Earnings Call Transcript - CDNA Q2 2022

Operator, Operator

Good day, and welcome to the CareDx, Inc. Second Quarter 2022 Earnings Call. Today’s conference is being recorded. At this time, I would like to turn the conference over to Ian Cooney, Vice President of Investor Relations. Please go ahead.

Ian Cooney, VP of Investor Relations

Good afternoon, and thank you for joining us today. Earlier today, CareDx released financial results for the quarter ended June 30th, 2022. The release is currently available on the Company’s website. Reg Seeto, Chief Executive Officer; and Abhishek Jain, Interim Chief Financial Officer, will host this afternoon’s call. Before we get started, I would like to remind everyone that management will be making statements during this call that include forward-looking statements within the meaning of federal securities laws. Any statements contained in this call that are not statements of historical facts should be deemed to be forward-looking statements. All forward-looking statements, including, without limitation, examinations of historical operating trends, expectations regarding coverage decisions, pricing and enrollment matters and our future financial expectations and results are based upon current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list of descriptions of the risks and uncertainties associated with our business, please see our filings with the Securities and Exchange Commission. The information provided in this conference call speaks only to the live broadcast today, August 4th, 2022. CareDx disclaims any intention or obligation, except as required by law, to update or revise any information, financial projections or otherwise or other forward-looking statements, whether because of new information, future events or otherwise. This call will also include a discussion of certain financial measures that are not calculated in accordance with generally accepted accounting principles. Reconciliation to the most directly comparable GAAP financial measure may be found in today’s earnings release filed with the SEC. I will now turn the call over to Reg.

