GENESIS 4:9: The changes made in the film adaptation of Jodi Picoult's My Sister's Keeper are noteworthy, if just for large they are. Picoult's ending has been abandoned altogether, and replaced with something considerably more straightforward. In addition, the guardian character has been eliminated entirely, along with Campbell's romantic subplot, replaced by a judge with her own complicated backstory. Other subplots get truncated as well (in particular, the brother's subplot is almost eliminated), and a new subplot added involving a romance between Kate and another cancer patient, which, while genunely affecting, adds a troubling "romantic" overtone to a key choice Kate makes in the film.
The major changes are so noticeable because at the start, the film is slavishly faithful to the book's structure of rotating narrators, with every character getting a voiceover segment to explain how they see it, and big chunks of prose seemingly being recited verbatim. It's not very cinematic to do so, and the performers give it a good effort, but are unable to overcome that obstacle.