Dr. James Covington was a surgeon who performed transplant surgeries that helped criminals stay alive and a member of The Blacklist.
A graduate of Yale University and Vanderbilt University, Covington was a respected cardio-thorasic surgeon prior to his criminal career. Once one of the foremost practitioners of his field, he lost his medical license after diverting a pair of adult lungs from the donor pool and implanting them in a sick 10 year old girl as part of an experimental treatment. When the intended recipient passed away and the District Attorney made plans to indict him, he vanished before the legal system required his arrest and made a career of implanting organs into those who could not or did not want to get one by legal means, but had the money to find other ways. However, he did not sell the organs; he leased them to his clients at 500,000 dollars a year. If they failed to meet payment, he would track them down and take the organs back, even if it killed them. Covington justified his actions by saying the money he gained from criminals has been used to help other children who need transplants. This implies he does not charge the parents of children he saves and does not sell organs to criminals but instead rents them out to maintain a steady income source to further his cause of helping children.
In the beginning of the episode, one of Covington's clients, investment banker Paul Wyatt, meets with Ronald Cassell, one of Covington's henchmen, at a restaurant. He tries to convince the man to give him more time, but runs away when he realizes that the time will not be given. He is then caught by another of Covington's men and taken to Covington's operating room, where the doctor tells him his time is up and repossesses the heart. Wyatt's body is later found in a homeless encampment, his chest ripped open.
The FBI find a lead to Covington through the Wellbright Foundation, a slush fund he has been using to pay a coroner, Dr. Albee, for functioning organs extracted from autopsies. They create a fake hit-and-run victim and provide a pig's heart Cassell will deliver to Covington, allowing them to track him. However, he spots Liz and Ressler as they are tailing him and is later hit by a truck and killed trying to outrun them.
Using a medical file found on Cassell and an emergency number Reddington forced out of another client of Covington's, gangster Bernard “B.B.” Babbitt, the FBI are able to narrow down Covington's base of operations to a 5 block radius. Liz and Ressler find the place and are surprised to discover a number of child patients and 2 parents whose son, Daniel, is about to be operated on by Covington. They detain Covington, who is unapologetic for his actions and explains that all the money he has made through his organ transplant ring has gone into his real project: a service that provides children with adult organs to keep them alive, the same kind of operation that lost him his license. Liz and Ressler allow him to finish Daniel's operation before arresting him.
- Nirah Ahmad and James Covington became criminals to save the life/lives of children.