The Marine Accident Investigation Branch (MAIB) found that the pilot fell from a ladder while attempting to board the roll-on/roll-off cargo vessel Finnhawk from the pilot boat Humber Saturn on January 8, 2023. Investigators concluded the pilot likely suffered a cardiac event during the transfer, causing him to lose consciousness, strike the deck of the pilot boat, and fall into the water. Although the pilot was quickly recovered onto Humber Saturn’s semi-submerged man-overboard recovery platform, mechanical defects prevented the system from being raised. Associated British Ports was urged to revise its risk assessments, upgrade pilot protective equipment to improve cold-water survivability, and align safety training with industry best practice. The findings underscore the high-risk nature of pilot transfer operations and highlight how failures in medical screening, equipment maintenance, and emergency preparedness can combine with fatal consequences.