as an expense when the related goods have been delivered or the related services have been performed, or when it is no longer expected that the goods will be delivered or the services rendered.
Patent Costs	Patent Costs All patent-related costs incurred in connection with filing and prosecuting patent applications are expensed as incurred due to the uncertainty about the recovery of the expenditure. Amounts incurred are classified as general and administrative expenses.
Foreign Currency Translation	Foreign Currency Translation The functional currency of each of the Company’s foreign subsidiaries is the currency of the local country. Assets and liabilities of the Company’s foreign subsidiaries are translated into U.S. dollars using the period-end exchange rates, and income and expense items are translated into U.S. dollars using average exchange rates in effect during each period. The effects of these foreign currency translation adjustments are included in accumulated other comprehensive loss, a separate component of stockholders’ equity. The Company also incurs transaction gains and losses resulting from intercompany transactions as well as transactions with customers or vendors denominated in currencies other than the functional currency of the legal entity in which the transaction is recorded. Realized and unrealized foreign currency transaction gains (losses) are included in the consolidated statements of operations as a component of other income (expense) and totaled ($ 1.3 million), ($ 1.0 million) and $ 1.0 million for the years ended December 31, 2022, 2021 and 2020, respectively.
Stock-based Compensation	Stock-Based Compensation The Company accounts for stock-based awards granted to employees, non-employees and directors based on the fair value of the award on the date of grant. The fair value of option awards is measured using the Black-Scholes option-pricing model. The fair value of restricted common stock awards is measured based on the difference between market value of the Company’s common stock on date of grant and the purchase price (if any). Generally, the Company issues awards with only service-based vesting conditions. Compensation expense for those awards is recognized over the vesting period of the respective award using the straight-line method. The Company accounts for forfeitures as they occur and records compensation cost assuming all option holders will complete the requisite service period. When the unvested portion of an award is forfeited, the Company reverses compensation expense previously recognized in the period of the forfeiture. The Company classifies stock-based compensation expense in its consolidated statements of operations in the same manner in which the award recipient’s payroll costs are classified or in which the award recipient’s service payments are classified.
Comprehensive Loss and Accumulated Other Comprehensive Loss	Comprehensive Loss and Accumulated Other Comprehensive Loss Comprehensive loss includes net loss as well as other changes in stockholders’ equity that result from transactions and economic events other than those with stockholders. The Company’s only elements of other comprehensive loss are foreign currency translation adjustments and unrealized gains (losses) on marketable securities. Accumulated other comprehensive gains (losses) on the consolidated balance sheets consists primarily of foreign currency translation adjustments. Accumulated other comprehensive loss attributable to unrealized gains (losses) on marketable securities has not been significant.
Net Income (Loss) per Share	Net Income (Loss) per Share Basic net income (loss) per common share is computed by dividing the net income (loss) by the weighted average number of shares of common stock outstanding for the period. Diluted net income (loss) per common share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding for the period, including potential dilutive common shares assuming the dilutive effect of outstanding stock awards. For periods in which the Company reports a net loss, diluted net loss per common share is the same as basic net loss per common share, since dilutive common shares are not assumed to have been issued if their effect is anti-dilutive. The Company reported a net loss attributable to common stockholders for each of the years ended December 31, 2022, 2021 and 2020. The Company’s potential dilutive securities have been excluded from the computation of diluted net loss per share as the effect would be to reduce the net loss per share. The Company excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to common stockholders for the periods indicated above because including them would have had an anti-dilutive effect: As of December 31, 2022 2021 Warrants to purchase common stock 14,440 64,440 Options to purchase common stock 3,288,791 2,797,550 Employee stock purchase plan 14,135 12,465 Restricted stock awards 24,315 — 3,341,681 2,874,455
Income Taxes	Income Taxes The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the financial statements or in the Company's tax returns. Deferred taxes are determined based on the difference between the financial statement and tax basis of assets and liabilities using enacted tax rates in effect in the years in which the differences are expected to reverse. Changes in deferred tax assets and liabilities are recorded in the provision for income taxes. The Company assesses the likelihood that its deferred tax assets will be realized and, to the extent it believes, based upon the weight of available evidence, that it is more likely than not that all or a portion of the deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by analyzing carryback capacity in periods with taxable income, reversal of existing taxable temporary differences and estimating the future taxable profits expected and considering prudent and feasible tax planning strategies. The Company accounts for uncertainty in income taxes recognized in the financial statements by applying a two-step process to determine the amount of tax benefit to be recognized. First, the tax position must be evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more-likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize in the financial statements. The amount of benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. The provision for income taxes includes the effects of any resulting tax reserves, or unrecognized tax benefits, that are considered appropriate as well as the related net interest and penalties.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Schedule of Estimated Useful Life of Assets	Property and equipment are stated at cost less accumulated depreciation and amortization. Depreciation and amortization expense is recognized using the straight-line method over the estimated useful life of each asset as follows: Estimated Useful Life Manufacturing equipment 5 years OCS Consoles 5 years Computer equipment and software 3 years Laboratory equipment 3 years Office and trade show equipment 5 years Leasehold improvements Shorter of term of lease or 15 years
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The Company excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to common stockholders for the periods indicated above because including them would have had an anti-dilutive effect: As of December 31, 2022 2021 Warrants to purchase common stock 14,440 64,440 Options to purchase common stock 3,288,791 2,797,550 Employee stock purchase plan 14,135 12,465 Restricted stock awards 24,315 — 3,341,681 2,874,455

Marketable Securities (Tables)

Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Components of Marketable Securities by Security Type	Marketable securities by security type as of December 31, 2021 consisted of the following (in thousands): December 31, 2021 Amortized Gross Gross Credit Losses Fair Value U.S. Treasury securities (due within one year) $ 63,907 $ — $ ( 33 ) $ — $ 63,874 U.S. government agency bonds (due within 3,001 — ( 3 ) — 2,998 $ 66,908 $ — $ ( 36 ) $ — $ 66,872

Fair Value of Financial Asset_2

Fair Value of Financial Assets and Liabilities (Tables)	12 Months Ended
	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis	The following table presents the Company’s fair value hierarchy for its assets that were measured at fair value on a recurring basis as of December 31, 2021 (in thousands): Fair Value Measurements at December 31, 2021 Using: Level 1 Level 2 Level 3 Total Assets: Cash equivalents: Money market funds $ 11,169 $ — $ — $ 11,169 Marketable securities: U.S. Treasury securities — 63,874 — 63,874 U.S. government agency bonds — 2,998 — 2,998 $ 11,169 $ 66,872 $ — $ 78,041

Inventory (Tables)

Inventory (Tables)	12 Months Ended
	Dec. 31, 2022
Inventory Disclosure [Abstract]
Schedule of Inventory, Current	Inventory consisted of the following (in thousands): December 31, 2022 2021 Raw materials $ 10,939 $ 7,274 Work-in-process 1,876 1,932 Finished goods 7,790 5,653 $ 20,605 $ 14,859

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	12 Months Ended
	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net consisted of the following (in thousands): December 31, 2022 2021 Manufacturing equipment $ 3,721 $ 1,769 OCS Consoles 10,878 8,865 Computer equipment and software 2,064 1,511 Laboratory equipment 671 668 Office and trade show equipment 2,121 177 Leasehold improvements 12,415 1,319 Construction-in-progress 482 5,267 32,352 19,576 Less: Accumulated depreciation and amortization ( 13,129 ) ( 9,735 ) $ 19,223 $ 9,841

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	12 Months Ended
	Dec. 31, 2022
Accrued Expenses And Other Current Liabilities [Abstract]
Schedule of Accrued Expenses and Other Current Liabilities	Accrued expenses and other current liabilities consisted of the following (in thousands): December 31, 2022 2021 Accrued payroll and related expenses $ 9,812 $ 5,173 Accrued logistics costs 2,581 — Accrued professional fees 965 1,973 Accrued research, development and clinical trial expenses 1,876 4,567 Accrued other 3,401 4,624 $ 18,635 $ 16,337

Long-term Debt (Tables)

Long-term Debt (Tables)	12 Months Ended
	Dec. 31, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt consisted of the following (in thousands): December 31, 2022 2021 Principal amount of long-term debt $ 60,000 $ 35,000 Less: Current portion of long-term debt — — Long-term debt, net of current portion 60,000 35,000 Debt discount, net of accretion ( 1,304 ) ( 511 ) Accrued end-of-term payments — 708 Long-term debt, net of discount and current portion $ 58,696 $ 35,197

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2022
Stockholders' Equity Note [Abstract]
Assumptions Used to Determine Grant Date Fair Value of Stock Options Granted	The following table presents, on a weighted average basis, the assumptions used in the Black-Scholes option-pricing model to determine the grant-date fair value of stock options granted to employees and directors: Year Ended December 31, 2022 2021 2020 Risk-free interest rate 2.33 % 0.90 % 0.91 % Expected term (in years) 6.03 6.03 5.97 Expected volatility 59 % 58 % 54 % Expected dividend yield 0 % 0 % 0 %
Summary of Stock Option Activity	The following table summarizes the Company’s option activity since December 31, 2021: Number Weighted Weighted Aggregate (in years) (in thousands) Outstanding as of December 31, 2021 2,797,550 $ 20.64 7.54 $ 14,625 Granted 1,195,910 19.48 Exercised ( 507,795 ) 9.19 Forfeited ( 186,586 ) 27.45 Expired ( 10,288 ) 31.89 Outstanding as of December 31, 2022 3,288,791 $ 21.56 7.86 $ 132,076 Vested and expected to vest as of December 31, 2022 3,288,791 $ 21.56 7.86 $ 132,076 Options exercisable as of December 31, 2022 1,603,499 $ 17.86 6.92 $ 70,331
Summary of Restricted Common Stock Activity	The following table summarizes the Company's restricted common stock activity since December 31, 2021: Shares Weighted Average Grant Date Fair Value Unvested restricted common stock as of December 31, 2021 — $ — Issued 26,093 28.74 Vested — — Forfeited ( 1,778 ) 28.12 Unvested restricted common stock as of December 31, 2022 24,315 $ 28.79
Schedule of Stock-Based Compensation Expense	The Company recorded stock-based compensation expense in the following expense categories of its consolidated statements of operations (in thousands): Year Ended December 31, 2022 2021 2020 Cost of revenue $ 125 $ 72 $ 27 Research, development and clinical trials expenses 1,465 1,114 396 Selling, general and administrative expenses 8,731 5,692 1,991 $ 10,321 $ 6,878 $ 2,414

