My Sister's Keeper is a novel that tells the story of Anna Fitzgerald, a girl who was born specifically to provide blood and bone marrow to her older sister Kate, who has cancer. When Anna turns thirteen, she learns that her parents want her to donate a kidney to Kate for an operation that may not even save Kate's life, and could have serious medical repercussions for Anna. Anna decides to sue for medical emancipation from her parents, and the trial that ensues tests the bonds of the Fitzgerald family.
The story takes place in the fictional town of Upper Darby, Rhode Island in 2004. Anna Fitzgerald 's older sister, Kate , suffers from acute promyelocytic leukemia, a blood and bone marrow cancer. Anna was born as a savior sister specifically so she could save Kate's life. At first it is successful, but the cancer continues to relapse throughout Kate's life.
Anna is usually willing to donate whatever Kate needs, but when she turns 13, she is told that she will have to donate one of her kidneys. The surgery required for both Kate and Anna would be major; it is not guaranteed to work, as the stress of the operation may kill Kate anyway, and the loss of a kidney could have a serious impact on Anna's life. Anna petitions for medical emancipation with the help of lawyer Campbell Alexander , so that she will be able to make her own decisions regarding her medical treatment and the donation of her kidney. This is done on the advice of Julia Romano , the court-appointed guardian ad litem whose job it is to decide what would be best for Anna. Julia was once romantically involved with Campbell when they went to university together, but Campbell broke her heart when he left her. Unbeknownst to Julia, Campbell left her because he discovered he had epilepsy and thought she deserved better.
Meanwhile, Anna's brother Jesse , who has spent most of his life being ignored in favor of ill Kate or donor Anna, spends most of his time setting fire to abandoned buildings with homemade explosives and using illegal drugs. He is a self-confessed juvenile delinquent, which leads to Brian eventually confronting Jesse for his behavior.
During the trial, it is revealed that Kate asked Anna to sue for emancipation because she did not want Anna to have to donate her kidney now that Kate has been ready to die, but Sara can't seem to understand that, and because she believes that she will die anyway. The judge rules in Anna's favor, and grants Campbell a medical power of attorney. However, as Campbell drives her home after the trial, their car is hit by an oncoming truck. Brian, the on-call firefighter who arrives at the scene, retrieves an unconscious and injured Anna from the wreckage of the crushed car and rushes her and Campbell to the hospital. At the hospital, the doctor informs Sara and Brian that Anna is brain-dead and asks them if they have considered organ donation. Campbell steps in and declares that he has the power of attorney and that "there is a girl upstairs who needs that kidney." Kate is prepared for surgery, and Anna's kidney is successfully transplanted. Kate survives the surgery and remains in remission. Jesse has reformed and graduates from the police academy, despite his criminal record.