Reg Seeto, CEO

Thanks, Ian. Good afternoon, everyone, and thank you for joining us for CareDx’s second quarter 2022 earnings call. I’d like to begin by focusing on the following financial, operational, and strategic highlights in Q2. Through strong execution discipline, I want to highlight, we have continued to maintain our excellent financial position with over $300 million in cash, no debt, industry-leading gross margins, and a demonstrated path to profitable growth. We returned to sequential mid-single-digit testing services volume growth. Importantly, we have now passed the nadir in transplant volumes, which we saw in Q1. We scaled our collections infrastructure to more efficiently capture the revenue opportunity from the increase in the mix of commercial and Medicare Advantage patients. Strategically, we’re delivering on our long-term mission and vision. Our vision is to be a leader in the transplant ecosystem, aiming to connect 1 in 2 transplant patients. AlloCare, our patient app, is a perfect example of that progress, with more than 50,000 downloads from pre and post-transplant patients. Our mission is to improve transplant outcomes by bringing innovative intelligence solutions, exemplified by our new artificial intelligence modalities with AiKidney and AiHeart. Now on to the first topic, our excellent financial profile. Our Board and management team believe that maintaining a strong balance sheet is crucial for CareDx’s success. You may recall that in Q1 of last year, we took advantage of favorable market conditions to bolster our cash position by raising $188 million through a public stock offering, ensuring that we can be self-funding for the foreseeable future. This is a competitive advantage for CareDx in the current market environment, particularly as we have a clear path to profitability. Unlike our peers, we do not have a near-term need to raise capital. Over the longer term, we have the flexibility to deploy capital in a way that will increase value for shareholders. We received very positive feedback from our long-term investors regarding this. Our path to profitable growth is built on industry-leading gross margin, and we continue to focus on driving efficiencies in our lab and through the benefits of automation and scale. We maintained our adjusted EBITDA margin versus Q1, despite increased costs in a conference-heavy spending quarter. After adjusting for non-recurring legal expenses in Q2, we would be close to breakeven, similar to Q1. Notably, 12 of our prior 15 quarters were positive adjusted EBITDA. Looking forward, even including non-recurring legal expenses, we are targeting to be adjusted EBITDA positive by the first half of 2023. On to transplant volume and performance. As we predicted last quarter, we were pleased to see an increase in transplant volume in Q2. We hope an increase in hospital staffing will lead to even further volume increases in the second half of the year, as elective procedures and living organ donation numbers return towards pre-COVID levels. Transplant volume in Q2 grew mid-single digits sequentially but declined by mid-single digits year-over-year. As a reminder, Q2 2021 was the highest ever quarter for transplant volumes. During Q2 2022, our testing services volume grew roughly 6% sequentially and 20% year-over-year, delivering over 45,000 tests. With these 45,000 tests, we passed a major milestone, where CareDx has delivered more than 500,000 patient test results across heart, kidney, and lung patients. We feel encouraged by our Q2 performance in the face of a challenging transplant market but are also pushing the organization to do even better in the back half of the year. Now looking at CareDx’s performance. For the second quarter of 2022, total revenue was $80.6 million, increasing 9% compared to the year-ago quarter, with most of our revenues coming from testing services, particularly kidney testing services. We continued with our winning formula of adding AlloSure name protocols, adding new centers, and now expanding further into community nephrology. At the end of June, we had more than 90 AlloSure Kidney protocols across both centers and community nephrology. We are starting to see nice progress in community nephrology, where we’ve expanded our field force and had our best-ever quarter. We’re encouraged by our continued progress in reaching this underserved population. Now on to heart and lung testing services. The HeartCare attachment rate remains greater than 95%, continuing to highlight the value of multimodality to both patients and physicians. We are pleased to see continued momentum for AlloSure Lung with over 1,400 tests ordered in the quarter and now used in 60% of lung centers. We remain in discussions with CMS over the reimbursement of AlloSure Lung and look forward to helping our patients receive reimbursement for this important test. Now on to collections/reimbursement. Increasing our rates of collection has been a major priority. We continue to scale our internal billing infrastructure and have now added third parties to increase our capabilities due to the influx of new Medicare Advantage and commercial plans. Achieving reimbursement coverage is critical. We use the greater than 80% coverage that AlloMap achieved as the gold standard, where we are covered by all the major insurers in Medicare. As a reminder, this was a long multi-year process that included conducting long-term studies, completing randomized control studies, and incorporating guidelines. We are working towards achieving a similar level of coverage for AlloSure Kidney, AlloSure Heart, and AlloSure Lung. This represents a significant upside opportunity. For example, if tests in 2021 were reimbursed at the same coverage levels as AlloMap Heart, then an additional $100 million plus would have been captured in the testing services bottom line. We continue to work closely with payers while investing in and producing the evidence required to receive reimbursement. Recently, we were pleased to see donor-derived cell-free DNA being considered as part of the next iteration of the ISHLT