So this is a little different then the past two installment of Things to Steal (Borrow), this is a mechanic I've brewed up in my games for my Dragonlands version of B/X, that can also be extended to 5th edition if I want to make it even rougher on my players.
First a little background, I've always been tinkering with D&D to get it closer to my ideal game/experience, one of the bigger concepts I've been tinkering with is Limb Health mostly via trying to tweak Dark Heresy's version of it, but it ended up being too convoluted at higher levels. My simple solution to achieve that gritty mood is via Death Saving Throws!
Instead of death or dying when you hit 0 Hit Points you get to make a Death Saving throw. If you roll equal to our lower than you Level, you live, however something nasty happens, either you lose an arm, your hand gets mangled, you lose an eye or something nasty, but hey, you lived! If you roll above your level, you die, that's it.
Now, I'm not going to give you a table of Injuries, you can find that all across the internet if you look, and I'd just be remaking the wheel, but poorly. But, I would just make up an Injury that makes narrative sense.
For older editions like B/X, it actually makes the Players heartier and more likely to live, barely, but if they do, they'll have a story they'll never forget. For newer editions, it will feel more dangerous, because you don't get to slowly die, you just die if you fail that save.
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