Kate Fitzgerald has acute promyelocytic leukemia. As neither her parents, firefighter Brian and lawyer Sara, nor older brother Jesse are a genetic match, Dr. Chance, Kate's oncologist, suggests designer in vitro fertilization. Anna is born as a savior sister. Beginning with the harvest of her umbilical cord at birth, over the next 11 years Anna donates compatible organs, blood, stem cells and tissue to Kate. Anna's life is one of hospitalizations, growth hormone injections, opioid painkillers, sleeping pills, bleeding, and infections. While Sara has no qualms over using Anna's body to treat Kate's, Brian is closer to Anna and has misgivings over their treatment of her. At age 15 Kate goes into kidney failure and Anna knows she will be required to donate one of hers. She realizes that having just a single kidney will restrict her life; precluding playing sports, drinking alcohol, maybe even having children, and putting her at risk should her one remaining kidney ever have an issue. Anna sues her parents for medical emancipation and the rights to her own body. Brian understands, though Sara is indignant. Attorney Campbell Alexander agrees to represent Anna as her guardian ad litem, suing for partial termination of parental rights. Campbell's covert epilepsy lends him sympathy to her predicament. Flashbacks detail Kate and Anna's close relationship and how Kate's illness has affected Jesse, who has run away from his summer camp. Kate meets a fellow cancer patient, Taylor, and they begin dating. They slow-dance at the hospital's prom for teen patients and later have sex. A few days later Kate is upset to have not seen Taylor since. Learning that Taylor has died, she attempts suicide by overdosing on painkillers but Anna stops her. Kate expresses hope that after she dies she will see Taylor. Kate requests to go to the beach one last time. Brian obtains permission and discharges her from the hospital for the day. Sara demands that Kate be returned to the hospital, but Brian refuses and threatens to divorce Sara if she does not join them. They enjoy one final family outing. At the hearing Jesse reveals that Anna is actually acting under Kate's instruction. Anna had wanted to give Kate her kidney but Kate, not wanting to live any longer, had persuaded Anna to refuse. Sara is forced to acknowledge what Kate has been trying to tell her: she is ready to die. Kate dies in her sleep later that day with her mother by her side. After Kate's death, Campbell reports that Anna has won the case. The family moves on with their lives. Sara, who had given up practicing law to look after Kate, returns to work, Brian retires from firefighting and counsels troubled youths, and Jesse receives an arts scholarship in New York. Anna reveals that every year on Kate's birthday, they go to Montana, which was her "most favorite place in the world.” She concludes that she was not born merely to save her sister, she was born because she had a sister, and that their relationship continues even in death.
Cast
Production
Upon the original creation of the film adaptation, sisters Dakota and Elle Fanning were cast to play Kate and Anna respectively. However, when Dakota heard that she would be required to shave her head for the role, she dropped out of the film as then did Elle. The two sisters were replaced, with Abigail Breslin taking on the lead role as Anna Fitzgerald and Sofia Vassilieva on the role of Kate Fitzgerald.
Reception
Critical response
The film received mixed reviews from critics. Rotten Tomatoes reports that 48% of reviews for the film were positive, based on 136 reviews, with an average rating of 5.54/10. The website's critical consensus reads, "My Sister's Keeper gets fine performances from its adult and child actors, but the director's heavy-handed approach turns a worthy emotional subject into an overly melodramatic tearjerker." Another aggregate review site Metacritic reported 51% positive reviews based on 28 reviews.
Box office
In its opening weekend it placed 5th with a total of $12,442,212, behind , The Proposal, The Hangover, and Up. The film left theatres on October 8, 2009 with a domestic total of $49,200,230 with a further $46,459,927 from foreign markets. It has grossed $95,660,157 worldwide.
