Reflection
At the opening of the film, we see Kathy standing in front of a window looking in on Tommy before his surgery. Then the image cuts to her in front of the window with the reflections of doctors over the top of her. The imagery shows that she does not want to focus on Tommy's surgery, only on the memories of the life that they've shared together.
Rain & Leaves
Romanek shows a wide shot of Hailsham in the rain with leaves from a tree in the foreground before cutting to Miss Lucy telling the children that their lives are made for organ harvesting, nothing more. The imagery tells us that the news Miss Lucy is about to present isn't good and the rain and cover of the leaves tells us that Hailsham isn't a place of love and nourishment, it is one covered in a secret.
Three's a Crowd
We see a shot of Ruth, Kathy, and Tommy sitting at a diner crammed next to each other in a booth. They've just been asked if they've had much experience with the outside world to which Ruth replies she has. But this imagery shows that they have no clue as they don't know how to sit, how to order food or make a decision about what to get.
In Between
Romanek composed a wide shot of Tommy and Kathy on a pier as the sun is setting. The colors and the presence of the sun and ocean show that there is life on this planet and Tommy and Kathy being on the grey pier places them in a spot of suspension neither belonging to life nor death. Which becomes their role as they are donors and nothing more to this world.
