When minutes matter

Other details spell out when and where to meet the two-person medical team, the weight of the gear they’ll bring, and the expected time for their return trip. But the two Learjet pilots, Steven Casciola and Jake Lewis, also understand the hard reality behind the short text: Someone in Ohio is dying and their soon-to-be-donated organs will give gravely ill patients elsewhere a chance to live.

For Casciola, 39, a veteran Learjet 31A captain, and Lewis, 28, a newly type-rated co-pilot, performing these short-notice, high-pressure, often middle-of-the-night medical flights is a privilege and something they seek out.

“There’s a real sense of purpose and mission,” said Casciola, a friendly, energetic, civilian pilot who has performed these consequential flights for the entire 16 years he’s flown for Skyward Aviation. The air charter firm is based near Pittsburgh, Pennsylvania, a city that’s been a center for organ transplant surgery for more than 40 years.

“We get to know the transplant teams pretty well,” he said, “and we focus on getting them where they need to be to perform their lifesaving work.”

The team arrives on the airport ramp in an SUV, and the pilots load their bulky gear.

There’s an outwardly normal-looking cooler for the lungs that’s designed to maintain a constant temperature of 4 to 8 degrees Celsius. But even with the specialized equipment, the clock is ticking. The teams must implant the lungs within six hours from the time they leave the donor.

Today, the medical team is Jenalee Coster, a thoracic surgeon, and Elijah Gray, a transplant coordinator. The flight to Columbus is short, just 25 minutes, and recovering the lungs will take about four hours. After returning to Pittsburgh, Coster will transplant those lungs in a 62-year-old woman suffering from chronic obstructive pulmonary disease (COPD). That procedure will take another eight to 12 hours.

“It’s shaping up to be a long day,” Coster says, in the aft right seat of the Learjet, wearing scrubs, scanning the news headlines on an iPhone, and sipping iced coffee. “But I’m fully caffeinated and ready for whatever happens.”

Gray slides into the seat next to her, and he’s texting the hospital in Columbus with updated arrival times. There’s an order to organ recovery based on shelf life: heart first, lungs second, livers, kidneys, and intestines next, and corneas last.

These kinds of transplants typically require close synchronization among nurses, doctors, technicians, and transportation providers at multiple hospitals in different cities.

The pilots begin their preflight inspections at least one hour before departure. Skyward performs its own maintenance, and the company’s three Lear 31As get the highest level of attention because of the critical nature of their medical missions.

Casciola has the line crew load the airplane with 3,500 pounds of fuel—enough to fly to their destination and back—to avoid any risk of fuel unavailability at Columbus.

The weather is good with mostly smooth air and visual conditions across the route, and Casciola files an IFR flight plan that tops out at just 16,000 feet. That’s nowhere near the Learjet’s 51,000-foot ceiling, but it’s high enough to go fast. The crew will cruise at 400 knots true (310 KIAS) in level flight.

They use the call sign “Medevac,” and air traffic controllers provide priority handling on both the out- and inbound legs. Sometimes, the preferential handling is subtle, and occasionally it’s obvious.

“There was a line of corporate jets waiting to leave Teterboro [Airport in New Jersey] one day, and we were told to back taxi on the runway in front of them so that we could turn around and get out first,” Casciola said. “Minutes matter.”

On today’s trip, the Learjet crew connects the airplane to a ground power unit before the medical team arrives. Co-pilot Lewis powers up the avionics, enters the flight plan, and performs the pre-start checklist alone.

Lewis is new to corporate aviation—but he’s also an emergency medical technician with a passion for helping people.

“That’s why I look forward to this kind of flying,” he said. “It’s a continuation of the work I did in emergency medicine.”

Once the medical team climbs aboard, Casciola deftly slides into the left seat. The Garrett engines start moments later, and the crew begins its taxi to Runway 10. The tower controller clears the Learjet for an immediate takeoff and a westward turn to Ohio.

The 1994 Learjet panel is a mix of digital and analog instruments. A lone Garmin GTN 750 is in the middle of the panel, and it’s linked to a legacy Universal flight management system.