guidelines. As a reminder, AlloMap has already been incorporated in the ISHLT guidelines. Regarding pricing, we do not set the Medicare price. Additionally, we target commercial contracts at or above the Medicare rate, and the main driver of fluctuations in ASPs is changes in payer mix. The success of our new launches with AlloSure Heart, AlloSure Lung, and the increased progress on our strategy to expand into community nephrology with AlloSure Kidney has increased the percentage of commercial patients receiving reimbursement. Moving on to innovation. On the pipeline, we continue to make progress with AlloMap Kidney and UroMap. In May, biomarkers in medicine published new data demonstrating that AlloMap Kidney provides valuable gene expression profiling to predict the probability of allograft rejection for both antibody-mediated rejection and T-cell mediated rejection. This represents the second independent validation of AlloMap Kidney using multicenter prospective data. We are on track with our delivery of AlloMap Kidney as part of our 2022 plan and plan to start the laboratory validation process for UroMap in the second half of this year. Additionally, we’re incorporating artificial intelligence into our testing services portfolio. We believe this represents the next major move within transplant patient care. We announced AiKidney at ATC, the only donor-derived cell-free DNA solution that features an additive AI-enabled algorithmic risk assessment tool. AiKidney will deliver information regarding the patient’s current risk of rejection as well as the prognosis of allograft survival at different time points. We also licensed AI technology for our heart franchise, the first offering being AI CAV, focusing on chronic allograft vasculopathy, highlighted at our June innovation day. Cedars Sinai, one of the leading heart transplant institutions in the United States, has been using this technology to assess CAV, which has led to a reduction in the need for angiograms. Now on to patient and digital solutions. This quarter, we recorded $6.8 million in revenue, a year-over-year increase of 128%, driven by our Medication Management acquisitions and strong performance across the portfolio. Patient and digital solutions are now on par with our products business. As a reminder, we have built this over the last three years and are now progressing at critical scale. We have developed an incredible and efficient transplant moat across 150-plus centers with over 80 transplant sites and more than 50 quality and administrative services. This moat allows us to expand pre-transplant, and we now have over 55,000 patient referrals to 60-plus transplant centers and have entered the community with the recent introduction of AlloHome, our personalized patient monitoring service. We are focused on playing a critical role in connecting patients across the transplant patient journey because this ecosystem remains highly fragmented. As part of this consolidation, our AlloCare app is now integrated with both TxAccess and MedActionPlan, connecting both pre and post-transplant patients. This patient focus is now enabling us to build a transplant data-like platform known as AiTraC, representing future opportunities to develop more algorithmic-based solutions. This focus on connecting the ecosystem is unique and delivers on our vision of being the leader in transplant. Moving to products, this quarter we reported $6.7 million in revenue, down 2% year-over-year, driven by foreign exchange and supply chain constraints. We were pleased to complete the IVDD registration process for our entire lab products portfolio, as part of the recent initiatives for operating in Europe, looking to reestablish momentum for this business line as the operating environment normalizes. Cell transplant therapy represents an entry into one of the most promising and exciting areas of clinical medicine. In addition to working with pharmaceutical partners, we signed our very first pharmaceutical partnership with AlloHeme at the end of Q2. Moving on to guidance, as you saw in our press release, we have lowered our guidance and now expect our full year revenue to be in the range of $325 million to $335 million. Abhishek will cover this in more detail in his section. As a transplant company, we made a commitment and a focus on patients. As part of this commitment, we have introduced new offerings, entered new organs, and expanded access to community patients. In the short term, the success of our strategy has significantly increased the mix of commercial patients. The lag in reimbursement for these commercial patients has impacted ASP dynamics. Compounding this has been an increase in complexity in collections due to patients shifting from Medicare to Medicare Advantage. In the longer term, the strong uptake of our offerings provides a longer runway to sustain growth. In closing, I’m proud of our performance in what has been a challenging environment during the first six months of the year. COVID, inflation, geopolitical concerns, and macro headwinds have combined for an eventful start to the year for everybody. In transplant, I believe the first half has marked a nadir for transplant volumes, and I feel confident we’ll see continued transplant volume improvement in the second half. We are focused on the near term, the opportunity to realize improved collections as we scale our infrastructure. Mid to long term, we have the opportunity to increase commercial coverage as our mix of commercial patients increases with new launches and expansion to new organs. From a market perspective, there are multiple drivers in place to double the number of transplant volumes being conducted, including government initiatives, increasing living donors, use of dissected organs, organ perfusion and transport technologies, and the potential of alternative organ supplies like Xenotransplantation. Finally, we’re proud to be the company focused on helping transplant patients by building connections of products, services, and other offerings across the transplant ecosystem. With that, I’ll turn it over to Abhishek.

