Organ donations: keep that liver at home.

It's a quiet civil war - but lives may hang in the balance.

The question is: How best can human organs be distributed to those who need them to survive? Today, more than 57,000 Americans wait for hearts, livers, lungs or kidneys that could save their lives. And 4,000 die each year waiting.

The U.S. Department of Health and Human Services (HHS) proposed a policy last year designed to "break down geographic barriers" to organ transplants. Basically, it says organs go to the sickest patients first, no matter where they live.

The rules are not final, but states are quickly passing laws to stop them. Four have passed laws keeping donor organs within their states (Louisiana, Oklahoma, South Carolina, Wisconsin); six (Arizona, Kansas, Missouri, Nevada, Tennessee and Texas) are considering such laws.

Senator Mario Gallegos Jr. sponsored legislation that passed the Texas Senate to keep donated organs within the state. He says that new federal regulations would lengthen the times for Texas patients and also increase the fees necessary to move donated organs longer distances.

States that have changed their laws still allow organ donations with interstate agreements, but are in direct conflict with the proposed federal policy that says geography cannot be a primary factor in organ allocation.

With the laws, states also are positioning themselves for legal challenges. Opponents to the proposed federal rule say HHS overstepped its bounds to begin with.

Currently, organs are given to patients at local transplant centers, and 63 banks in the nation procure organs in their local areas and assign them to hospitals. When an organ becomes available, it is offered to people in the area, starting with the sickest. If there are no local patients, then it is offered regionally and then nationally.

Opponents of this federal plan point out that more than one transplant may be conducted on the sickest patients and the person still dies. Case in point was elderly baseball player Mickey Mantle who died two months after his liver transplant (which was necessitated by cancer).

Another major problem is that organs, such as livers, which are the most sought after for transplants, are only viable 12 to 18 hours and can only be transported short distances.

And according to an Associated Press poll, some areas do better than others when it comes to saving lives through transplants. In upper Wisconsin, for example, there were 146 organs donated (and transplants made) for every 1,000 deaths in a year while in Mississippi there were only 18 organs donated. In fact, three of the top five organ banks serve Wisconsin, Minnesota and the Dakotas. And that primarily is why the federal government wants to regulate the system and even out the statistics.

Meanwhile some in the organ transplant community are advocating a search for ways to increase donations. Pennsylvania became the first state that no longer requires hospitals to obtain family consent if the deceased has an organ donor card.

The state also is planning a three-year pilot program that would make donors eligible for $300 in state funeral benefits - the first program of its kind in the nation.