Christy Martinez is getting off a train in Philadelphia heading to college. She arrives at the campus and meets a friend. She begins having trouble breathing and collapses. Daniel Noonan is getting into his car and driving off to work after saying goodbye to his mother. A terrible accident lands him in a Boston County Hospital.
A young man walks the halls of the William H Foster transplant wing, looking for Dr. Jordan. Several doctors are walking into the wing and one of the nurses with them gives the young man directions. Dr. Jordan meets with Ryan and explains that the transplant coordinator quit last week and Ryan is going to have to cover that job.
The doctors begin their rounds with Carson Hayes a former heart patient of Andy's. He has ignored his doctor's instructions by eating poorly, smoking cigars and ignoring his diabetic condition. He is 52 years-old and needs a double bypass. Dr. Jordan checks in on one of her patients, Ben Parnell who has bad kidneys. He is on kidney dialysis, needs it for eight hours three times a week, and has been receiving it for the past five years.
Dr. Jordan introduces the young man, Ryan, their new assistant to the transplant coordinator, to the staff. Dr. Miranda Foster, a surgical fellow, Dr. Andy Yablonski the attending surgeon and Dr. David Lee the surgical resident. Andy expresses his concern that Ryan is too young and inexperienced for the job, but Dr. Jordan reassures him that this is not the case. David tells Ryan that he likes cheese steaks for food on their donor runs. Dr. Jordan informs Miranda that she will be the lead doctor on the next donor run.
Christy is brought into the ER and the doctor, Lisa Reed brings her patient to Andy. It turns out Christy has pulmonary fibrosis and is need of a transplant.
Andy brings this patient to the staff at their meeting and due to her being in remission for only three and a half years, they will not approve her for a transplant.
Daniel is declared brain dead and the hospital discusses organ donation with his mother. Daniel was a registered donor.
Carson reaches out to his son, Jeremy, whom he hasn't seen in over ten years. When Jeremy arrives at his father's room, he is angry and tells his father to leave him alone as he storms out.
Ryan receives his first donor notification, Daniel's kidneys are a match for Ben Parnell and he begins making the appropriate arrangements. Andy finds out about the run and asks about the lungs. He is informed that the lungs have been damaged, but may still be viable to use for Christy. Andy asks Miranda to take a look at the lungs and bring them back if they can be used.
He runs into Dr. Jordan who is unhappy about not being informed in regards to his plans with Christy. Andy apologizes and Dr. Jordan approves the procedure realizing this is her only chance to live. Andy talks to the patient and her father about the transplant and explains the risks. Without the transplant, she will die in a few weeks. With the transplant, the lungs may not work and she could die during the surgery. Her father does not like the option, but Christy reminds him she is an adult and she gives her permission to proceed.
Miranda, Ryan and David head to the airport to board the plan for Boston. Ryan states he has never been on a private plane and David states he flies one every year to Vermont. Miranda learns that Ryan has no medical training and he was hired to support the transplant coordinator, not be him. As they discuss Ryan's previous jobs, a stringer for a newspaper and a farm reporter on a local radio station, Miranda realizes that he is not going to be very helpful.
Once they arrive at the hospital, they learn that the recovery has been put on hold; it seems that Detective Shannahan from the Boston police Department has tied Daniel to an open murder case. He states that they need to collect evidence from the body to determine if he is guilty. . AS they are collecting evidence, Detective Shannahan approaches Miranda and Daniel's mother with some questions. Miranda chastises him for being so mean to the mother and he comments that she raised a criminal. The police have gathered their evidence and it turns out Daniel is guilty of murdering a young girl, Faith. They release the body and the team is now free to harvest the organs. Miranda creates a video connection between herself and Andy, so he can view the lungs, which he approves. The team is on their way back.
Carson goes into a medical crisis and even through, they try to revive him, he dies. The team has landed in Philadelphia and are in an ambulance racing back to the hospital when they run into a traffic jam. They discover that a bomb threat was called in regarding the federal building and the have all traffic stopped around the site. They have a small window of opportunity as the lungs will not be viable for much longer and they need to get them to hospital now. Ryan takes off running and comes back with good news; the FBI has agreed to escort them through the jam to the hospital.
Miranda returns to the hospital to find Carson has died and she finds Jeremy. They share that they both had problems with their fathers and both of their fathers died.
Miranda and Andy are on the roof, sharing a beer and she inquires about his home. He points to the location of his home, even though his is current living in a hotel. He explains that he lives near Monongahela. He points the other way stating that is the Allegheny River and the third side is the Ohio River; hence the Three Rivers.
Daniel's Mother is seen entering the hospital and stops to look at a wall with many names on it. Andy approaches her and explains that this is where they honor the people who have donated their organs. She explains that she is Daniel's mother and Christy asked her here and Andy tells her that Christy is very excited to meet her. Andy tells her that Daniel's name will be added to the wall and she is happy.