Variants: Death and Dying

After several years of play I have decided that death doesn’t pose the threat I think it should or have the consequences I feel it should have.
To address these issues I offer the following.
If you are playing in a campaign with these rules you won't usually need to keep track of any of this. Your GM will keep track of it for you.  Just know that death, for want of a better term, is deadlier.

Clarification: Lesser Death, Death and True Death

These definitions do not apply to standard D&D using RAW (Rules As Written). In D&D - Dead is Dead. I feel that it is more effective if there is a little more to it than that.

When a character dies their soul does not necessarily depart the mortal realm, at least not right away.  This makes it possible for spells like Revivify and Raise Dead to bring them back to life because the character isn't really dead.
This "not quite dead" state is called "Lesser Death".
When a character is in the Lesser Death state, they are unconscious and can't be healed or revived by anything but spells and effects that would raise them. For all intents and purposes they are "dead" - the only real difference is Revivify and Raise Dead can be used to bring them back.

Death results when the soul leaves the body.
The soul will eventually leave the mortal realm on it’s own - this takes 3 days or a number of days equal to the half characters Level (or hit dice, round up) plus their Wisdom bonus, whichever is higher (a 5th level character with a 14 Wisdom reaches True Death in 5 days).
This timetable replaces the 10 day limit as defined in the Raise Dead spell.

When the soul leaves the body there is still a connection between the two. When this connection is lost, “True Death” occurs.
A character immediately dies the True Death if the body takes catastrophic damage such as having their Brain or Heart destroyed or removed.
If you are using the Deadly Death Optional Rule there is a chance that certain spells intended to raise a character may trigger True Death instead.
Once a character has reached True Death spells like Revivify and Raise Dead will no longer work. Resurrection, True Resurrection or drastic measures such as Reincarnation or Wish are required to bring them back to life.

OPTION: Sudden Death 

Whenever your character is reduced to 0 Hit Points they must make a roll with a DC of 6 + 2 for every time they have been reduced to 0 since their last Long Rest.
Like a Death Save, nothing affects this roll.
A character who fails this roll dies, but not the True Death. They can be brought back by spells such as Revivify and Raise Dead.
If the character succeeds they are not killed instantly but they are still at 0 and must still make Death Saves as normal.

OPTION: Deadly Death

When an attempt is made to bring a dead character back to life using Revivify, Raise Dead, Resurrection or True Resurrection there is a chance that the spell won’t work.
When one of these spells is cast the target must make a special “Vitality roll” on a d20. Like a Death Save, nothing affects this roll.

• When Revivify used to bring a dead character back to life they make a roll that succeeds on a 2+. On a 1 the spell fails and they die the True Death.
• When Raise Dead used to bring a dead character back to life they make a roll that succeeds on a 4+. On a 1, 2 or 3 the spell fails and they die the True Death.
• When Resurrection or True Resurrection is used to bring a character who has suffered true death back to life they make a roll with a DC of 6 + twice the number of times they have been Resurrected before. If this roll is failed, the spell works but the target loses 1pt of Constitution permanently. On a roll of a 1, the spell fails and they can no longer be resurrected.  

OPTION: Exhausting Unconciousness  

Any time a character is reduced to 0 hit points they gain a level of Exhaustion. This should be recorded even if they die, because if they are Revivified the Exhaustion still exists.
Raise Dead clears all levels of exhaustion then inflicts the usual -4 penalty. It is possible for a character who has been Raised to gain new levels of exhaustion that stack with this penalty.

OPTION: Death Trauma  

Being brought back from the dead is traumatic. In this case we are talking about the truly dead - those whose spirits have left their bodies.
When a character is Resurrected (by means of Resurrection or True Resurrection) they need to make a Wisdom save of 15 + twice the number of times they have come back (so DC 17 the first time, 19 the second and so forth).

• If the save is failed, the character suffers long term madness for up to 6 weeks or for 1 play session (at the GMs discretion). 
• If the save is failed and a 1 to 5 was rolled, the character suffers indefinite madness. The effects are permanent. 

In neither case can spells be used to cure the madness. Only unusually powerful magic such as a wish or divine intervention will undo them. A quest could be undertaken to find a way in which case the GM will be obligated to come up with something.

OPTION: Unreliable Reincarnation  

The reincarnation spell can be used to bring a character back from true death but the affected character has to make a special DC 8 “Incarnation roll”. Like a Death Save, nothing affects this roll.

• If the save is failed, the spell works but the character’s personality undergoes a permanent, drastic change.
• If the save is failed and a 1, 2 or 3 was rolled, the character is returned to life as an animal. Memories and personality are lost. The effects are permanent.