Abhishek Jain, Interim CFO

Thank you, Reg. We are pleased with the results from the second quarter, and I would like to echo the comments about our incredibly deep and efficient moat across the transplant centers and our ability to deliver on our vision of being the leader in the transplant ecosystem. I would like to highlight the following: strong cash position of $306 million, strong volume growth, and impressive gross margin performance. Excluding sequestration, we improved our ASP change versus Q1 from 4.9% to 3.7% through better collections. Our model for profitable growth expects positive adjusted EBITDA by the first half of 2023, even including elevated legal expenses. I want to start by highlighting our financial strength. We ended the quarter with $306 million in cash, cash equivalents, and marketable securities. As we return towards breakeven adjusted EBITDA, we expect future uses of cash to be driven mainly by capital allocation decisions focused on increasing shareholder value. We are confident that the business is self-funding into the foreseeable future. Moving to the quarter, in Q2, we recorded total revenues of $80.6 million, up 9% compared to $74.2 million in the second quarter of 2021. Testing services revenue grew by 3% to $67.1 million. Product revenues decreased 2% year-over-year to $6.7 million, and digital and patient solutions revenue increased 178% year-over-year to $6.8 million, driven by our recent acquisitions of The Transplant Pharmacy and MedActionPlan. Notably, our testing volumes grew by 20% to approximately 45,000 tests. A quick reminder that our strong testing volume growth came despite a tough comparison from Q2 2021, which was an all-time high quarter for transplant volumes. For the quarter, we saw solid sequential growth in all organs, particularly encouraging is the continued strong uptake of our AlloSure Lung, where the volumes grew to over 1,400 tests for the quarter and greater than 95% attachment rate for AlloSure Heart. The non-GAAP gross margin for the quarter was 68.8% compared to 70.3% in the second quarter of last year and 67.9% in Q1. We continue to maintain healthy gross margins of over 74% in our testing services business despite strong adoption of our new tests that drives the mix shift between the tests that are reimbursed versus not reimbursed. We are very pleased with the durability of our gross margin profile and proud of our lab and supply chain teams as they continue to drive efficiencies. Non-GAAP operating expenses for the second quarter were $62.4 million, up about $2 million sequentially from Q1 2022. The increase in our operating expenses was driven by sales and marketing expenses in a conference-heavy quarter. We remain disciplined with our spending and plan to keep operating expenses flat in the second half. For the second quarter of 2022, we recorded a negative adjusted EBITDA of $5.7 million compared to negative adjusted EBITDA of $5.6 million in the previous quarter. As Reg mentioned, we are targeting to be adjusted EBITDA positive in the first half of 2023 and are confident in our ability to drive profitable growth. Now I would like to add some color on the factors driving our ASP change in the quarter and our assumptions for the second half of the year to help investors better understand the mix shift in the business. Firstly, there is a mandatory Medicare sequestration impact on ASP of 1% in Q2. Excluding this, the ASP change of 3.7% improved by about 110 basis points over the last quarter. As discussed in our last call, the ASP impact results from first driving our strategy to expand into a higher commercial mix of patients, driven by our new launches and our expansion into community nephrology. The second part of ASP impact is due to increased complexity in collections due to the patients shifting from Medicare to Medicare Advantage. To provide further clarity, our strategy to serve patients along the entire journey has resulted in a marked increase in the mix of patients on commercial pay. Given this leadership strategy, 75% of the change in ASP was driven by incremental volumes of commercial payers and AlloSure Lung, while the other 25% was driven by the shift from Medicare to Medicare Advantage patients. Our ASP assumption for the full year now includes a mid-teens impact based on the factors discussed. We have increased our focus on the reimbursement strategy to capture this significant opportunity over the mid to long term while scaling our collections infrastructure to comply with increased administrative steps. Regarding the information request from the government, we do not have any material updates to report. We continue to cooperate and are moving efficiently in responding to the request. Turning to guidance, we are revising our full year guidance to a range of $325 million to $335 million from the previous $330 million to $350 million. This change in midpoint, adjusting from $340 million to $330 million, is primarily driven by revised ASP assumptions due to a higher mix of commercial patients, including growth in our AlloSure Lung test and a shift from Medicare to Medicare Advantage patients. We believe the industry has hit the nadir of transplant volumes, and we will see improvement as staffing shortages dissipate in the back half of the year. Our business model and a solid cash position provide a competitive advantage for CareDx, placing us in a position of strength. We have a large untapped opportunity to drive sustainable profitability through increased reimbursement coverage and an exciting pipeline of products. With that, I’ll open the call for questions.

Operator, Operator

And our first question will come from Andrew Cooper with Raymond James.

