A newly released investigation by the UK’s Marine Accident Investigation Branch (MAIB) has concluded that a combination of medical, procedural, and equipment failures led to the death of an experienced marine pilot during a routine boarding operation near the Humber Estuary in January 2023. The pilot fell while attempting to board the ro-ro vessel Finnhawk from the pilot boat Humber Saturn, likely after suffering a cardiac event that caused him to lose consciousness. Although he was rapidly recovered from the water, a defective man-overboard recovery platform could not be raised, leaving him partially submerged in cold water for more than 40 minutes before transfer to a lifeboat and evacuation by helicopter. The MAIB found that the pilot’s medical certificate should not have declared him fully fit for duty, that the port authority’s stop-work procedures failed despite expressed concerns about his condition, and that no formal occupational fitness standard existed for pilots. Equipment shortcomings and the absence of a secondary recovery method further reduced survival chances. The report issued multiple safety recommendations to Associated British Ports, the Maritime and Coastguard Agency, and industry bodies, urging improved medical oversight, enhanced recovery equipment, and stronger training and risk assessment to prevent similar tragedies.