[9] The player takes the role of Hisao Nakai, an ordinary boy whose life changes dramatically after a heart attack caused by his long-dormant cardiac arrhythmia.

[10] The gameplay of Katawa Shoujo is choice-based, in which the player reads through text and occasionally has the chance to respond to prompts with a variety of preset responses.

Each of these paths chronicle Hisao's deepening and eventually romantic relationship (or lack thereof) with one of the five main female characters; these may variously end well, poorly, or neutrally.

[12][13] From January 2007, the sketch was discussed extensively on the 4chan image board, and a development group was assembled from users of 4chan and other internet communities, who are of various nationalities; not necessarily Japanese.

[5] Additionally, they announced that a second physical release would be sold by the Japanese translation team at Comitia 112 and Comiket 88 (May 5 and August 16, 2015, respectively, at Tokyo Big Sight).

On June 6, 2015, Four Leaf Studios announced the end of support and development for the visual novel and official translation projects, concluding with a final bug/typo patch.

They released the English script files in full and instructions on how to patch in and distribute any future fan translations into languages not included in the final official version.

[25] Four Leaf Studio continued supporting fan works officially, hosting selected artists at their Comiket booth while selling new content such as original artbooks and light novels based on the game, with the last attendance taking place in 2017.

He also meets Kenji Setou, his near-sighted hall mate; Shiina “Misha” Mikado, Shizune’s Japanese sign language interpreter and fellow classmate; Mutou, his out-of-touch science teacher; and Yuuko, the school’s exasperated librarian who works part-time at a local tea shop, the Shanghai.

Alternatively, if the player refuses to acknowledge any of them, Hisao spends the festival drinking whiskey on the rooftop with Kenji, and proceeds to fall off the roof to his death in a drunken stupor.

In this route, Hisao is advised to get exercise to help with his condition, and becomes Emi’s running partner on the school track in the mornings.

In this route, Hisao - who became an avid bookworm during his time in the hospital - bonds over this shared interest with Hanako, and spends the festival playing chess with her and later having tea with her and Lilly at the Shanghai.

While doing group work, Misha and Shizune inadvertently cause Hisao to reveal this to Hanako, who suddenly begins having a panic attack.

Distraught at this turn of events, Hisao talks it over with Lilly, who reveals that she will be heading to her home in Scotland to visit her ill aunt for a time.

Due to her absence and her upcoming birthday (which coincides with the anniversary of the fire), Hanako shuts herself in her room for several days.

The neutral ending occurs when Hisao ignores Lilly’s advice; upon going to Hanako’s room, the two play a chess game, reaffirming their friendship.

The good ending occurs when Hisao takes Lilly’s advice, ultimately not visiting Hanako in her room, instead devoting his time to studying for exams.

Lilly eventually returns, and to celebrate a long weekend, she invites Hisao and Hanako to spend some time in a guest house in Hokkaido.

The day after arriving there, the trio try to walk into town, when Hisao suddenly experiences another heart flutter that knocks him unconscious.

Hisao and Lilly spend their time in bliss as exams pass while Hanako joins the newspaper club and becomes more socially active, but this idyllic living is interrupted when Akira reveals she will be moving to Scotland to work at her father’s company.

Later, while having sex again, Hisao’s heart flutters again, which starts to become a regular occurrence seemingly ignited by alcohol he has frequently drunk with Lilly prior.

A week later, Lilly moves out of Yamaku, making amends with Shizune and giving a tearful goodbye to Hanako as she does; the neutral ending occurs here should the choices made throughout the route reflect as such.

In this route, Hisao helps Rin and Emi paint a mural for the festival and expresses interest in joining the art club to its supervising teacher, Shinichi Nomiya.

However, after learning about how Sae’s husband committed suicide due to his artistic devotion, a concerned Hisao visits Rin and discovers her masturbating on the floor.

In this route, after frequent pestering from Shizune and Misha, Hisao decides to join the Student Council despite the three of them being the only members, and spends the festival with them watching fireworks on the rooftop.

Hoping to properly connect with Shizune, Hisao begins taking a sign language elective and receiving tutoring from Misha.

At the same time, Shizune, fearing Hisao has become depressed due to his condition, repeatedly holds menial contests with him in the hopes of lifting his spirits.

Misha, who cut her hair during the trip, also begins acting increasingly distant and lethargic, especially after she and Shizune have an offscreen fight.

Raita mentioned that he had been "closely watch[ing] over" the production of the game and that he was "deeply affected" by the thought of the challenges that the development team had to overcome.

[39] Two previously unreleased bonus tracks, "When It's Hard to Smile" and "Carefree Days", were released separately on February 10, 2010, and December 24, 2014, respectively.