My Sister’s Keeper is a 2004 novel by bestselling author Jodi Picoult centered on the controversy of savior siblings. In the novel, Anna Fitzgerald fights for medical emancipation in order to have a choice in whether or not she will donate a kidney to her sister, Kate, who has leukemia. In 2009, the novel was adapted into a feature film released by New Line Cinema. The movie was directed by Nick Cassavetes and starred Cameron Diaz and Abigail Breslin.

This guide is based on the Atria Books e-book version of the text.

Content Warning: My Sister’s Keeper discusses difficult topics such as medical emancipation, painful medical procedures, suicidal ideation, and a suicide attempt. It also includes child death.

Plot Summary

Anna Fitzgerald, 13, has saved up money for weeks and has roughly $137. Anna makes an appointment with Campbell Alexander, a lawyer, intending to use her carefully-saved money to file a petition for medical emancipation. Campbell initially dismisses the precocious girl’s request, but Anna explains that she was conceived to be a blood and organ donor for her ailing sister but now does not want to donate a kidney. Campbell agrees to take the case but refuses the money.

Kate Fitzgerald, Anna’s older sister, was diagnosed with acute promyelocytic leukemia when she was two years old. Anna’s mother, Sara, met with doctors to conceive a donor to save Kate’s life; this child is Anna. Doctors used Anna’s umbilical cord blood to give Kate a transplant that placed her in remission for five years. However, when Kate is eight, her cancer returns, and Anna must donate leukocytes on three occasions in order to treat her sister. When the leukocytes fail to put Kate into remission, Anna is treated with growth factor in order to build up her bone marrow so a bone marrow transplant can be performed on Kate.

While Sara and her husband, Brian, are focused on Kate’s health and Anna’s donations, their oldest child, Jesse, is often pushed onto neighbors and relatives, growing up with a sense of failure for his inability to help Kate and feeling as though he is invisible to his parents. For this reason, Jesse acts out, often getting into trouble at school. Unbeknownst to his firefighter father, Jesse has begun lighting fires in abandoned buildings.

Kate has long been hospitalized because the treatments used to save her life have taken a toll on her kidneys. She is experiencing kidney failure, and Sara wants Anna to donate one of her own, but Anna is hesitant because of the long-term consequences of such a donation.

Sara is served the petition for Anna’s medical emancipation while attending to Kate at her dialysis session. She demands that Anna drop the petition and convinces Anna to say she will. However, the next day, Anna tells Campbell that she still wants to go through with the lawsuit. Sara and Campbell meet with Judge DeSalvo, who plans a hearing for the following Monday and appoints a guardian ad litem to help decide what is best for Anna.

Julia Romano, the guardian ad litem, is a former girlfriend of Campbell’s. She is hesitant to take the case for this reason, but sympathizes with Anna’s plight. Julia visits Anna and believes she is struggling to remain committed to the case because of her mother’s strong-arming. The guardian ad litem goes to Campbell and suggests he do something about separating Anna and Sara. Campbell files for a restraining order that will force Sara to leave the family home, but Judge DeSalvo refuses to grant it. Instead, Brian decides to move Anna into the firehouse with him.

Kate’s health continues to deteriorate as the day of the hearing comes. Several doctors testify that Anna is not old enough to make her own medical choices and that refusing the kidney will result in Kate’s death and negatively affect Anna’s own psychological health. Campbell hopes that Brian will testify that he doesn’t believe Anna should be forced to donate the kidney, but he surprises him by saying the opposite. Julia, however, gets on the stand and tells Judge DeSalvo that she doesn’t think anyone in the Fitzgerald family is capable of making such a complicated decision.

Campbell convinces Anna to testify. Anna reveals that Kate asked her not to donate the kidney because she is tired of being sick all the time. As Anna testifies, Campbell’s service dog causes a commotion. Not long after, Campbell has a grand mal seizure. The hearing is temporarily sidelined, with Campbell finally able to tell Julia what he’s been hiding since they broke up 15 years ago. However, Campbell insists on completing the hearing and finishes Anna’s testimony. Judge DeSalvo announces his decision, telling Anna that he will grant her petition for medical emancipation—under the condition that Campbell be her medical power of attorney to assist her in making medical decisions.

After the hearing, Anna stays at the courthouse to sign paperwork, then gets a ride home with Campbell. Due to rain and slick roads, Campbell and Anna end up in a car accident; Anna is declared brain-dead. Campbell allows Anna to become an organ donor, ensuring that one of her kidneys is given to Kate. Shortly after the organ retrieval, Brian and Sara remove Anna from life support.

Kate reflects on the past eight years. After her kidney transplant, her health has been stable with no new indications that her leukemia will return. Campbell and Julia got married; Brian struggled with alcohol for a while, but is now sober; Sara grieved, but is as strong as ever; Jesse graduated from police academy; and Kate herself is now a dance teacher who still misses her sister.