Portrayals of brain death in film and television are as fictional as the characters, researchers say.

After reviewing films and TV shows featuring a storyline about brain death, they found that while 19 characters were declared brain dead, no portrayals showed a proper examination that would allow doctors to reach that conclusion.

"In most cases it was inaccurate and misleading," said lead author Dr. Ariane Lewis, a neurologist at NYU Langone Medical Center in New York.

The inaccurate and unprofessional portrayals could be a problem for real people faced, for example, with deciding when to donate a loved one's organs, or in understanding legislation on the topic, write Lewis and her coauthors - an ethicist and a fellow neurologist - in the American Journal of Transplantation.

Unlike living people in comas or in a persistent vegetative state, someone pronounced brain dead is legally dead. Brain death occurs when brain function ends and the body can only be kept functioning by machines.

Declaring a person brain dead requires an extensive examination set by the American Academy of Neurology (AAN) that looks for - among other things - the patient being comatose, lacking brainstem reflexes and not being able to breathe on their own.

Lewis said the new study builds on another piece of research that found descriptions of brain death in the press are often also incorrect.

"Once I did the media approach, I wanted to switch and do the film and television approach," she said.

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For the analysis, the researchers searched archives of the Paley Center for Media and the Internet Movie Database for film and TV show titles that mentioned brain death. After excluding irrelevant titles like those that used "brain dead" to refer to a person's intelligence, they were left with 34 titles. Of those, 24 were available for viewing.

Lewis and coauthor Dr. Joshua Weaver of New York Presbyterian-Weill Cornell Medical Center reviewed each broadcast and evaluated their portrayals of brain death.

Of 19 characters declared brain dead in the films and TV shows, none were evaluated using the AAN examination. Six characters were examined for coma, nine were tested for at least one brain stem reflex and two were tested for the ability to breathe on their own.

Both Lewis and Weaver concluded that only 13 percent of the reviewed films and TV shows gave audiences an accurate description of brain death.

The researchers also found that 17 films and TV shows addressed the topic of organ donation, but those discussions were "professional" only in a minority of cases.

"Everything you see on television isn't necessarily real," Lewis said. "I think many people believe what they see in medical shows."

If people's perspectives of brain death are skewed by these portrayals, they may be misinformed about news stories and also ill prepared to understand legislation involving the matter, the researchers argue.

Though few people will experience someone in their lives being declared brain dead in a hospital, Lewis said, these portrayals may cause them to misunderstand the situation.

Because movies and television "serve as a key source for public education," the study team writes, the quality of productions featuring brain death should be improved.

"For Hollywood in general, I think it's something to take into consideration, because the public thinks these productions are factually based," she said.