Death's door part 3: Dicing with death

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Variant death rules for 5e: knockout table

When you take damage that reduces you to 0 hit points, the DM rolls a KO roll, which is a d20 minus the amount of damage taken in excess of 0 hit points. For example, if you had 10 HP and take 15 damage, roll 1d20-5. This roll does not benefit from advantage, Luck, or any other bonus. You can not go below 0 hit points.

Knockout roll	Effect
-40 or less	Dead and dismembered: a body part is lost, or the body partially/totally destroyed, as appropriate. A sword might sever a forearm, while a white dragon's breath might cause you to freeze, fall, and shatter into a thousand pieces.
-39 to -30	Dead.
-29 to -20	Grievously wounded. Become unconscious and dying, automatically gain two death saving failures, and gain two levels of exhaustion. Gain a nasty scar.
-19 to -10	Seriously wounded. Become unconscious and dying, automatically gain one death saving failure, and gain two levels of exhaustion.
-9 to 0	Wounded. Become unconscious and dying, and gain one exhaustion.
1 to 5	Trauma. Save vs. unconsciousness (Constitution, DC 20). Whether you succeed or fail, you are dying, and you gain one exhaustion.
4 to 9	Die standing up. Save vs. unconsciousness (Constitution, DC 10). Whether you succeed or fail, you are dying, and you gain one exhaustion.
10 to 14	General anesthesia. Save vs. unconsciousness (Constitution, DC 10). Whether you succeed or fail, you are at 0 hit points but stabilized, and you gain one exhaustion.
15 to 19	On the ropes. Regain 1 HP, fall prone, drop anything you are holding in your hands, and lose concentration.
Natural 20	Adrenaline surge. Regain 1d6+CON hit points. Gain a cool scar.

Dying: At the start of each of your turns, make a death saving throw (d20, 10+ is a success, 20 counts as two successes, 1 is not special). After three failures, you are dead. You automatically gain one failure whenever you take damage. After three successes, you are stabilized. You are also stabilized automatically if you receive any healing, or are tended to (see below).

Stabilized: Death save tallies are reset to zero. While unconscious and stabilized, at the start each of your turns, make a DC 10 Constitution save. On a success, you regain consciousness. You also regain consciousness if you receive any healing, or are tended to. If you take any damage while stabilized, you are destabilized and start dying (make a new KO roll).

Tending to: Tending to a character’s wounds to improve their status requires you to use your action while within 5 feet. You must either succeed on a DC 10 Medicine check, or spend one use from a healer’s kit (automatic success).

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Rationale

The Death and Dismemberment table is a classic. The linked post lists numerous different versions of this concept, many with a 2d6 and big negative/positive effects at each end of the scale. I prefer the roll to instead be modified by the excess damage the hit deals. I like the idea that a giant's heavy hit is more likely to knock you out than a goblin's little cuts. But many little goblin cuts should still wear you down and make you increasingly less effective at fighting. That's your cue that you are dicing with death, and even if you manage not to fall down dead or unconscious, you'll bleed to death standing up - or perhaps get disarmed of your magic sword. Now do you attempt to grab it, or leave it but escape with your life? Now that's an interesting choice for a player to make!

You won't find many long-lasting injuries on this table. They seem to either make your character as good as dead/retired (I've seen a dwarf PC commit suicide because they were beaten and had their beard cut off), or else take them out of the adventure for weeks. Perhaps your mileage varies, and you have multiple characters per player who can sub in while the one rests their broken leg in town.

While this table has some positive outcomes, it still ups the attrition from the normal 5e rules. Although instant death only happens at massive damage, most of the outcomes give you exhaustion. As a reminder of what exhaustion does in 5e: three levels is disadvantage on all rolls, five levels makes you unable to move, and six means death. I have also made getting back into the fight a little harder, increasing the steps required to two, in comparison to 5e's usual one-step recovery. So that should balance out the fact that hitting a natural 20 can save you even from big hits. It's a reminder that combat to the death is unpredictable and risky, as it should be.

Next time I'll be looking at what can be done about that old chestnut: tracking initiative.