Three Rivers is an American medical drama television series that aired on CBS from October 4, 2009, to July 3, 2010, and starred Alex O'Loughlin in the role of a famous transplant surgeon in Pittsburgh, Pennsylvania. On November 30, 2009, after just eight episodes of the season had aired Sunday at 9:00 pm (EST), CBS announced that Three Rivers had been pulled from its schedule with no plans to have it returned, and the series was later officially cancelled. However, the remaining unaired episodes were burned off Saturdays at 8:00 pm (EST).
 With the long-running NBC drama ER coming to an end, CBS executives put out a call for a new medical show to fill the void. Carol Barbee was introduced via Curtis Hanson to a pitch by Steve Boman, a former transplant coordinator and Chicago newspaper reporter, for a drama about a transplant hospital. Barbee decided to undertake the project, telling it from three points of view: the donor's, the recipient's, and the doctor's. The location for the show's setting in Pittsburgh was decided based on a determination that the  University of Pittsburgh Medical Center (UPMC) was the world's leading transplant center with the coincidence that the dominant topographical feature of the city, the confluence of the Allegheny, Monongahela, and Ohio rivers, would provide an allegory for the show's three points of view. Barbee did her research for the show at The Cleveland Clinic with Dr. Gonzalo Gonzalez-Stawinski, who also tutored the show's lead star Alex O'Loughlin. Dr. Robert Kormos, co-director of heart transplantation at UPMC, also provided input. Transplant pioneer Thomas Starzl, who visited the set, is the inspiration for the fictional transplant pioneer who is revealed to be the father of character Dr. Miranda Foster.
 The pilot for the Pittsburgh-set medical drama was filmed in western Pennsylvania in March and April 2009 using the closed Brownsville Tri-County Hospital and the David L. Lawrence Convention Center for hospital interior scenes. Post-pilot recasting resulted in actors Julia Ormond and Joaquim de Almeida departing and Alfre Woodard and Amber Clayton joining the series. Ultimately, the pilot was dropped and a new episode was shot for the television premiere. A high-tech, more visually appealing hospital set for the ER and ICU was built on sound stages 19 and 20 at Paramount Pictures, where interior scenes were thereafter produced, although location shooting still occurred in Pittsburgh for exterior shots.
 Following a bus crash, the parents of a young college football player must make a heartbreaking decision regarding donation of his organs. Meanwhile, Andy and Ryan rush to find a procurement team to give a man a heart transplant he desperately needs.
 A car crash victim insists he wants to be taken off the life support machine so that he can help others with his organs while Andy and Sophia do all they can to save him.
 When a woman's husband needs a new kidney, she contemplates beginning a "Daisy Chain" which means she will donate a kidney to someone and they in turn will donate their kidney until the chain is completed with her husband getting his kidney. Andy is not sure he wants to support such an action and he is concerned that another patient is rejecting his recently transplanted heart.