Andrew Cooper, Analyst

Thanks for the questions. Maybe just first, I want to get a sense of where specifically on transplant volumes today you think the mix is in terms of Medicare, Medicare Advantage, and true commercial. And then to some degree, talk us through what your actual volumes look like on each of that, at least directionally? And then lastly, why has that been something that’s been difficult for you to predict. It sounds like the guidance is really tied to that mix dynamic. I just want to understand what’s changed relative to your expectations prior? And maybe what have you learned since this time last year that informs what the mix might look like going forward?

Reg Seeto, CEO

Yes. Thanks, Andrew. It’s Reg here. Thanks for the question. We’re excited about this quarter, and we had a strong quarter in volume growth. In terms of the volume progression and the mix, we continue to see a significant increase in our commercial percentage of total patient volume. That’s because of the strategy we instituted, bringing new launches such as AlloSure Lung, AlloSure Heart, and now expanding in community nephrology. If you look at the evolution of that, the greatest increase or change has been in our commercial percentage, which used to be under 50%, but now is above 50% in terms of commercial patients. We’re seeing this mix continue, where commercial continues to increase. Probably at the start of this time last year, it was around the 47% range, and now we’re about 53%. So we’ve got a 6% delta change that we’ve seen. On the Medicare side, we’re seeing that decline by about the same amount, with the rest made up through Medicare Advantage. As you can see, quite a bit of a dynamic shift is taking place.

Andrew Cooper, Analyst

And then maybe kind of sticking to similar topics, but just conversations with payers and agencies continue to build the data sets out there. Any updates you can give us on conversations with some of those commercial payers and efforts to ensure you get paid for Medicare Advantage as well.

Reg Seeto, CEO

Yes. Absolutely. This is a process. And the good thing about that’s why I mentioned AlloMap Heart as the gold standard. There, you have coverage with every national payer and most of the major regionals. We used 80% as reference, but it’s well in excess of that. So that standard was set over a long period of time, which began with excellent studies being published in reputable journals, including long-term studies, randomized control phases, and getting into guidelines. We have seen success with our approach across these new offerings. This is why we conducted comprehensive studies, which are expected to yield similar outcomes for AlloSure Heart, AlloSure Lung, and AlloSure Kidney. It is a process but one that is well understood given our experience with AlloMap.

Operator, Operator

We’ll take our next question from Alex Nowak with Craig-Hallum Capital Group.

Alex Nowak, Analyst

I wanted to follow up on the ASP comments here and hope to clarify. There's obviously the newer tests out there in heart and lung that have a higher mix of commercial that leads to less coverage there than Medicare. But then I’m curious why the ASP decline quarter-on-quarter. Shouldn’t you start to lap that amount here at some point? If you look at test volumes from Q1 to Q2, do you think commercial test volumes are pretty consistent from those two quarters? So I guess I’m trying to figure out what specifically led to a sequential decline in price for Q2.

Reg Seeto, CEO

Yes. I’ll provide some comments, and then I am going to let Abhishek add in more detail. Firstly, there was a new mandatory change as part of sequestration, which was the 1% mentioned by Abhishek. Additionally, there was a larger increase in the commercial mix of these patients between Q1 and Q2. So I don’t know if you want to add some commentary there, Abhishek.

Abhishek Jain, Interim CFO

No. Thank you, Reg. You have covered most of it. But the key here is that when we start to look at the commercial side, the increased volume was primarily driven by exempt patients on the commercial side. As I mentioned earlier, it was about 75% of our ASP change, driven by our strategy because we continue to move into community nephrology, thus increasing our volume in that space. Similarly, AlloSure Lung actually increased over 50%. So those are the two primary factors that are driving the ASP change. The remainder comes from the Medicare sequestration and a small part related to collections.

Alex Nowak, Analyst

When we are thinking about the growth embedded in the new guidance, can you just remind us how much acquisitions added to sales in 2022? And then what does the guidance assume for growth in testing volumes? It looks like the guidance almost implies flat growth for the second half compared to the first half.

