The movie starts out with the main character, Ben Thomas, (Will Smith), making a 911 call to report a suicide. When dispatch asks the identity of the victim, Ben responds, "I am." Then goes through a series of flashback stories to show how he got to that point.
Early in the story, Ben is shown on the phone trying to start a fight with a blind telemarketer and pianist named Ezra Turner (Woody Harrelson). Despite attempts by Ben to infuriate him, Ezra does not fight back while taking some of Ben's stinging abuse and then hangs up the phone. Ben then recites the names of seven people from a list that was shown before his call to Ezra.
The movie then flashes back to the start of Ben's journey. He is an IRS agent who uses his position of power to get close to people and learn more about them. First, he meets Stewart Goodman (Tim Kelleher), a man who needs a bone marrow transplant. Goodman runs a nursing home, and upon his trip there, Ben realizes that Goodman is very cruel to his patients. He forced an old lady to take a drug against her will, and punished her by not letting her take a bath or shower. Ben angrily confronts Goodman about this and storms out. Goodman thinks all he is losing is time to pay his medical bills.
Ben then visits his friend Holly and with her help, he finds Connie, who is being abused by her boyfriend. He tells her he can drastically change her and her children's lives, but she refuses his help. Ben seeks out another friend of his, named George, who is on dialysis because of a bad kidney. Because Ben has learned that George has been raising money to give college scholarships to high school students, he decides to donate one of his kidneys to him. Connie eventually calls Ben, sounding destitute. Ben convinces her to take her family to his home (It was shown earlier that Ben decided to move out of his house and into a motel room so that he could give his house to a deserving person), where they will be safe from her boyfriend. She drives to her new home with her family, along with the deed to the house given to her by Ben.
Ben also seeks out Emily Posa (Rosario Dawson), a woman whose heart is failing. He finds Emily at the hospital and follows her to her room. He observes her and another young patient named Nicholas, who also needs a bone marrow transplant. After Emily confronts Ben, he tells her he is from the IRS and that she hasn't paid her taxes because of her mounting medical bills. With time, Emily and Ben start a relationship. Ben asks the hospital staff about her survival chances and is told that, given her blood type, Emily only has a 3-5% chance of finding a matching donor.
One rainy night, Ben is confronted by his brother, who is actually the real Ben Thomas. Will Smith's character's name is really Tim. Tim stole his brother's identification in order to use the IRS badge to find the people he's been looking for. After learning Emily's prognosis, he goes back to his apartment and makes the very same 911 call seen at the beginning of the movie. He fills the tub with ice water, climbs in and then drops in a box jellyfish. As the jellyfish stings him, the events in his life that prompted his suicide are shown. While riding in a car with his fiancée, he gets an email/text from work. While looking at his cell phone, he drifts into another lane and into oncoming traffic. The ensuing wreck kills his fiancée, as well as six other people who were riding in the van his car hit. Because of Tim, seven people died. This is the list that Tim was reciting after his heated conversation with Ezra. There are also constant flashes to newspaper clippings he's collected of these seven innocent lives.
With the reason for Tim's suicide explained, the paramedics arrive and take him to the hospital, where he dies. Emily receives his heart via a transplant. This is the reason why he fills his tub with ice water; in order to properly preserve his heart after his death.
At the end of the movie, it is revealed that Tim's brother, the real Ben Thomas, also needed a double lung transplant and that's what got 'Ben' started in donating his organs. He also donated part of his liver to an ailing woman, Holly, who is shown earlier in the movie. Emily cries hearing this news. She decides to seek out Ezra. When she finds Ezra, he is playing the piano at a big event with a children's choir performing behind him. He is no longer blind. Ben gave him his eyes. Gone are Ezra's blank blue eyes; now he has 'Ben's dark brown eyes. Ezra realizes who Emily is and as tears roll down her face, they embrace and the movie ends.
Tim Thomas had decided long ago to commit suicide and decided to donate his organs, but only to 'good' people who were deserving of such a gift. Hence, Tim tempted Ezra to get angry and discovered he was a good man. Tim refuses to help and did not donate his bone marrow to the caretaker Stewart Goodman, because he was a 'bad' man.
The seven people Tim helps are Emily Posa (to whom he gives his heart), Ezra Turner (to whom he gives his eyes), Ben Thomas (to whom he gives his lung), Holly (to whom he gives his liver), Connie (to whom he gives his house), Nicholas (to whom he donates bone marrow) and George (to whom he donates a kidney to in order to get off dialysis). Hence the title of the movie is finally revealed: 'Ben' Thomas donates seven pounds of flesh in order to seek redemption for the seven innocent lives he took that rainy night.
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