The episode begins with Arizona and the others upset that Jackson has a bigger say than they do in hospital matters. Webber argues with Catherine about it, but she says she has made a good decision. Jackson shows up late to their meeting. Cristina suggests waiting for Hunt to join the conversation. Jackson says the foundation thinks new leadership would help morale, so Hunt will be let go. None of the doctors are happy to hear this. Jackson takes the position that they should be grateful the foundation saved the hospital.
Jackson gets into an argument with Meredith and Cristina and, in the end, they walk out. Cristina tells Hunt what just happened. Heather tells Cristina her UNOS is on the line with a heart and lungs for one of her patients. Stephanie reports to April about a new patient, Brad, who is 31 and has ALS. Brad, who is himself a doctor, says he's donating his organs, but Stephanie tells him he's nowhere close to brain dead. His mother tells them he wants to donate after his heart stops. He says he's being kept alive by a machine, which he wants to shut off. Hunt confronts Jackson about the suggestion that they're looking for new leadership. Hunt is upset that they're all discussing such things behind his back.
Derek explains to Hunt there are politics at play, but Hunt says he's tired of being lied to. Their exchange turns heated quickly, and Hunt says he's been trying to clean up the mess that Derek and the others made. Derek says that they shouldn’t even begin to get into who did this. Hunt realizes what Derek means, and turns to Jackson. He announces that he's quitting. Cristina chases Hunt down and he tells her he's done. Hunt says Derek is right, that it is his own fault. Cristina tells him no one is blaming him, but Hunt insists that some do. Jo and her boyfriend are debating who the real doctor is between them. Alex shows up in the elevator and asks about their patient.
Jackson finds Catherine in a meeting and tells her he doesn't understand the documents he's been asked to read. She says no one does, but he has to listen to the suits. The parents of Alex's patient, Jalen, the 16-year-old girl who's getting a kidney today, catch her kissing a teenage boy, who's also getting dialysis. They don't like it, but overlook it as Alex shares the news that she's getting a kidney. Jalen tells the boy, who doesn't seem happy. The doctors join up for an emergency meeting after Hunt's departure. Cristina admits she told Hunt and they ask her to keep their discussions private. Bailey tells Jackson about the Pegasus protocols for surgeries that are still in place. She wants him to change them because he's the boss now.
Cristina tells her patient about the donor heart and lung that are coming. The man, Mr. Schultz, has a rival patient who has also been waiting for a heart. He wants to talk to a supervisor. The men were neighbors and the other guy's wife left him for Schultz. Alex asks Meredith for a kidney procurement. The kidney is in Montana. Meredith tells Jo to book a plane to Montana and says they'll go together. April tries to talk Brad out of his decision. He says this is why he didn't tell her. He says that ALS is 100 percent fatal and, if he donates his organs, his death can mean something. Alex gives Jalen her medicine instructions. She reluctantly agrees to do whatever he says. He tells her about the side effects and she looks troubled. April asks Cristina whether she'd donate her organs if she was dying. Cristina says she thinks what Brad is doing is awesome. She's suddenly struck with an idea.
Meredith is on a plane, talking to Derek on a phone. She tells Derek that Alex is being a baby about the transplant. Jo defends Alex, saying he's just feeling abandoned by the other doctors. Jalen has locked herself in the bathroom, and there's no response. Her parents say she's giving them the silent treatment, but Alex hears Jalen's phone beep. He goes to the dialysis room and takes the boy's phone. Cristina and Heather explain to Schultz that Crimp is going to get Schultz's heart, but Crimp refuses. He gets up to leave. Cristina calls Meredith to update her on the transplant situation. Meredith and Jo walk into the O.R. in Montana, where the surgeons are wrapping up. They don’t respond when Meredith asks where the kidney is. Jo is demanding a kidney from another surgeon, but Meredith says the right kidney hopped a flight to Seattle.
Jalen agrees to let Alex into the bathroom. She says, after hearing the side effects, she's not ready. Alex reasons with her and, in the end, she is convinced. Meredith calls Alex and tells him the kidney is already on its way. Jackson is still overwhelmed, and Bailey says that she did her surgery her own way. Cristina brings him an authorization for her domino transplant. Alex comes over and asks Jackson who sent his kidney flying coach to Seattle. Jackson doesn't know what Alex is talking about. Bailey says he's talking about the protocol. She points out that Pegasus' policy states donated kidneys from outside a certain radius will be flown unaccompanied.
Webber tells Catherine that Jackson is drowning, and he is taking the hospital with him. Catherine asks him to calm down and says that Jackson will eventually manage. Webber tells her that, if Jackson fails at it this, it will follow him his whole career. She walks away. Jackson overhears the whole conversation. Cristina goes over to Crimp and urges him to get over his issues with Schultz. She tells him that he can beat Schultz by taking his perfectly good heart and outliving him. He gives in. Brad is telling his friends and family what's going to happen when his heart stops, and that the surgeons will only have five minutes to open him up to save his organs.
Derek and Cristina get into an argument about who's to blame, and she doesn't think it's about Hunt. Brad is wheeled to the O.R. His breathing tube is removed and he starts to convulse. Jalen's kidney is delivered to the hospital by a courier. Alex and Cristina battle over their transplants and who gets the O.R., which is the only one that is staffed. April comes out and tells them to shut up because her patent is dying in the O.R. next door, and he'd like to do it in peace. Jackson sees all this and suddenly takes a stand. He tells April to go back to her patient, who can take as long as he needs. Jackson tells Cristina to use O.R. 2 and tells Alex that his patient can wait, because heart and lungs trump kidneys. Alex isn’t happy about it, but, in the end, agrees. Meredith shows up later with the kidney and Alex says it's about time.
Jo leaves and Meredith takes a moment to tell Alex that she's sorry for everything, but they bought the hospital for him and everyone else. She tells asks him to drop the attitude because nobody wants to work with him anymore. Derek meets Hunt and tells him that nobody blames him for hiring that plane. Hunt reminds Derek that he blamed him for it that morning. Derek admits he is pissed about all that’s happened and he took it out on him.
Brad passes away. April starts the clock for harvesting his organs. His mother cries and hugs him. April reminds her they only have five minutes or this will all have been for nothing. April ends up having to pull Brad's sobbing mother away from him.
That night at the bar, Alex finds Jo and her boyfriend. He apologizes, and thanks her for working hard for the kidney. He offers to buy her a beer and she says she's all set. Alex leaves, and Jo's boyfriend notes she is distracted. Jo apologizes and laughs it off. Back at the hospital, Catherine tells Webber that Jackson stepped up. He says it was one day, but it's ultimately not fair to Jackson. They debate a bit about the issue. He eventually tells her she'll always know what's best for Jackson.
The doctors and Jackson sign the paperwork to formally become the new board. Jackson says he'd like to discuss some things he thinks are top priorities. He moves that they reinstate Hunt. He also announces that the E.R. will be reopened. He says that, from now on, the foundation will follow their lead. Jackson tells them he's got one more suggestion. He proposes that the hospital be named “Grey Sloan Memorial Hospital”. Everyone agrees, happily. The episode ends at this point.