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Schedule of Loss Before Income Taxes	Loss Before Income Taxes The domestic and foreign components of loss before income taxes were as follows (in thousands): Year Ended December 31, 2022 2021 2020 United States $ ( 36,416 ) $ ( 44,321 ) $ ( 28,803 ) Foreign 251 142 87 $ ( 36,165 ) $ ( 44,179 ) $ ( 28,716 )
Reconciliation of U.S. Federal Statutory Income Tax Rate to Company's Effective Income Tax Rate	A reconciliation of the U.S. federal statutory income tax rate to the Company’s effective income tax rate is as follows: Year Ended December 31, 2022 2021 2020 Federal statutory income tax rate ( 21.0 )% ( 21.0 )% ( 21.0 )% State taxes, net of federal benefit ( 5.4 )% ( 6.9 )% ( 5.7 )% Federal and state research and development tax ( 5.4 )% ( 2.4 )% ( 3.6 )% Nondeductible items ( 2.8 )% ( 3.2 )% ( 0.2 )% Deferred tax effect of change in state blended rate 16.2 % ( 1.7 )% 7.8 % Return to provision 2.6 % 1.1 % 1.7 % Other 0.1 % ( 0.2 )% 0.0 % Change in deferred tax asset valuation allowance 15.8 % 34.3 % 20.9 % Effective income tax rate 0.1 % 0.0 % ( 0.1 )%
Schedule of Net deferred Tax Assets	Net deferred tax assets consisted of the following (in thousands): December 31, 2022 2021 Deferred tax assets: Net operating loss carryforwards $ 92,445 $ 94,672 Capitalized research and development expense 8,109 4,291 Research and development tax credit carryforwards 13,565 12,186 Accrued expenses 2,994 2,528 Stock-based compensation expense 3,492 2,254 Lease liability 2,218 2,299 Section 163(j) interest 754 — Other 483 170 Total deferred tax assets 124,060 118,400 Deferred tax liabilities: Other ( 885 ) ( 674 ) Right-of-use assets ( 1,284 ) ( 1,562 ) Total deferred tax liabilities ( 2,169 ) ( 2,236 ) Valuation allowance ( 121,891 ) ( 116,164 ) Net deferred tax assets $ — $ —
Summary Changes in the Valuation Allowance for Deferred Tax Assets	Changes in the valuation allowance for deferred tax assets during the year ended December 31, 2022 related primarily to the capitalization of research and development costs required under Section 174 and current year federal and net operating losses generated, partially offset by a decrease in deferred tax assets related to state net operating loss carryforwards due to a change in the state effective tax rate. Changes in the valuation allowance for deferred tax assets during the years ended December 31, 2021 and 2020 related primarily to the increase in net operating loss carryforwards in 2021 and 2020. The changes in the valuation allowance were as follows (in thousands): Year Ended December 31, 2022 2021 2020 Valuation allowance as of beginning of year $ ( 116,164 ) $ ( 101,029 ) $ ( 95,024 ) Decreases recorded as benefit to income tax provision — — — Increases recorded to income tax provision ( 5,727 ) ( 15,135 ) ( 6,005 ) Valuation allowance as of end of year $ ( 121,891 ) $ ( 116,164 ) $ ( 101,029 )

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2022
Leases [Abstract]
Summary of Components of Lease Expense	The components of the Company’s lease expense under ASC 842 are as follows: Year Ended December 31, 2022 2021 Operating lease cost $ 1,353 $ 1,353 Short-term lease cost 806 159 Variable lease cost 718 640 $ 2,877 $ 2,152
Summary of Supplemental Disclosure of Cash Flow Information Related to Leases	Supplemental disclosure of cash flow information related to the leases were as follows (in thousands): Year Ended December 31, 2022 2021 Cash paid for amounts included in the measurement of operating $ 1,948 $ 1,901
Summary of Future Annual Lease Payments	Future annual lease payments under the Company’s Leases as of December 31, 2022 are as follows (in thousands): Year Ending December 31, 2023 $ 1,997 2024 2,047 2025 2,098 2026 2,150 2027 2,204 Total future minimum lease payments 10,496 Less: imputed interest ( 1,637 ) Total operating lease liabilities $ 8,859
Summary of Lease Liabilities on Consolidated Balance Sheet	The following table represents lease liabilities on the consolidated balance sheet (in thousands): December 31, 2022 Current operating lease liabilities $ 1,444 Operating lease liabilities, net of current portion 7,415 Total operating lease liabilities $ 8,859

Segment Reporting and Geograp_2

Segment Reporting and Geographic Data (Tables)	12 Months Ended
	Dec. 31, 2022
Segment Reporting [Abstract]
Long-lived assets by geographical area	See Note 15 for revenue by country. Long-lived assets by geography are summarized as follows (in thousands): December 31, 2022 2021 Long-lived assets by country (1) : United States $ 18,568 $ 9,085 All other countries 655 756 Total long-lived assets $ 19,223 $ 9,841 (1) The Company’s only long-lived assets consist of property and equipment, net of depreciation, which are categorized based on their location of domicile.

Revenue (Tables)

Revenue (Tables)	12 Months Ended
	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Recognized Revenue Net of Payments	The reconciliation of gross product revenue to net product revenue for these certain payments is shown below (in thousands): Year Ended December 31, 2022 2021 2020 Gross product revenue from sales to customers $ 77,854 $ 30,780 $ 27,809 Less: Clinical trial payments ( 1,380 ) 1,123 2,717 Total net product revenue $ 79,234 $ 29,657 $ 25,092 Clinical trial payments for the year ended December 31, 2022 include adjustments for certain clinical trial accrual estimates. As clinical trials reach the end of their follow up period, the Company updates its accrual estimates. The Company will continue to update its clinical trial accrual estimates as all information related to clinical trial payments is received.
Schedule of Net Revenue by Organ and Country	The Company disaggregates revenue from contracts with customers by organ type and geographical area as it believes this presentation best depicts how the nature, amount, timing and uncertainty of the Company’s revenue and cash flows are affected by economic factors, as shown below (in thousands): Year Ended December 31, 2022 2021 2020 Revenue by country by organ(1): United States Lung total revenue $ 7,967 $ 9,843 $ 5,392 Heart total revenue 29,902 10,103 8,599 Liver total revenue 46,169 1,915 5,248 Total United States revenue 84,038 21,861 19,239 All other countries Lung revenue 880 822 802 Heart revenue 8,451 7,579 5,598 Liver revenue 90 — — Total all other countries revenue 9,421 8,401 6,400 Total revenue $ 93,459 $ 30,262 $ 25,639 (1) Revenue by country is categorized based on the location of the end customer. Total revenue includes product and service revenue. Net revenue includes product revenue only.

