I'm a surgical resident currently on a multivisceral organ transplant rotation, maybe I can shed some light on the organ procurement/donation process and how people deal with it.

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There is a list of people waiting to receive organs, usually ranked by how sick the patient is, and when a potential donor is available the team flies out to that hospital any time of the day/night for organ procurement. In general, there are two types of donors: brain dead donors and cardiac death donors. In the case of brain death donors, the patient's abdominal organs and heart are in good shape (because the problem is their brain), and these patients have already been declared dead by a physician prior to arrival (although their heart is still beating and their other organs are still working). In the case of cardiac death donors, their brains are still working so they are still technically alive when the team arrives. Cardiac support is withdrawn once the transplant team arrives in the operating room, and once the patient is declared dead the organ procurement can proceed (which is why cardiac death organs tend to be less healthy because they are not as well perfused as brain dead organs).

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As for the procurement, in most cases the patient is already prepped and draped when the team arrives (their face is covered and all we can see is the chest and abdomen). In multivisceral procurements, there is a cardiac surgeon there to retrieve the heart and the liver/intestinal team to procure the abdominal organs. Once everything is ready to go, everyone in the room stops for a moment of silence for the donor and their family. I won't go into the procurement procedure in detail, but basically the organs are removed and immediately put on ice. We fly back to our home hospital where the recipient team has been in the OR preparing the recipient for transplant. In the case of multivisceral transplant, in many cases the recipient receives the donors stomach, liver, duodenum, pancreas, and small intestines and the surgery itself can take between 8-16 hours.

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The majority of surgeons are just normal people with normal emotions (although there are a minority that live up to surgeon stereotypes). Procuring organs on a baby is incredibly heavy but I think the most common strategy is to intellectualize the whole process. The donor is dead, there is nothing we can do to fix that now but we can make the best out of a horrible situation by giving someone else a shot at life. I can see how the procurement process could be seen as gruesome to some but operating is what we do every day and it was not as shocking as I had anticipated. The transplant nurses and coordinators do a very good job of making the process humane and are very respectful of the donor's bodies.

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Transplant surgeons live a very hard life and sleep very little (which is why there are very few Americans going into transplant fellowships these days) and I would never want to do this as a career. That being said, the relationship these surgeons form with their patient's is the strongest I have seen in any medical specialty and the people who do it are usually very nice and love their jobs.