It's not true that violent games are trying for realism with the violence. There are a couple of series that went down that path, such as Soldier of Fortune, bu

It's not true that violent games are trying for realism with the violence. There are a couple of series that went down that path, such as Soldier of Fortune, but most of them don't feature anything beyond blood and "rag doll" physics. The stories of most of these games are close to a hero fantasy. Having the people you shot scream in terrible agony as their organs fell out wouldn't exactly work with that theme.