Nature of the Business and Ba_2

Nature of the Business and Basis of Presentation - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Net loss	$ 36,231	$ 44,215	$ 28,748
Accumulated deficit	478,677	442,446
Cash	$ 201,182	$ 25,580	$ 24,581

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2022 USD ($) Letter Segment	Dec. 31, 2021 USD ($) Letter	Dec. 31, 2020 USD ($)	Dec. 31, 2020 USD ($)	Jan. 01, 2021
Letters of credit outstanding	$ 500,000	$ 500,000
Number of letters of credit maintained | Letter	2	2
Restricted cash non-current	$ 500,000	$ 500,000
Allowance for credit losses	0	0
Provisions for credit losses	0	0		$ 0
Write off accounts receivable balances		0	$ 0
Impairment losses on long-lived assets	0	0	0
Capitalized software development costs	0	0	0	$ 0
Provision for loss on contracts	0
Credit losses	$ 0	0	0
Number of operating segments | Segment	1
Term of product warranties	1 year
Product warranty description	The Company provides a one-year warranty on its OCS Consoles and disposable sets and replaces or repairs any OCS Console or disposable set that does not function in accordance with the product specifications
Contract with customer, asset, after allowance for credit loss	$ 0	0
ASU No. 2016-02
Change in accounting principle, accounting standards update, adopted					true
Change in accounting principle, accounting standards update, immaterial effect					true
Change in accounting principle, accounting standards update, adoption date					Jan. 01, 2021
Other Income (Expense) [Member]
Foreign currency transaction gains (losses)	(1,300,000)	(1,000,000)	$ 1,000,000
Maximum [Member]
Write off accounts receivable balances	100,000
Product warranty accrual	$ 100,000	$ 100,000
Performance obligations satisfaction period	1 year
Customer Concentration Risk [Member] | Revenue [Member] | Significant Customer Benchmark [Member] | Minimum [Member]
Concentration risk percentage	10%
Customer Concentration Risk [Member] | Revenue [Member] | Customer One [Member]
Concentration risk percentage	14%	11%	14%
Customer Concentration Risk [Member] | Revenue [Member] | Customer Two [Member]
Concentration risk percentage			10%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Significant Customer Benchmark [Member] | Minimum [Member]
Concentration risk percentage	10%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer One [Member]
Concentration risk percentage		21%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Two [Member]
Concentration risk percentage		15%

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Schedule of Estimated Useful Life of Assets (Detail)	12 Months Ended
	Dec. 31, 2022
Manufacturing Equipment [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	5 years
OCS Consoles [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	5 years
Computer Equipment and Software [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	3 years
Laboratory Equipment [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	3 years
Office and Trade Show Equipment [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	5 years
Leasehold Improvements [Member]
Property Plant And Equipment [Line Items]
Estimated Useful Life	Shorter of term of lease or 15 years

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Summary of Potentially Dilutive Securities Excluded from Calculation of Diluted Net Loss Per Share (Detail) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Warrants to purchase common stock	3,341,681	2,874,455
Warrants to purchase common stock [Member]
Warrants to purchase common stock	14,440	64,440
Options to purchase common stock [Member]
Warrants to purchase common stock	3,288,791	2,797,550
Employee stock purchase plan [Member]
Warrants to purchase common stock	14,135	12,465
Restricted stock awards [Member]
Warrants to purchase common stock	24,315

Marketable Securities - Additio

Marketable Securities - Additional Information (Detail)	Dec. 31, 2022 USD ($)
Investments, Debt and Equity Securities [Abstract]
Marketable Securities	$ 0

Marketable Securities - Compone

Marketable Securities - Components of Marketable Securities by Security Type (Detail) $ in Thousands	Dec. 31, 2021 USD ($)
Schedule Of Available For Sale Securities [Line Items]
Marketable Securities, Amortized Cost	$ 66,908
Marketable Securities, Gross Unrealized Losses	(36)
Marketable Securities, Fair Value	66,872
U.S. Treasury Securities (due within one year) [Member]
Schedule Of Available For Sale Securities [Line Items]
Marketable Securities, Amortized Cost	63,907
Marketable Securities, Gross Unrealized Losses	(33)
Marketable Securities, Fair Value	63,874
U.S. Government Agency Bonds (due within one year) [Member]
Schedule Of Available For Sale Securities [Line Items]
Marketable Securities, Amortized Cost	3,001
Marketable Securities, Gross Unrealized Losses	(3)
Marketable Securities, Fair Value	$ 2,998

Fair Value of Financial Asset_3

Fair Value of Financial Assets - Additional Information (Detail) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets measured at fair value	$ 0	$ 78,041,000

