Miranda pulls all the surgical residents and interns for a "domino surgery," -- 12 kidney transplants in six O.R.s at the same time. "This whole surgery is a giant house of cards. If we lose one donor, we lose them all," Miranda advises the team.
Complications arise with one young man whose estranged father is paying him $10,000 to donate his kidney. Izzie complains to Miranda, but they all agree to turn a blind eye so that the surgery -- which is making national news -- can go on.
The surgeries are canceled when a female donor learns that her husband's donor is also his lover of three years and decides not to donate her kidney. Miranda reminds her that five other peoples' lives are on the line as well and the woman agrees to go ahead with the surgery.
A medical journal features Meredith and Derek's clinical trial -- but it's Derek's face that's on the cover for "The Shephard Method." She's bitter that Derek didn't give her credit and says, "You can't call it the Shephard-Grey Method because then people would think you had help!" Derek replies that as a second-year resident, she doesn't "deserve" the credit. Derek tells Miranda that Meredith is being "silly", but Miranda scolds him, "That girl worked her ass off for you and you got all the credit," and advises him that "thank you" goes a long way with "'silly, emotional' women." Derek gives Meredith a prized gift, a kidney in a jar, and tells her, "I couldn't have done it without you." Meredith forgives him but has not forgiven herself for not being as good a surgeon as her mother was at her age.
Erica and Callie finally have sex, but the next day Callie confides to Mark, " It was not good at all. I choked." Callie is shocked to hear that Erica considered the evening "fun" and that she wants to see her again tonight. Callie tells Erica that she might not be into the whole "girl touching" thing but then realizes that's not her problem.
"I like to be good at things," she explains to Mark, and asks him to show her what to do. "I'll show you the Sloan Method," Mark smiles. The next time she sees Erica, a newly emboldened Callie orders, "Take off your pants."
Alex and Izzie take sides over who's to blame for the rotten father-son relationship among the kidney patients. Izzie is clearly talking about Alex when she tells the father, "Some people are just broken. All you can do is try not to care too much so you won't be disappointed." The father crashes after the transplant and Alex, who had been taking the son's side, yells at him to make amends with his father before it's too late.
That night, Izzie confronts Alex. "It is not too late for us," she tells him, saying, "I care about you," over and over until he finally kisses her.
The residents each have to give up one intern to George. They squabble over who to keep and Miranda reminds them they weren't exactly the cream of the crop either. She calls Alex "lazy," Izzie "whiny," Meredith "depressing," and Cristina "annoying."
George's new residents give him no respect and Lexie is hurt that he didn't even ask for her. "You are a jerk. Screw you, Dr. O'Malley," she says in disgust.
Just as Cristina announces to Joe, "There are no real men left in the world," she overhears Owen, the military doctor, telling the bartender that he's, "Starting work tomorrow."