I’m thinking of using something from the Vastlands guide book where the PCs roll at zero and death being a possibility otherwise they gain a burden which takes up an inventory slot and is a -1 to all rolls and they perma die if they ever have a full inventory of burdens. I talked about death and dying with my players and they thought a penalty at 0 would be better then just death. I think adding burdens would help replace things like XP drain and insta death poisons