Fair Value of Financial Asset_4

Fair Value of Financial Assets - Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis (Detail) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Marketable securities:
Marketable securities		$ 66,872,000
U.S. Treasury Securities [Member]
Marketable securities:
Marketable securities		63,874,000
U.S. Government Agency Bonds [Member]
Marketable securities:
Marketable securities		2,998,000
Fair Value, Recurring [Member]
Cash equivalents:
Cash equivalents and marketable securities	$ 0	78,041,000
Fair Value, Recurring [Member] | U.S. Treasury Securities [Member]
Marketable securities:
Marketable securities		63,874,000
Fair Value, Recurring [Member] | U.S. Government Agency Bonds [Member]
Marketable securities:
Marketable securities		2,998,000
Fair Value, Recurring [Member] | Money Market Funds [Member]
Cash equivalents:
Cash equivalents		11,169,000
Fair Value, Recurring [Member] | Level 1 [Member]
Cash equivalents:
Cash equivalents and marketable securities		11,169,000
Fair Value, Recurring [Member] | Level 1 [Member] | Money Market Funds [Member]
Cash equivalents:
Cash equivalents		11,169,000
Fair Value, Recurring [Member] | Level 2 [Member]
Cash equivalents:
Cash equivalents and marketable securities		66,872,000
Fair Value, Recurring [Member] | Level 2 [Member] | U.S. Treasury Securities [Member]
Marketable securities:
Marketable securities		63,874,000
Fair Value, Recurring [Member] | Level 2 [Member] | U.S. Government Agency Bonds [Member]
Marketable securities:
Marketable securities		$ 2,998,000

Inventory - Schedule of Invento

Inventory - Schedule of Inventory, Current (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 10,939	$ 7,274
Work-in-process	1,876	1,932
Finished goods	7,790	5,653
Inventory, net	$ 20,605	$ 14,859

Property and Equipment, Net - S

Property and Equipment, Net - Schedule of Property and Equipment, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 32,352	$ 19,576
Less: Accumulated depreciation and amortization	(13,129)	(9,735)
Property and equipment, net	19,223	9,841
Manufacturing Equipment [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	3,721	1,769
OCS Consoles [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	10,878	8,865
Computer Equipment and Software [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	2,064	1,511
Laboratory Equipment [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	671	668
Office and Trade Show Equipment [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	2,121	177
Leasehold Improvements [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	12,415	1,319
Construction-In-Progress [Member]
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 482	$ 5,267

Property and Equipment, Net - A

Property and Equipment, Net - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Property Plant And Equipment [Line Items]
Depreciation and amortization expense	$ 3,478	$ 1,817	$ 1,577
OCS Consoles [Member] | Cost of Revenue [Member]
Property Plant And Equipment [Line Items]
Depreciation	$ 1,700	$ 1,400	$ 1,300

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities - Schedule of Accrued Expenses and Other Current Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accrued Expenses And Other Current Liabilities [Abstract]
Accrued payroll and related expenses	$ 9,812	$ 5,173
Accrued logistics costs	2,581
Accrued professional fees	965	1,973
Accrued research, development and clinical trial expenses	1,876	4,567
Accrued other	3,401	4,624
Accrued expenses and other liabilities current	$ 18,635	$ 16,337

Long-term Debt - Schedule of Lo

Long-term Debt - Schedule of Long-term Debt Instruments (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
Principal amount of long-term debt	$ 60,000	$ 35,000
Long-term debt, net of current portion	60,000	35,000
Debt discount, net of accretion	(1,304)	(511)
Accrued end-of-term payments		708
Long-term debt, net of discount and current portion	$ 58,696	$ 35,197

Long-term Debt - Additional Inf

Long-term Debt - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Jul. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jun. 29, 2018
Debt Instrument [Line Items]
Long-term Debt, Gross		$ 60,000	$ 35,000
Repayments of long-term debt		36,050
Loss on extinguishment of debt		$ 575
Orbi Med [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross					$ 35,000
Description of variable rate basis		London Interbank Offered Rate (“LIBOR”), subject to a minimum of 1.0% and a maximum of 4.0%
Basis spread on variable rate		8.50%
Final payment		3%
Repayments of long-term debt	$ 35,000
Debt instrument, end of term payment accrued interest	1,100
Loss on extinguishment of debt	600
Orbi Med [Member] | Credit Agreement [Member]
Debt Instrument [Line Items]
Debt instrument, maturity month and year		2022-07
Orbi Med [Member] | Minimum [Member]
Debt Instrument [Line Items]
Paid in kind interest threshold		11.50%
Orbi Med [Member] | Maximum [Member]
Debt Instrument [Line Items]
Interest rate effective percentage		11.50%
Paid in kind interest threshold		12.50%
Orbi Med [Member] | London Interbank Offered Rate (LIBOR) | Minimum [Member]
Debt Instrument [Line Items]
LIBOR rate		1%
Orbi Med [Member] | London Interbank Offered Rate (LIBOR) | Maximum [Member]
Debt Instrument [Line Items]
LIBOR rate		4%
Canadian Imperial Bank of Commerce [Member]
Debt Instrument [Line Items]
Interest rate effective percentage		6.10%
Average effective interest rate		6.60%	11.20%	11.20%
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | Term Loan [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 60,000
Debt instrument, maturity month and year	2027-07
Debt Instrument, Frequency of Periodic Payment	monthly
Interest Only Payment Period	24 months
Interest Only Payment Additional Extension Period	1 year
Debt Instrument, Payment Terms	Borrowings under the CIBC Credit Agreement are payable in monthly interest-only payments for the first 24 months, and then payable in equal monthly principal payments plus accrued interest until the maturity date of the CIBC Credit Agreement in July 2027. If certain revenue milestones are met after the first 24 months, the Company may extend the interest-only repayment period by one additional year.
Description of covenants		The financial covenants include, among other covenants, (x) a requirement to maintain a minimum liquidity amount of the greater of either (i) the consolidated adjusted EBITDA loss (or gain) for the trailing four month period (only if EBITDA is negative) and (ii) $10.0 million, and (y) a requirement to maintain total net revenue of at least 75% of the level set forth in the total revenue plan presented to CIBC.
Minimum liquidity covenant amount		$ 10,000
Minimum percentage to maintain total net revenue set forth in total revenue plan presented		75%
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | Term Loan [Member] | In Event Of Default [Member]
Debt Instrument [Line Items]
Increasing applicable margin		2%
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | Term Loan [Member] | Upfront Fees and Other Costs [Member]
Debt Instrument [Line Items]
Debt instrument discount gross	$ 1,500
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | Interest Rate Option Two | Term Loan [Member]
Debt Instrument [Line Items]
LIBOR rate	1%
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | Prior to 12 Months After Closing Date [Member] | Term Loan [Member]
Debt Instrument [Line Items]
Debt instrument, prepayment fee percentage	2%
Canadian Imperial Bank of Commerce [Member] | Credit Agreement [Member] | 12 to 24 Months After Closing Date [Member] | Term Loan [Member]
Debt Instrument [Line Items]
Debt instrument, prepayment fee percentage	1%
Canadian Imperial Bank of Commerce [Member] | Term Secured Overnight Financing Rate [Member] | Credit Agreement [Member] | Interest Rate Option One [Member] | Term Loan [Member]
Debt Instrument [Line Items]
Basis spread on variable rate	2%
Canadian Imperial Bank of Commerce [Member] | Term Secured Overnight Financing Rate [Member] | Minimum [Member] | Credit Agreement [Member] | Interest Rate Option One [Member] | Term Loan [Member]
Debt Instrument [Line Items]
LIBOR rate	1.50%
Canadian Imperial Bank of Commerce [Member] | Prime Rate | Minimum [Member] | Credit Agreement [Member] | Interest Rate Option Two | Term Loan [Member]
Debt Instrument [Line Items]
Basis spread on variable rate	4%
Canadian Imperial Bank of Commerce [Member] | Amount Over Federal Funds Effective Rate [Member] | Minimum [Member] | Credit Agreement [Member] | Interest Rate Option Two | Term Loan [Member]
Debt Instrument [Line Items]
Basis spread on variable rate	0.50%

