Born blind, Mag has been given surgically enhanced eyes by GeneCo at the cost of indefinite employment, though she is soon resigning. There, she meets Blind Mag, an opera singer and GeneCo's celebrity spokesperson. Rotti lures Shilo to GeneCo's fair with the promise of a cure for her disease. One night, Shilo secretly visits Marni's tomb and runs into the omniscient GraveRobber, who is digging up bodies to secrete Zydrate, a euphoric and addictive pain-killer that he sells on the street to keep up with his GeneCo payments ('21st Century Cure'). Shilo's overprotective father Nathan believes he killed Marni with a treatment he created for her illness – in truth, a jealous Rotti secretly poisoned Marni's medicine and blackmailed Nathan, promising not to arrest him if he agreed to become GeneCo's head Repo Man, though he has led Shilo to believe he is a doctor ('Legal Assassin'). Shilo has inherited a rare blood disease from Marni, which requires her to stay indoors, though she longs to see the outside world ('Infected'). Rotti's children Luigi, Pavi and Amber bicker over who will inherit GeneCo ('Mark It Up'), but Rotti believes none of them are worthy heirs and instead plans to give his fortune to 17-year-old Shilo Wallace, the daughter of his ex-fiancée Marni ('Things You See In A Graveyard'). The CEO of GeneCo, Rotti Largo, discovers he is terminally ill.

Clients who miss payments are hunted down by Repo Men, skilled assassins who 'repossess' the organs ('Genetic Repo Man'). The megacorporation GeneCo provides organ transplants on a payment plan.

By the year 2056, an epidemic of organ failures has devastated the planet.

Nathan repo the genetic opera