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ANN ARBOR, Mich. - The patient lay on the operating table, prepped for transplant surgery. In the air over Lake Michigan, a twin-engine plane sped his way, carrying a team of surgeons and technicians, along with a donor organ on ice.

The plane never made it, crashing into the lake's choppy waters and killing all six people aboard Monday.

Now the critically ill patient could become the accident's seventh fatality.

"It was a very sad moment in the operating room'' when word was received that the plane had gone down on its way from Milwaukee, said Dr. Jeffrey Punch, chief of transplant surgery at the University of Michigan Health System hospital in Ann Arbor.

Hospital officials and organ-donation authorities would not identify the transplant patient other than to say he was a man, and would not say what type of organ he was awaiting, citing medical privacy rules. But one of the doctors killed was a cardiac surgeon, suggesting the patient was about to get a new heart or lungs.

He was put back on the waiting list for another organ and was reported to be "very critically ill.'' Authorities would not comment on his chances of finding another organ in time.

The Cessna 550 Citation crashed about 5 p.m., shortly after takeoff on a flight to Ann Arbor that should have taken 42 minutes. One of the pilots reported severe difficulty steering the plane because of trouble with its trim system, which controls bank and pitch, said National Transportation Safety Board investigator John Brannen.

Brannen said the pilot had signaled an emergency and was making a left turn and heading back to the Milwaukee airport when the plane went down.

The cause of the crash was under investigation. Brannen said the plane's safety and maintenance records were not immediately available.

Killed were both pilots, two University of Michigan surgeons, and two technicians whose job was to prepare the organ for transplant.

"We now know our team is lost,'' said Dr. Robert Kelch, chief executive of the University of Michigan Health System. "This is a tremendous blow to the institution, one from which we won't quickly or easily recover.''

He added: "They died while trying to do what it is they do every day - helping someone else find hope.''

As of Tuesday afternoon, the donor organ, which was packed in ice in a cooler, had not been found. Hearts can last outside the body for only four to six hours and lungs eight hours, said Dr. Tony D'Alessandro, executive director of University of Wisconsin Hospital and Clinic Organ Procurement Organization.

On the morning of the crash, the Ann Arbor hospital's Survival Flight Team had received word that an organ was available at an unidentified hospital in the Milwaukee area, and immediately assembled to bring it back to Ann Arbor, officials said.

The team included two veterans, cardiac surgeon Dr. Martinus "Martin'' Spoor and transplant donation specialist Richard Chenault II, who had flown dozens of such missions. Also on the team was Dr. David Ashburn, a 35-year-old physician-in-training in pediatric cardiothoracic surgery, and another transplant donation specialist, Richard LaPensee.

The team flew to Milwaukee, and the two surgeons removed the donor's organ, which was then packaged for transport. The team contacted the Ann Arbor hospital and gave the go-ahead for the surgery to begin on the transplant patient at 2:45 p.m., Punch said.

The plane took off as light rain fell with winds at 12 mph, gusting to 22 mph. At the controls were Dennis Hoyes and Bill Serra, two pilots who worked for Marlin Air Inc., the university's jet-service contractor. The company had no comment.

The plane hit the water at about 190 mph, authorities said. By midday Tuesday, only small parts of the aircraft - including pilot seats and small pieces of the cockpit - had been found, the Coast Guard said. Divers searched in water as deep as 50 feet until Tuesday afternoon when high waves forced them to pull out. The search was to resume today.

The operating room at Ann Arbor was immediately notified that the plane had gone down, and the surgeons stopped the operation more than two hours after it had started, hospital officials said.

Hospital officials would not disclose how far along the surgery was, but said that typically they do not remove the transplant recipient's old organ until they have a replacement in hand.

A recent NTSB study found that accidents involving emergency medical services flights - those carrying patients or organs for transplant - have been increasing. Between January 2002 and January 2005 there were 55 such accidents and 54 deaths. The study found several safety problems.

According to NTSB reports on its Web site, the agency has investigated 36 accidents or minor incidents involving Cessna 550 Citations since 1983. Five of the accidents involved fatalities, killing 22 pilots and passengers. None of the accident reports mention trim malfunctions.

That track record is "excellent,'' considering the number of hours flown, said Steve Brown, senior vice president for operations National Business Aviation Association, which represents 8,000 corporations and businesses that use airplanes.

"The Citation series is one of the most popular aircraft in the fleet of business aviation aircraft,'' he said. "The pilots like it. You might think of it as a user-friendly aircraft.''

Spoor, 37, made about 10 air transplant flights per year, the university said.

Chenault, 44, spent 18 years coaching girls at Father Gabriel Richard High School near Ann Arbor, a coed Catholic school with 500 students in grades nine through 12. He was going to get coach-of-the-year honors in both girl's track and girl's cross country at a sports banquet Monday night, but never made it.

LaPensee, 48, enjoyed flying radio-controlled model planes. And when a spot opened for a University of Michigan life flight medical technician three years ago, he jumped at it.

Ashburn, 35, came to the university in 2005 for a cardiac surgery residency and would have begun his pediatric cardiac surgery fellowship in July, said Mary-Lynn Hodges, a family friend.

"Every day, the doctors, nurses and flight personnel of Survival Flight do heroic work in saving the lives of others, and that is how we will remember those who perished in Monday's tragedy - as selfless heroes,'' University of Michigan President Mary Sue Coleman said.

Each year, the Survival Flight Team flies about 150 organ donations and 1,200 patients by helicopter and jet.

Dr. Sue V. McDiarmid, the president of the United Network for Organ Sharing, which coordinates organ transplants, said a recipient who does not get an organ retains his or her spot on the list. The patient's eligibility for an organ is calculated according to a formula that is based, in part, on how sick the person is.


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