Equity - Additional Information

Equity - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended	12 Months Ended
	Nov. 30, 2022	Dec. 31, 2022	Dec. 31, 2021
Class Of Stock [Line Items]
Preferred stock, shares authorized		25,000,000	25,000,000
Preferred stock, no par value
Common stock, shares authorized		150,000,000	150,000,000
Common stock, no par value
Common stock, voting rights		Each share of common stock is entitled to one vote on all matters submitted to a vote of the Company’s stockholders.
Common stock, dividends, declared		$ 0
Common stock, dividends, paid		$ 0
Proceeds from issuance of warrants		$ 438
Exercise Price of $8.75 Per Share [Member]
Class Of Stock [Line Items]
Warrants exercised to purchase shares of common stock	50,000
Preferred stock warrants convertible conversion price	$ 8.75
Proceeds from issuance of warrants	$ 400
Exercise Price of $17.47 Per Share [Member]
Class Of Stock [Line Items]
Preferred stock warrants shares issued upon conversion		14,440
Preferred stock warrants convertible conversion price		$ 17.47
Class of warrant or rights expiration date		May 06, 2024

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions		12 Months Ended
	Apr. 15, 2019	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2020	Aug. 31, 2021
Aggregate intrinsic value of stock options exercised		$ 15	$ 16.3		$ 2.9
Weighted average grant-date fair value of stock options granted		$ 11.32	$ 18.63		$ 7.91
Unrecognized compensation cost related to unvested employee and director stock-based awards		$ 22.3
Weighted average period for unrecognized compensation cost		2 years 6 months
Restricted stock awards [Member] | Common Stock
Shares granted			0	0
Performance-based Vesting [Member]
Shares granted		0
2019 Stock Plan [Member]
Share-based compensation arrangement by share-based payment award, number of shares authorized	3,428,571
Share based compensation arrangement by share based payment award number of shares available for grant		820,336
2019 Stock Plan [Member] | From 2014 Plan [Member]
Share-based compensation arrangement by share-based payment award, number of shares authorized	1,595,189
2019 Stock Plan [Member] | Restricted stock awards [Member] | Common Stock
Shares granted		26,093
2019 Employee Stock Purchase Plan [Member]
Share-based compensation arrangement by share-based payment award, number of shares authorized	371,142
Share based compensation arrangement by share based payment award number of shares available for grant		290,453
Purchase price of common stock, percent	85%
Number of shares issued		30,143
2021 Inducement Plan [Member] | Common Stock
Share-based compensation arrangement by share-based payment award, number of shares authorized						1,000,000
Share based compensation arrangement by share based payment award number of shares available for grant		478,938

Stock-Based Compensation - Assu

Stock-Based Compensation - Assumptions Used to Determine Grant Date Fair Value of Stock Options Granted (Detail)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Stockholders' Equity Note [Abstract]
Risk-free interest rate	2.33%	0.90%	0.91%
Expected term (in years)	6 years 10 days	6 years 10 days	5 years 11 months 19 days
Expected volatility	59%	58%	54%
Expected dividend yield	0%	0%	0%

