The narrative is told from the perspective of Kathy H., a 31-year-old "carer" who looks after "donors" as they undergo a series of surgeries until they "complete"—a clinical euphemism for death.
As young adults, Kathy and her two closest friends, Ruth and Tommy, move to "The Cottages". This transitional phase is marked by their growing awareness of their purpose and a desperate search for their "possibles"—the original humans they were modeled from.
The first part of the novel focuses on Kathy’s childhood at Hailsham, a seemingly idyllic but isolated boarding school. Here, students are encouraged to create art, which is collected by a mysterious figure known as "Madame" for her "Gallery".