Reg Seeto, CEO

Yes. Sure. First of all, the guidance change is coming primarily as we look into our ASP, as of where we are today. We are now assuming that this mix shift will continue in the second half of the year, which is the reason we are revising our ASP assumptions from high single digits to mid-teens now. This change has shifted the midpoint of the guidance from the previous $340 million to the new midpoint guidance of $330 million. I add that there has not been any change in our assumptions as it relates to volume.

Alex Nowak, Analyst

Okay. I think you guys broke up on my end, but we can follow up offline. Thanks.

Reg Seeto, CEO

Yes, we didn’t hear that last question. So let’s address it when you’re back online.

Operator, Operator

We’ll take our next question from Brandon Couillard with Jefferies.

Brandon Couillard, Analyst

Abhishek, just in terms of the phasing of the back half of the year, should we assume that ASPs step down sequentially in both the third quarter and fourth quarter? And I know this may be a little preliminary, but would it be your initial view that this mix begins to stabilize as we move into ‘23? Or do you think it’s likely to continue at a slower rate?

Abhishek Jain, Interim CFO

Sure. As I look into the second half of the year, my ASP assumptions are based on current trends. We assume that the mix shift we’ve seen so far will continue in the next half of the year. Second, the Medicare sequestration cut will go up to 2% in Q3, which will have the same impact as it did in Q2, but it will go away in Q4. So those are the two assumptions I am making. Other than that, our midpoint assumption will continue as it was for the second half of the year.

Reg Seeto, CEO

Brandon, we haven’t guided for ‘23 yet, but in terms of that commentary, the sequestration will go away, and we expect our commercial numbers will improve over 2023, particularly as we build more commercial contracts. In addition, we’ll see improved collections.

Brandon Couillard, Analyst

Well, I mean, you’re kind of discussing the 2023 outlook in terms of targeting positive adjusted EBITDA by the first half. I mean just in general, why provide that target now? And what’s the key driver of that shift to profitability? Is it stronger top-line growth or actually a moderation in OpEx spending, as you kind of indicated would be the case for the second half?

Reg Seeto, CEO

Yes. We thought it was important to communicate this path to profitability to our investors and our long-term investors. Using adjusted EBITDA as the proxy makes sense now since we have had 12 of our prior 15 quarters positive adjusted EBITDA. In the last few quarters, we incurred some additional non-recurring spending, but this will eventually go away, such as legal expenses. So as we look into 2023, we expect that our operational model will include both OpEx and top-line growth that can absorb what we have incurred and return us to positive adjusted EBITDA.

Brandon Couillard, Analyst

And last question, just on KidneyCare, any chance you could be more specific about the timeline for MolDx submission? And what are the next milestones towards commercializing that test?

Reg Seeto, CEO

Yes. We feel very good about AlloMap Kidney. We’ve completed our second independent validation study and our CLIA validation. We will proceed with the MolDx submission, and as mentioned, our CLIA team is in the process of training for this. We feel optimistic about the progress in AlloMap Kidney in particular, and UroMap is expected to start CLIA validation in the second half of this year as well. Both represent exciting opportunities for the organization, especially in the kidney space.

Operator, Operator

We will take our next question from Mason Carrico with Stephens.

Jacob Johnson, Analyst

It’s Jacob on for Mason. So on the Medicare to Medicare Advantage switch in patients, I know you mentioned building out the infrastructure for combating this negative impact, which has been a big part of the ASP headwind. Could you maybe talk about the infrastructure you’re building out there and some metrics to show collection rates may start improving?

Reg Seeto, CEO

Yes. I can describe the infrastructure, but also want to highlight that we’ve seen improvements in collections as part of that shift in volume dynamics. The infrastructure we’ve built during the first half of the year revolves around three main areas: people, process, and using third-party support. We’ve increased our headcount and engaged third-party partners to assist. The process for submitting claims has become more complex when moving from Medicare to Average Advantage or any commercial plans. We’ve adopted additional measures in terms of verification, requiring different information than previously, leading to longer processing times. This necessitates added personnel dedicated to this transition. As we shift towards a higher commercial mix, we are scaling up in terms of both process and people.

