Summary
A great game that will never have the large audience it deserves.
The Good
First off, we need to get two important things out of the way regarding this game. The first item is a spoiler, so if you already know that you are going to purchase _Kana: Little Sister_, then just stop reading now. This isn't the review for you.
For the still-curious, this is a spoiler that could make or break whether you even consider playing this game, so I think it's important enough to mention. So here goes...
There is ABSOLUTELY NO INCEST in this title, thanks to a convenient plot twist. I consider this worth saying because I knew it before I played the game, and it did not hurt my enjoyment - and more importantly, had I not known, I wouldn't have played the game at all. And that really would have been a shame because this might be the best bishoujo game ever released in the US.
Second item: If you play bishoujo ("hentai") games for titillation, brother, this isn't the game for you.
There is plenty to like about _Kana: Little Sister_, but talking about a game of this type, nothing matters if the story doesn't hold up. I'm happy to report that it does. If you're the type who might enjoy a heart-rending romance, this game might be just the ticket for you. I would put it on par with most films in that regard, and it is head and shoulders above just about any computer game romance (of which, interestingly, you'll find little outside of bishoujo games). Personally, I generally don't need a three-hanky computer game, and between that and the incestuous title, I stayed away from this game for a long time. I shouldn't have. Although the story doesn't really have any moments that I would consider "fun", I also wouldn't call it depressing. It might actually change the way you think about certain things. Life, sickness, death - it's highly unusual for a game to try to tackle the "big questions", but this game actually does so with quite a bit of grace. And yes, you might just be a bit misty-eyed at the end.
In brief, _Kana_ is the story of siblings Taka and Kana, and it follows their progression from childhood into young adulthood. Kana, two years younger than Taka, is afflicted with chronic renal failure, which in layman's terms means that her kidneys do not function properly, and that she will likely die while she is still young. Taka is a callous young child who can't stand Kana or the attention their parents shower upon her. An incident during a family trip makes Taka realize how fragile his little sister really is, and it changes their relationship forever.
For those of you who may be unfamiliar with bishoujo games, _Kana_ plays basically like a "Choose Your Own Adventure" novel. The game features large hand-drawn illustrations and a scrolling story that occasionally stops and allows you to make a choice, resulting in a plot branch. Although it is more or less an adventure game, this means something very different in Japan than it does here. There are no puzzles, per se, and overall there isn't a great deal of interactivity. Your choices have a far greater impact on the story here, however, than they do in most bishoujo games. You will make about 30 such decisions in the game. _Kana_ plays at its own pace, and it will probably take you around 4-6 hours to play it through the first time. In subsequent plays through, you have the option to automatically fast forward through story elements you have already seen. The game will automatically stop for a plot branch or event you haven't seen yet. Since the game does little to clue you in as to which choices will drastically change the course of the story, you will be playing this game for quite a while unless you resort to using a walkthrough. None of the endings are bad, but you will not see the best ("True") ending your first time through the game.
Endings, plural? That's right. _Kana_ has six of them, to be exact, although only four really count. There are three "real" endings, plus three variations of a fourth ending which can be best described as taking place in an "alternate universe". You also get to see a short epilogue, one you have unlocked enough of the endings. The great thing about bishoujo games as compared to traditional American adventure games is that while so many American games are content to give you a mind-blowing intro movie and a thirty-second ending (Quest for Glory V being the all-time worst offender here, IMO), bishoujo games often go all-out to make the ending the best part of the game. Nowhere is this more evident than in _Kana_. Each ending is very long, highly emotional, and features the best graphics in the game. This is the first bishoujo game I have ever played that kept me glued until I saw every ending. Even if you don't go that far, you will play the game through more than once because you won't see the best ending the first time. This makes the replay value quite high, and trust me, once you see the best ending you'll agree it was worth it. Especially after seeing the normal ending, which just might leave you bawling on your keyboard.
While the story is obviously the best and most important aspect of this game, the graphics are also worth mentioning. Unless you are experienced with bishoujo games or early non-animated graphic adventure games (from Telarium, et al), the still hand-drawn frames might take some getting used to. The artwork in this game is simply gorgeous though, and I have seen only a few bishoujo games that can compare. If you like great hand-drawn 2D computer graphics, it simply doesn't get much better than _Kana_.
That's all there is to bishoujo games, really - story, graphics, and sound. I can't comment on the sound, because I play bishoujo games with the sound off. Stretch a half hour of music into a five hour game, and it's going to get repetitive no matter how good it is; and I read much faster than the voice actors speak.
The Bad
Actually, nothing. They probably could have taken the sex scenes out, though. I already have experience with bishoujo games, so I'm not squeamish about graphic sex in a computer game. It isn't necessary here though, and it limits the potential audience of an otherwise top-notch game. On the plus side, there are only a few sex scenes, and the artwork therein is quite beautiful.
The problem with putting sex scenes in a game like _Kana_ is that you automatically exclude so many people from experiencing a great story. Your average _King's Quest_ fan isn't going to touch a bishoujo game. Basically, bishoujo games are only played by people who have already played bishoujo games, and curious fans of Japanese animation. But then, many bishoujo gamers prefer the typical 'pick your favorite girl from a harem and proceed to woo' type of game, and will be automatically turned off by the incestuous title, limiting the potential audience even further. I myself actually was the same way, refusing to try this game until it was practically the only one left that I hadn't looked at.
Which is really too bad, because the bishoujo game genre could actually use more titles like _Kana_, not less. It would go a long way toward people thinking of the bishoujo game as a legitimate art form, rather than just cartoon porn.
The Bottom Line
Bishoujo games are like James Bond films. They are more aptly judged in relation to one another, than they are to the industry as a whole. Taken in that regard, _Kana_ could be the best bishoujo game ever released for the Western market. If you are an anime fan wondering what all the fuss is about, make _Kana_ your first foray into bishoujo games and I bet you won't regret it. Judged as an adventure game, _Kana_ rates about a 4 - 4.5/5. Judged as a bishoujo game, it's an easy 5/5. It's just too bad that most will write it off as a niche title within a niche genre.