The planet Plateau, in the Tau Ceti system, was settled by humans some 300 years before the plot begins. On arrival, the crew of the first colony ship used the weapons aboard ship to force the colonists (awoken from suspended animation) to accept a dictatorship, and by the time of the story there is a firm class division between Crew and Colonists, held together by fear of 'Implementation', the secret police who take criminals and dissidents to the organ banks, where they are cut up for fresh organs to keep the Crew and docile Colonists young and healthy.

Much of A Gift From Earth revolves around Niven's idea that organ transplants would lead to a shortage of suitable donors, causing citizens to support widespread capital punishment for even trivial crimes, in order to ward off the effects of their own aging and death. This theme recurs in other Niven stories, particularly the Gil Hamilton stories.