Jacob Johnson, Analyst

And then moving on to my next question, could you provide an update on the inclusion of donor-derived cell-free DNA in ISHLT guidelines? Talk about the potential impact the inclusion would have on expanding commercial coverage for AlloSure Heart.

Reg Seeto, CEO

Incorporating donor-derived cell-free DNA into national guidelines like ISHLT would be a pivotal moment. However, we cannot comment on the timeline, as it’s developed by committees and subcommittees in that respect. The inclusion would help us significantly in discussions with commercial payers, as it serves as a validation proof point, much like AlloMap did in the past.

Operator, Operator

We’ll take our next question from Yi Chen with H.C. Wainwright.

Yi Chen, Analyst

In the prepared remarks, you mentioned that relatively low transplant volumes are a result of a staff shortage. Can you comment on what created the staff shortage?

Reg Seeto, CEO

Yes. The shortages across healthcare are well documented. During COVID, a significant number of staff moved roles or left for other institutions, impacting many organizations, resulting in staffing shortages. Many employees left nursing and similar roles during COVID, leading to permanent attrition in those positions. This dynamic is evident now in a variety of institutions and across the healthcare landscape. However, when attempting to recover and support activities during the pandemic, scheduling elective procedures has become significantly more complicated, especially for living donor transplants, which were previously done on weekends, for example.

Yi Chen, Analyst

What evidence have you observed to believe that the situation could improve in the second half?

Reg Seeto, CEO

While it’s challenging for us to predict exactly when staffing levels will normalize across the landscape, we’ve seen trends towards a return to normalcy in terms of staffing. Accepting COVID as a part of the health landscape has changed perceptions, leading to a return of healthcare professionals to their roles. Many healthcare facilities are seeing lower rates of attrition among their staff, and we’re optimistic that we could see a more normalized staffing situation in Q3 and Q4.

Yi Chen, Analyst

The federal government has declared Monkeypox a public health emergency aimed at speeding new vesting distribution. Do you think that could possibly create another round of staff shortages?

Reg Seeto, CEO

I’d prefer not to speculate on the potential impacts of Monkeypox. It is still early in the process, and I would not want to overestimate the influence it may have on staffing. It’s important to wait and see how this evolves in the future because I don’t believe that it is an airborne concern.

Operator, Operator

We go to our next question from E.V. Koslosky with Goldman Sachs.

E.V. Koslosky, Analyst

It’s great to see transplant volumes recovering sequentially. Could you provide color around trends you’ve been seeing so far in July?

Reg Seeto, CEO

The trends in July, based on weekly observations, appear to be somewhat similar to what we observed in June, likely in the mid-single digits.

E.V. Koslosky, Analyst

Despite being up sequentially, we’re still down versus last year. However, you've proven that you can grow testing volumes in a down transplant market. What would happen if transplant volumes take longer to get back to last year’s levels?

Reg Seeto, CEO

We’ve seen the nadir in Q1, and we predicted a rebound in Q2. I think it’s more challenging to compare this year with last due to the peak in transplant volumes witnessed in Q2 2021. This year, we are likely to see year-over-year improvements in Q3 and Q4. Factors contributing to sequential growth include a rebound in the living donor population, which has not yet returned to pre-COVID levels, and other drivers such as the increased use of DCD versus DBD patient hearts. Ultimately, we believe in the long-term potential of the market and hope to see improvements in the second half of the year.

Operator, Operator

There are no further questions at this time. I’ll turn the call back to Reg for any additional or closing remarks.

Reg Seeto, CEO

I want to thank all the investors, analysts, and shareholders who joined today. It’s been a tough six months for many organizations. We’re excited by the momentum that’s come out of Q2 and what we can achieve in the second half of the year. Thank you all for your support of the transplant community. These patients need our help, and we are proud to be 100% focused on transplant. Thank you again for your commitment, and we look forward to follow-up discussions.

Operator, Operator

Thank you for participating in today’s call. You may now disconnect.