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Death and Dying Edit
This variant takes away some of that predictability. No longer does a dying character have a set number of rounds to live. This heightens the tension in combat when one of your allies has fallen, because you don't know exactly when his clock is going to run out.
0 Hit Points Edit
With this variant, characters can't be reduced to negative hit points - 0 is the maximum. There is no automatic hit point total at which a character dies. Instead, any character who takes damage that reduces his hit points to 0 must make a Fortitude save to avoid falling unconscious or dying.
The Fortitude Save Edit
When a character's hit points are reduced to 0, he must attempt a Fortitude save (DC 10, +2 per 10 points of damage dealt by the attack or effect). Success means the character is disabled; failure indicates that he is dying. Failure by 10 or more means the character is dead. (If the character rolls a natural 1, he is dying. Calculate the numeric result; if he missed the DC by 10 or more, he is dead.) The possible results of the save are as follows.
Disabled: A disabled character is conscious, but can only take a single move or standard action each turn (but not both, nor can she take full-round actions). She moves at half speed. Taking move actions doesn't risk further injury, but if a disabled character takes any standard action (or any other action the DM deems strenuous, including some free actions such as casting a quickened spell), she must succeed on a Fortitude save (against the same DC as the save made when reduced to 0 hit points) to remain disabled; otherwise, she becomes dying after she completes the action.
If a disabled character takes any lethal damage, she must make a new Fortitude save (DC 10, +2 per 10 points of damage dealt by the attack or effect), but any result other than dead means the character is now dying. A disabled character who is dealt (or who is currently suffering from) any nonlethal damage becomes unconscious (since the character's nonlethal damage now exceeds his hit points) but does not begin dying.
Dying: A dying character is unconscious and near death. Each round on his turn, a dying character must make a Fortitude save (DC 10, +1 per turn after the first) to become stable. If the character fails the save, he dies. If the character succeeds on the save by less than 5, he does not die but does not improve. He is still dying and must continue to make Fortitude saves every round.
If the character succeeds on the save by 5 or more but by less than 10, he becomes stable but remains unconscious. If the character succeeds on the save by 10 or more, he becomes conscious and disabled. Another character can make a dying character stable by succeeding on a DC 15 Heal check as a standard action (which provokes attacks of opportunity).
Stable: A stable character is unconscious. Every hour, a stable character must succeed on a Fortitude save (DC 10, +1 per hour after the first) to remain stable. If the character fails the save, he becomes dying. If the character succeeds on the save by less than 5, he does not get any worse, but does not improve. He is still stable and unconscious, and must continue to make Fortitude saves every hour.
If the character succeeds on the save by 5 or more, he becomes conscious and has 1 hit point. Another character can grant a stable character a +2 bonus on his Fortitude saves to remain stable by tending to him for at least 10 minutes during the hour between saves and by making a DC 15 Heal check.
Dead: A dead character's soul immediately departs the body, and getting it back into the body is a major hassle. Unless you have access to powerful divine magic, you can't do much with a dead character except go through his pockets for loose gold pieces.
A disabled, stable, or dying character has 0 hit points. Healing that raises her above 0 hit points makes her conscious and fully functioning again, just as if she had never been reduced to 0. A spellcaster retains the spellcasting ability she had before dropping to 0 hit points. (Of course, a character suffering from nonlethal damage equal to or in excess of her current hit points must still deal with the ramifications of that state; see Nonlethal Damage.
For example, Lidda is smashed by a hill giant's club for 26 points of damage, but she only has 14 hit points left. She is reduced to 0 hit points. She must immediately attempt a DC 14 Fortitude save (base DC 10, +4 because the damage dealt was at least 20 points but less than 30 points). She rolls a 5, so she is unconscious and dying. (Had she rolled any worse, the attack would have killed her outright.)
On her next turn, she must succeed on a DC 10 Fortitude save to become stable. She rolls a 13, which is enough to remain dying but not good enough to become stable. Next round, the DC increases to 11, and she rolls a 16. Since that result exceeds the DC by at least 5 points, Lidda becomes stable but remains unconscious. Assuming that she isn't healed by her friends (or slain by her enemies) in the meantime, she must succeed on a DC 10 Fortitude save 1 hour later to remain stable.
Massive Damage Edit
If a single attack deals sufficient damage to force a saving throw against massive damage (typically 50 points, though if you use a variant system - see Massive Damage Thresholds and Results, - that amount may vary dramatically), the target of the attack makes a Fortitude save as normal. If the save fails, the target's hit point total is reduced to 0, and he must immediately attempt a second Fortitude save (DC 10, +2 per 10 points of damave dealt by the attack or effect) to determine if he is dead, dying, or merely disabled (as outlined above).
For example, Tordek is blasted by the fiery breath of an old red dragon. Failing his Reflex save, he takes 88 points of fire damage. Thankfully, Tordek wears a major ring of fire resistance, which reduces this damage by 20 points to 68. This number is far lower than his current hit points, but is enough damage to trigger a DC 15 Fortitude save due to massive damage. Unfortunately, Tordek rolls a natural 1 on the saving throw and is reduced to 0 hit points. He must now attempt a Fortitude save to see if he is merely disabled, dying, or if this attack slays him outright. The DC is 22 (base 10, +12 because the damage dealt is at least 60 but not 70 points). This time Tordek rolls a 23, which is good enough to remain disabled. Tordek remains conscious, but may attempt only a standard action or a move action (plus free actions) each round, and if he takes a standard action, he must make another DC 22 Fortitude save to remain disabled after taking that action. If he fails that save, or if he takes even a single point of lethal damage, he is rendered unconscious and begins dying (or may be slain outright).
Behind the Curtain: Death and Dying Edit
This variant system increases a character's chance of surviving in combat against monsters that deal out tremendous amounts of damage per attack, since any character brought to 0 hit points against such a creature has a chance of survival. It eliminates the fear that every high-level character that faced: taking damage from a creature's attack that knocks him down close to 0 hit points, knowing that a second attack is coming and that it will probably deal enough damage to send him well below -10 hit points.
This variant also reduces some of the swing factor of massive damage, since a single blown save won't make the difference between life and death. In fights against monsters who can routinely deliver 50 or more points of damage per hit - not terribly uncommon at higher levels - this keeps combat from being a grim game of "Who will be the first to roll a natural 1?"