After being accosted by a pair of men at a Washington, D.C. café, shady investment manager Paul Wyatt’s body is found in an alleyway with the heart removed. After the medical examiner discovers that the missing organ was actually a transplant, Ellen Wyatt admits her husband used his ill-gotten gains to lease a new heart from a discredited cardiothoracic surgeon named Dr. James Covington, who “repossessed” it when Paul couldn’t make his payments. As Liz struggles with nightmares about Tom and her suspicions of Samar Navabi’s motives for joining the task force, Red and his associate Niko Demakis lay plans to maintain control of an Indonesian port widely used for trafficking contraband. But when he’s told that Berlin has enlisted an operative named Mr. Vargas to take it over instead, Red orders Demakis to see that no one in their syndicate defects.
With help from Ellen, Liz and Ressler track down Dr. Gordon Albee, a medical examiner who’s being paid to supply organs for Covington’s off-the-books transplants. Agreeing to set a trap that will lead the agents to Covington, Albee calls to arrange for a pickup. But when the courier realizes he’s being followed and flees, he’s killed by an oncoming car, leaving the FBI without access to his boss. Meanwhile, after telling Red that two of their partners are working to undermine their deal, Demakis secretly conspires with Vargas to kill him for Berlin.
After tracking down the next illegal transplant patient, Red threatens to let him die of a heart attack unless he turns on Covington. However, when Liz and Ressler burst in during surgery on a gravely ill boy at the makeshift hospital, Covington reveals he’s using the proceeds from his operations to provide transplants to children with no other hope for survival. Even though she knows they have to shut down the ward, Liz persuades Ressler to allow Covington to save the child’s life before arresting him. After confronting Red, Demakis learns he’s been double-crossed by Vargas and the syndicate, while Liz warns Samar that Red is playing her, unaware that she’s being tracked by a sniper. Finally, having won his latest showdown with Berlin, Red heads to a cabin in the woods where he finds his wife Naomi angrily awaiting his arrival.