The plot originates in Almodóvar's earlier film The Flower of My Secret (1995) which shows student doctors being trained in how to persuade grieving relatives to allow organs to be used for transplant, focusing on the mother of a teenager killed in a road accident. The film deals with complex issues such as AIDS, homosexuality, transsexualism, faith, and existentialism.
The film was a commercial and critical success internationally, winning the Academy Award for Best Foreign Language in addition to the Golden Globe for Best Foreign Language Film and the BAFTA Awards for Best Film Not in the English Language and Best Direction (Almodóvar). The film also won 6 Goya Awards including Best Film, Best Director (Almodóvar), Best Actress
The film centers on Manuela, an Argentine nurse who oversees donor organ transplants in Ramón y Cajal Hospital in Madrid and single mother to Esteban, a teenager who wants to be a writer.
On his seventeenth birthday, Esteban is hit by a car and killed while chasing after actress Huma Rojo for her autograph following a performance of A Streetcar Named Desire, in which she portrays Blanche DuBois. Manuela has to agree with her colleagues at work that her son's heart be transplanted to a man in A Coruña. After traveling after her son's heart, Manuela quits her job and journeys to Barcelona, where she hopes to find her son's father, Lola, a transvestite she kept secret from her son, just as she never told Lola they had a son.
Almodóvar dedicates his film "To all actresses who have played actresses. To all women who act. To men who act and become women. To all the people who want to be mothers. To my mother."
Almodovar recreates the accident scene from John Cassavetes' Opening Night as the epicenter of the dramatic conflict.
The film was mainly shot on location in Barcelona.
The soundtrack includes "Gorrión" and "Coral para mi pequeño y lejano pueblo," written by Dino Saluzzi and performed by Saluzzi, Marc Johnson, and José Saluzzi, and "Tajabone," written and performed by Ismaël Lô.
The film premiered in Spain on 8 April 1999 and went into general theatrical release on 16 April. It was shown at the Cannes Film Festival, the Karlovy Vary Film Festival, the Auckland Film Festival, the Austin Film Festival, the Thessaloniki International Film Festival, and the New York Film Festival before going into limited release in the US. It eventually grossed €9,962,047 in Spain ($12,595,016), $8,272,296 in the US and $59,600,000 in foreign markets for a worldwide box office total of $67,872,296.
Wesley Morris of the San Francisco Examiner called the film "a romantically labyrinthine tribute that piles layers of inter-textual shout-outs to All About Eve, Tennessee Williams, Truman Capote, Federico García Lorca and Alfred Hitchcock, and beautifully assesses the nature of facades . . . Almodovar imbues his Harlequin-novel-meets-Marvel-comic-book melodramas with something more than a wink and a smile, and it is beguiling. His expressionism and his screenwriting have always had fun together, but now there is a kind of faith and spirituality that sexcapades like Law of Desire and Kika only laughed at . . . t contains a host of superlative firsts: a handful of the only truly moving scenes he has filmed, the most gorgeous dialogue he has composed, his most dimensional performances of his most dimensional characters and perhaps his most dynamic photography and elaborate production design."
Jonathan Holland of Variety called the film "emotionally satisfying and brilliantly played" and commented, "The emotional tone is predominantly dark and confrontational . . . But thanks to a sweetly paced and genuinely witty script, pic doesn't become depressing as it focuses on the characters' stoic resilience and good humor."
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