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock Option Activity (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Number of Shares
Beginning Balance	2,797,550
Granted	1,195,910
Exercised	(507,795)
Forfeited	(186,586)
Expired	(10,288)
Ending Balance	3,288,791	2,797,550
Vested and expected to vest as of December 31, 2022	3,288,791
Options exercisable as of December 31, 2022	1,603,499
Weighted Average Exercise Price
Beginning Balance	$ 20.64
Granted	19.48
Exercised	9.19
Forfeited	27.45
Expired	31.89
Ending Balance	21.56	$ 20.64
Vested and expected to vest as of December 31, 2022	21.56
Options exercisable as of December 31, 2022	$ 17.86
Weighted Average Contractual Term
Options Outstanding	7 years 10 months 9 days	7 years 6 months 14 days
Vested and expected to vest as of December 31, 2022	7 years 10 months 9 days
Options exercisable as of December 31, 2022	6 years 11 months 1 day
Aggregate Intrinsic Value
Options Outstanding	$ 132,076	$ 14,625
Vested and expected to vest as of December 31, 2022	132,076
Options exercisable as of December 31, 2022	$ 70,331

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Restricted Common Stock Activity (Details) - Restricted stock awards [Member] - Common Stock [Member] - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested Stock, Issued		0	0
2019 Stock Plan [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested Stock, Issued	26,093
Unvested Stock, Forfeited	(1,778)
Unvested Stock, Ending Balance	24,315
Weighted Average Grant Date Fair Value
Unvested Stock, Issued	$ 28.74
Unvested Stock, Forfeited	28.12
Unvested Stock, Ending Balance	$ 28.79

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Stock-Based Compensation Expense (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Allocated Share-based Compensation Expense	$ 10,321	$ 6,878	$ 2,414
Cost of revenue [Member]
Allocated Share-based Compensation Expense	125	72	27
Research, development and clinical trials expenses [Member]
Allocated Share-based Compensation Expense	1,465	1,114	396
Selling, general and administrative expenses [Member]
Allocated Share-based Compensation Expense	$ 8,731	$ 5,692	$ 1,991

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 28, 2019
Income Taxes [Line Items]
Foreign income tax provision	$ 100,000
Operating loss carryforwards, limitations on use	These ownership changes may limit the amount of carryforwards that can be utilized annually to offset future taxable income or tax liabilities. In general, an ownership change, as defined by Section 382, results from transactions increasing the ownership of certain stockholders or public groups in the stock of a corporation by more than 50% over a three-year period.
Valuation allowance	$ 121,891,000	$ 116,164,000	$ 101,029,000	$ 95,024,000
Unrecognized tax benefits	0	0
Unrecognized tax benefits, related interest and penalties accrued	0	0
Accrued interest or penalties related to uncertain tax positions	$ 0	0
Earliest Tax Year [Member]
Income Taxes [Line Items]
Open Tax Year	2019
U.S. Federal [Member]
Income Taxes [Line Items]
Operating loss carryforwards	$ 378,500,000
Operating loss carryforwards begin to expire	2023
U.S. Federal [Member] | Expiration Beginning in 2023 [Member]
Income Taxes [Line Items]
Operating loss carryforwards	$ 209,500,000
U.S. Federal [Member] | Non-expirable [Member]
Income Taxes [Line Items]
Operating loss carryforwards	$ 169,000,000
Percentage of annual deduction of taxable income	80%
State [Member]
Income Taxes [Line Items]
Operating loss carryforwards	$ 321,200,000
Operating loss carryforwards begin to expire	2030
Foreign [Member]
Income Taxes [Line Items]
Operating loss carryforwards	$ 0
Research and Development Tax Credits [Member]
Income Taxes [Line Items]
Income tax benefits	0	0	0
Research and Development Tax Credits [Member] | U.S. Federal [Member]
Income Taxes [Line Items]
Tax credit carryforwards	$ 9,000,000
Tax credits carryforwards begin to expire	2023
Research and Development Tax Credits [Member] | State [Member]
Income Taxes [Line Items]
Tax credit carryforwards	$ 5,500,000
Tax credits carryforwards begin to expire	2024
Net Operating Loss [Member]
Income Taxes [Line Items]
Income tax benefits	$ 0	0	0
Maximum [Member]
Income Taxes [Line Items]
Foreign income tax provision		$ 100,000	$ 100,000

Income Taxes - Schedule of Loss

Income Taxes - Schedule of Loss Before Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
United States	$ (36,416)	$ (44,321)	$ (28,803)
Foreign	251	142	87
Loss before income taxes	$ (36,165)	$ (44,179)	$ (28,716)

Income Taxes - Reconciliation o

Income Taxes - Reconciliation of U.S. Federal Statutory Income Tax Rate to Company's Effective Income Tax Rate (Detail)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal statutory income tax rate	(21.00%)	(21.00%)	(21.00%)
State taxes, net of federal benefit	(5.40%)	(6.90%)	(5.70%)
Federal and state research and development tax credits	(5.40%)	(2.40%)	(3.60%)
Nondeductible items	(2.80%)	(3.20%)	(0.20%)
Deferred tax effect of change in state blended rate	16.20%	(1.70%)	7.80%
Return to provision	2.60%	1.10%	1.70%
Other	0.10%	(0.20%)	0%
Change in deferred tax asset valuation allowance	15.80%	34.30%	20.90%
Effective income tax rate	0.10%	0%	(0.10%)

Income Taxes - Schedule of Net

Income Taxes - Schedule of Net deferred Tax Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 28, 2019
Deferred tax assets:
Net operating loss carryforwards	$ 92,445	$ 94,672
Capitalized research and development expense	8,109	4,291
Research and development tax credit carryforwards	13,565	12,186
Accrued expenses	2,994	2,528
Stock-based compensation expense	3,492	2,254
Lease liability	2,218	2,299
Section 163(j) interest	754
Other	483	170
Total deferred tax assets	124,060	118,400
Deferred tax liabilities:
Other	(885)	(674)
Right-of-use assets	(1,284)	(1,562)
Total deferred tax liabilities	(2,169)	(2,236)
Valuation allowance	$ (121,891)	$ (116,164)	$ (101,029)	$ (95,024)

