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Players are blasé about dying

And they’re right to be! It’s common to drop unconscious and pop back up the next round to the sound of a friend’s Healing Word (which is usually a bad joke). In most combats, the death save system is a variable timer which informs the party how to prioritise healing fallen players. The top of the timer is never dramatic, so players only start seeing the tension as that candle burns low. I’m always OK with metagaming around that timer, but I’m not OK with players feeling numb to (or unaware of) the drama of dying.

The solution isn’t deadlier

I saw a great joke where someone had redacted and edited the Player’s Handbook so the section on death and dying read: 

“When your character reaches zero hit points, you are u̵n̵c̵o̵n̵s̵c̵i̵o̵u̵s̵ dead.” 

That’s how a lot of homebrew in this area looks: characters die more often.

• Healing from zero hit points gives you exhaustion.
• A death save succeeds on a roll of 15 or higher.
• Death save results are hidden from the players, so you don’t know how close you are to death. (Admittedly this last one is cool, though it feels too competitive for me.)

But I want character death to be special moment! I don’t want Dungeon Masters to build callouses in their party by stacking bodies, cutting off the sensation of a meaningful character exit.

Make death saves permanent

The drama of death in D&D lives in that three-save timer, but the rules drain that drama every time we reset the timer each combat. So let’s stop doing that. How would you feel about EVERY death save if you knew every failure was permanent? I’d pay attention. I’d lean forward at the table for your death saves, too. So here’s the rule to send your players:

“When you fail a death save, that failure is permanent.”

And to counteract the increased lethality, with the added bonus of beefing up lower-level survivability, you can add this, too:

“Instead of three death failures slots, you have five.”

Is this balanced?

I’m bad at math, but I wrote some code to play through 10,000 death saves to see how lethal this system is. Remember: we’re looking for three successes or a single natural 20, and if we roll a 1, it counts as two failures.
At 5 saves, you have ~6.4% chance to die.
At 4 saves, you have ~19.4% chance to die.
At 3 saves, you have ~40.2% chance to die.
At 2 saves, you have ~57.9% chance to die.
At 1 save, you have ~78.1% chance to die.