ATC clears the airplane directly to its destination and allows the pilots to delay their descent until the last moment. As soon as the pilots report John Glenn International Airport (CMH) in sight, they’re cleared for a visual approach to Runway 10R and taxi to a midfield FBO. There, a hospital van meets the airplane on the ramp and whisks the medical team away.

Before they leave, however, the team has a request for the flight crew: Greek food.

Casciola and Lewis note their request and carry an insulated, soft-sided food container in a borrowed crew car to The Mad Greek restaurant and load it with carryout. Today, there’s a gyro platter and a salmon salad as well as baklava for dessert.

“The medical teams are typically in surgery all morning, and then sometimes they’re at it again until late at night,” Casciola said. “The only time they have to relax and eat is on the airplane. And a short flight like this doesn’t give them much time for that, either.”

Longer missions

Most of Skyward’s organ transplant flights are within 500 nautical miles of Pittsburgh, but that’s changing. As the science of preserving organs outside the body advances, transporting them longer distances becomes feasible. Last year, a Falcon 900 brought a donated heart from Juneau, Alaska, to Boston, Massachusetts, the longest transplant trip of its kind at 2,505 nautical miles.

The Pennsylvania-based Center for Organ Recovery & Education (CORE) is Skyward’s largest single client and schedules scores of medical flights throughout the year. The nonprofit agency’s territory includes western Pennsylvania and West Virginia, and it’s one of 56 federally designated organizations that coordinate transplants across the United States.

The flight to Columbus is short, just 25 minutes, and recovering the lungs will take four hours.CORE officials said there’s a great deal of research on preserving and even generating organs for transplant, but the most immediate benefit people can make is volunteering to become a donor. More than 100,000 U.S. patients are awaiting transplants, and an average of 17 of them die each day without receiving one. Roughly 60 percent of U.S. citizens are listed as organ donors. Meanwhile, the success rate of transplant surgeries has made remarkable gains over the years with almost all showing survival rates of 90 percent or more after five years.

Miracle man

All of Skyward’s medical flights are made under FAR Part 135 with daily duty times up to 14 hours. Medical transplant flights often take place in the middle of the night, and in all sorts of weather. Charleston, West Virginia, is one of Skyward’s most frequent destinations, and it’s notorious for fog, low ceilings, and ice.

In the air, the Learjet crew has little interaction with the medical team. They’re all performing their vastly different but complementary jobs. Unlike charter trips for high-end passengers, the pilots don’t go out of the way to avoid bumps to give their passengers a smooth ride. Within reason, they’ll plow through weather to avoid delays. The pilots also dress casually in jeans and a company sports shirt, and since all their trips are out-and-backs in the same day, they don’t have to spend multiple nights in hotels.

The medical teams don’t share details about their patients or the nature of each mission so that pilots can make unemotional, aviation-based go/no-go decisions. Despite all that, some cases hit close to home.

Amanda Dickey, a Skyward charter manager, noticed a company flight to New York was taking place about the same time her uncle, a retired machinist suffering from pulmonary fibrosis, was preparing to receive a lung transplant. The New York flight was postponed for one day by high winds, and so was her uncle’s surgery.

“That’s when I connected the dots,” she said. “We’d be transporting his medical team and donated lungs.”

The surgery took place in February and her uncle, Terry Riddle, 66, is recovering well at his home in New Stanton, Pennsylvania.

“He was off oxygen two days after the surgery,” Dickey said. “At the hospital, they were calling him the miracle man.”

Just like that

Organ donation had a moment recently when singer-songwriter Bonnie Raitt won a Grammy for “Just Like That,” a song about a real-world event in which a grief-stricken mother whose son died in an accident met the man who received his heart.

He sat down and took a deeper breath
Then looked right in my face
I heard about the son you lost
How you left without a trace
I’ve spent years just trying to find you
So I could finally let you know
It was your son’s heart that saved me
And a life you gave us both

Despite the song’s popularity, neither the Learjet pilots nor the medical team were aware of it. That seemed surprising, but perhaps it shouldn’t be. They’re immersed in similar hope and heartbreak every day of their working lives, and they share in the satisfaction that comes from creating new life and promise out of what would otherwise be only tragedy and loss.

“The reward for us is that we get to use our flying skills to contribute to a team that saves lives,” Casciola said. “That makes me feel really good, and it keeps me coming back.”

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