Three Rivers (TV series)

Development

Following the conclusion of the long-running NBC drama ER, CBS executives sought a new medical show. Carol Barbee was introduced via Curtis Hanson to a pitch by Steve Boman, a former transplant coordinator and Chicago newspaper reporter, for a drama centered on a transplant hospital. Barbee decided to develop the project, structuring it around three points of view: the donor's, the recipient's, and the doctor's. The show's Pittsburgh setting was chosen because the University of Pittsburgh Medical Center (UPMC) was considered the world's leading transplant center, and the city's three rivers provided an allegory for the three perspectives.

Barbee conducted research at The Cleveland Clinic with Dr. Gonzalo Gonzalez-Stawinski, who also tutored Alex O'Loughlin. Dr. Robert Kormos, co-director of heart transplantation at UPMC, also contributed input. Transplant pioneer Thomas Starzl, who visited the set, served as the inspiration for a fictional transplant pioneer revealed to be the father of character Dr. Miranda Foster. The pilot 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 interiors.

After the pilot, recasting occurred: Julia Ormond and Joaquim de Almeida departed, while Alfre Woodard and Amber Clayton joined. The pilot was ultimately dropped, and a new episode was shot for the television premiere. A high-tech hospital set for the ER and ICU was built on sound stages 19 and 20 at Paramount Pictures, where interior scenes were thereafter produced, though location shooting in Pittsburgh continued for exterior shots.