Why does Elara need the Saintess title?

Only the Silver Spring water reserved for the Saintess can halt her Wolf Soul Decay Syndrome.

Who receives the title instead of Elara?

Alpha Kael Ashborne gives the title and water to Rosalie, their adopted Omega sister.

He Left Me to Die, I Came Back an Heiress

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He Left Me to Die, I Came Back an Heiress — A werewolf Saintess with a fatal illness watches her mate give her cure to an adopted sister, leaving her one month to live.

Elara has been selected by the Moon Goddess as the Silver Moon Pack's Saintess for seven consecutive years. Each time, her intended mate Alpha Kael Ashborne awards the title and its exclusive Silver Spring water to Rosalie, their adopted Omega sister, claiming the honor will earn Rosalie pack respect. Elara's parents support the decision and dismiss her objections as selfishness. Unknown to them, Elara suffers from Wolf Soul Decay Syndrome, a condition only the Saintess's water can halt. With a single month of life remaining, she stops resisting their demands, letting them believe she has matured while she prepares for her inevitable death.

Quick answers

Why does Elara need the Saintess title?: Only the Silver Spring water reserved for the Saintess can halt her Wolf Soul Decay Syndrome.
Who receives the title instead of Elara?: Alpha Kael Ashborne gives the title and water to Rosalie, their adopted Omega sister.