Income Taxes - Summary of Chang

Income Taxes - Summary of Changes in the Valuation Allowance for Deferred Tax Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Valuation allowance as of beginning of year	$ (116,164)	$ (101,029)	$ (95,024)
Increases recorded to income tax provision	(5,727)	(15,135)	(6,005)
Valuation allowance as of end of year	$ (121,891)	$ (116,164)	$ (101,029)

Leases - Additional Information

Leases - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Lease expiration month and year	Dec. 31, 2027
Lessee, operating lease, existence of option to extend [true false]	true
Lessee operating lease description	two noncancelable leases (the “Leases”) that expire in December 2027 and include a lease incentive, fixed payment escalations, and rent holidays. The Leases include an option to renew for an additional five years.
Lessee, operating lease, renewal term	5 years
Lease base rent annual increase	2.50%
Leasehold improvements landlord allowance	$ 3.4
Lease incentive	$ 3.4
Operating lease, weighted-average remaining lease term	5 years	6 years
Operating lease, weighted-average discount rate	6.70%	6.70%

Leases - Summary of Components

Leases - Summary of Components of Lease Expense (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating lease cost	$ 1,353	$ 1,353
Short-term lease cost	806	159
Variable lease cost	718	640
Lease expense	$ 2,877	$ 2,152

Leases - Summary of Supplementa

Leases - Summary of Supplemental Disclosure of Cash Flow Information Related To Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 1,948	$ 1,901

Leases - Summary of Future Annu

Leases - Summary of Future Annual Lease Payments (Detail) $ in Thousands	Dec. 31, 2022 USD ($)
Leases [Abstract]
2023	$ 1,997
2024	2,047
2025	2,098
2026	2,150
2027	2,204
Total future minimum lease payments	10,496
Less: imputed interest	(1,637)
Lease liabilities	$ 8,859

Leases - Summary of Lease Liabi

Leases - Summary of Lease Liabilities on Consolidated Balance Sheet (Detail) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Current operating lease liabilities	$ 1,444
Operating lease liabilities, net of current portion	7,415	$ 8,604
Total operating lease liabilities	$ 8,859

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Millions	1 Months Ended	12 Months Ended
	Jan. 31, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Defined contribution plan, contribution amount		$ 0	$ 0	$ 0
Recorded unconditional purchase commitment, minimum quantity required	$ 9.5
Recorded unconditional purchase commitment, maturity year and month	2029-12
Remaining purchase commitment		$ 7

Segment Reporting and Geograp_3

Segment Reporting and Geographic Data - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2022 Segment
Segment Reporting [Abstract]
Number of operating segments	1

Segment Reporting and Geograp_4

Segment Reporting and Geographic Data - Geographic Areas Long-lived Assets (Detail) - USD ($) $ in Thousands		Dec. 31, 2022	Dec. 31, 2021
Geographic Areas, Long-Lived Assets [Abstract]
Long-lived assets	[1]	$ 19,223	$ 9,841
United States [Member]
Geographic Areas, Long-Lived Assets [Abstract]
Long-lived assets	[1]	18,568	9,085
All Other Countries [Member]
Geographic Areas, Long-Lived Assets [Abstract]
Long-lived assets	[1]	$ 655	$ 756
[1] The Company’s only long-lived assets consist of property and equipment, net of depreciation, which are categorized based on their location of domicile.

Revenue - Schedule of Recognize

Revenue - Schedule of Recognized Revenue Net of Payments (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Total revenue	$ 93,459	$ 30,262	$ 25,639
Net product revenue [Member]
Disaggregation of Revenue [Line Items]
Gross product revenue from sales to customers	77,854	30,780	27,809
Less: Clinical trial payments	(1,380)	1,123	2,717
Total revenue	$ 79,234	$ 29,657	$ 25,092

Revenue - Additional Informatio

Revenue - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenue from Contract with Customer [Abstract]
Research development and clinical trials expenses	$ 1	$ 2.1	$ 1.6

Revenue - Schedule of Net Reven

Revenue - Schedule of Net Revenue by Organ and Country (Detail) - USD ($) $ in Thousands		12 Months Ended
		Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation Of Revenue [Line Items]
Total revenue		$ 93,459	$ 30,262	$ 25,639
United States [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	[1]	84,038	21,861	19,239
All Other Countries [Member]
Disaggregation Of Revenue [Line Items]
Total revenue		9,421	8,401	6,400
Lung revenue [Member] | United States [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	[1]	7,967	9,843	5,392
Lung revenue [Member] | All Other Countries [Member]
Disaggregation Of Revenue [Line Items]
Total revenue		880	822	802
Heart revenue [Member] | United States [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	[1]	29,902	10,103	8,599
Heart revenue [Member] | All Other Countries [Member]
Disaggregation Of Revenue [Line Items]
Total revenue		8,451	7,579	5,598
Liver revenue [Member] | United States [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	[1]	46,169	$ 1,915	$ 5,248
Liver revenue [Member] | All Other Countries [Member]
Disaggregation Of Revenue [Line Items]
Total revenue		$ 90
[1] Revenue by country is categorized based on the location of the end customer. Total revenue includes product and service revenue. Net revenue includes product revenue only.

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Director [Member]
Related Party Transaction [Line Items]
Compensation expense	$ 0.4	$ 0.4	$ 0.3