Anna sells her locket at a pawn shop to add to the money she is saving to hire a lawyer.

Anna meets lawyer Campbell Alexander and asks him to help her sue her parents for rights over her own body.

Campbell agrees to represent Anna after she explains her parents want her to donate a kidney to her dying sister.

Sara is served Anna's petition papers by the sheriff while attending Kate's hospital dialysis session.

Judge DeSalvo schedules the medical emancipation hearing for one week away and appoints a guardian ad litem for Anna.

Jesse sets fire to an abandoned warehouse and watches from a distance as his father's fire crew responds.

Kate vomits blood and is rushed to the hospital, where doctors confirm she is in end-stage renal failure.

The court hearing begins; Campbell questions Sara on the stand about every medical procedure Anna has undergone on Kate's behalf.

Brian agrees to testify for Campbell, telling him he does not believe Anna should be forced to donate a kidney.

Brian shocks Campbell in court by changing his testimony to support Sara's push for Anna's kidney donation.

Anna takes the stand and reveals that Kate herself asked her not to donate the kidney.

Campbell suffers a grand mal seizure and collapses on the courtroom floor during Anna's testimony.

Judge DeSalvo grants Anna medical emancipation and names Campbell as her medical power of attorney.

Anna signs her emancipation paperwork at the courthouse and accepts a ride home from Campbell in the rain.

Anna is declared brain-dead after a car accident; Campbell uses his power of attorney to authorize her kidney donation to Kate.

Anna Fitzgerald, conceived to be a donor for her leukemic sister Kate, decides she wants the legal right to choose what happens to her own body. She hires lawyer Campbell Alexander, setting off a court battle against her own parents. As the hearing unfolds, witnesses testify about Anna's history of painful procedures and the consequences of refusing to donate. Anna's testimony delivers the story's most shocking revelation, and Campbell suffers a grand mal seizure at a critical moment. The judge rules in Anna's favor, but tragedy follows immediately after the hearing ends. A fatal car accident on rain-slick roads triggers an outcome none of the characters anticipated, one that fulfills Sara's wish for Kate while robbing the family of their youngest daughter forever.

Anna's fight for medical emancipation and its devastating resolution.

Sara notices a row of bruises on Kate's back and rushes her to the doctor, who sends the family to the hospital.

Kate is diagnosed with APL leukemia, and Sara promises Brian that she will not allow Kate to die.

Sara suggests to Brian that they conceive another child who would be a genetic donor match for Kate.

Anna is born on New Year's Eve, and her umbilical cord blood is immediately transfused into Kate.

Kate's cancer returns on her eighth birthday, and Anna must donate leukocytes three separate times to try to treat her.

Jesse tells guardian ad litem Julia about a Christmas he spent alone at a neighbor's house while his parents were at the hospital.

Brian rescues a young girl from a burning house in the middle of the night and carries her to safety.

Brian moves Anna into the firehouse to give her space to think, away from Sara's pressure at home.

Jesse is arrested for stealing a judge's car; Campbell negotiates a short probation and license surrender on his behalf.

Kate begins hemorrhaging again; Sara insists on pursuing arsenic treatment while Brian argues for letting Kate die at home peacefully.

Jesse pulls a homeless man from a burning boathouse and flees the scene as sirens close in.

Sara offers Anna a deal — no future donations if she agrees to the kidney transplant — and Anna refuses.

Campbell and Julia share their first kiss on a sailboat after having dinner together at the marina.

Brian confronts Jesse at home with arson evidence; Jesse breaks down and admits he could never do anything to save Kate.

Kate narrates the epilogue, reflecting that eight years after receiving Anna's kidney, her leukemia has remained in remission.

My Sister's Keeper is built on years of medical crisis and family strain that predates Anna's lawsuit. Kate's leukemia diagnosis when she is two years old sets everything in motion, leading Sara and Brian to make the extraordinary decision to conceive a genetically matched donor child. As Kate endures relapse after relapse, the family fractures quietly around her — Jesse is forgotten at neighbors' houses and holidays, while Anna's pain from procedures goes largely unacknowledged. Secondary characters like Julia and Campbell carry their own intertwined history, and Jesse's arson activities escalate until Brian is forced to confront the truth about his son. The story closes in the epilogue with Kate's reflective voice, surveying a family forever changed by loss but still moving forward.

The Fitzgerald family's history of hardship, neglect, and hidden struggles.

Sara and Brian learn that Jesse is not a genetic match for Kate, prompting them to consider conceiving a donor child.

Campbell mistakes Anna's appointment for a birth control inquiry before Anna corrects him and explains the kidney donation situation.

Sara accuses Anna of signing her sister's death sentence after learning Anna still intends to pursue the lawsuit.

Julia visits the Fitzgerald home, finds Sara dismissive and controlling, and pushes Campbell to file for a restraining order.

Anna sneaks into Kate's hospital room with Jesse's help, while Jesse pretends to be drunk to distract Sara.

Dr. Harrison Chance tells the Fitzgerald family that Kate will likely die within the week without a kidney transplant.

Brian tells Sara he plans to testify on Anna's behalf and admits he no longer believes Kate will get better.

Sara presents a child psychiatrist in court who testifies that refusing to donate would cause Anna lasting psychological harm.

Julia testifies that no member of the Fitzgerald family is capable of making an unbiased medical decision for Anna.

Campbell tells Julia — after being moved to chambers following his seizure — that he has had epilepsy since the night they broke up.

Anna reveals on the stand that Kate had attempted suicide because she was exhausted and tired of waiting to die.

Judge DeSalvo visits Kate privately at the hospital before returning to announce his ruling the following morning.

Anna tells Campbell during their drive that in ten years she simply wants to still be Kate's sister.

Brian arrives at a rain-slick car accident and crawls to the windshield, where he recognizes Anna critically injured inside.

Jesse graduates from the police academy years later, having transformed his destructive grief into a career protecting others.

Beneath the surface of Anna's lawsuit lies a series of pivotal moments that quietly redirect every character's path. From the early revelation that Jesse cannot be Kate's donor — sparking the decision to conceive Anna — to the courtroom moment when Julia admits no one in the family can make an unbiased choice, the novel turns on discoveries that shift power and change relationships. Campbell's long-hidden epilepsy is exposed by his own body at the worst possible moment, and Anna's testimony on the stand reveals the truth that Kate has been asking to stop fighting all along. Even after the ruling, the characters face one final, irreversible turn. In the years that follow, each surviving family member finds an unexpected path forward, with Jesse's transformation from arsonist to police officer standing as the novel's quietest act of redemption.

The key decisions, discoveries, and emotional shifts that reshape every character.