In the nation's capital it is legal for doctors to act to preserve the organs of people whose hearts have stopped - even before family members have given permission for donation.

The Washington Hospital Center has done it six times in the past two years - surgically implanting catheters to flush ice-cold fluid into the kidneys of patients kept from brain death only by life-support equipment."It gives us an additional four hours to run down the family" for consent before the organs become unusable for transplant, said Bill Ritchie, the hospital's director of decedent services.

But top medical experts Thursday recommended national standards against such aggressive organ-procurement tactics unless, as in the District of Columbia, local laws are passed specifically allowing them.

"The best public policy would be to have consent," said Dr. Roger C. Herdman, senior scholar for the nonprofit Institute of Medicine, which made the recommendations after completing a study requested by the Health and Human Services Department.

Patients whose hearts have stopped beating could help solve the nation's shortage of transplant organs by providing 1,000 extra donors each year, said Dr. John Potts of Massachusetts General Hospital in Boston, who led the institute's research team.

"To ensure that these patients receive proper care, however, it is critical that all transplant organizations adopt a consistent approach that respects the wishes of patients and families," Potts said.

People whose hearts have stopped - most often because of injury from a car accident, homicide or suicide - but who are not brain-dead because of life-support measures, account for only about 1 percent of all organ donors.

To be successful, organ recovery from such patients must take place quickly. The opportunity is easily lost if family members cannot be reached for consent.

Organ recovery from patients who are brain-dead is far more common, because their beating hearts can continue to preserve other organs indefinitely while complicated emotional and ethical decisions are made.

But with more than 50,000 sick Americans on waiting lists for organ transplants - more than 4,000 of whom died still waiting last year - federally supervised organ procurement organizations increasingly have become aggressive about pursuing those whose hearts have stopped.

In some cases, hospitals have taken steps to preserve organs in such patients before family members could be found to give consent. But unlike in the District of Columbia, most have nothing so formal as a law to guide them.

The Institute of Medicine recommended the following national standards be established to ensure ethical practices and public trust in organ donation programs:

- Decisions about whether to use organ-preserving medical procedures on patients who are not brain dead should be made only with family consent, unless nonconsensual intervention is specifically allowed by law. Only the District of Columbia, Virginia and Florida have such laws.

- Discussion of organ donation with family members should take place only after the family has made an independent decision to withdraw life support.

- A five-minute wait should be required after life support is withdrawn and before organ recovery begins to ensure a patient's heart would not resume beating on its own.

- The doctor who declares death should not be involved in any way with an organ-procurement organization.

- Families should be allowed to attend the death of organ donors and should not be required to bear any costs associated with the donation.