In an article that suggests something that can only be described as so-obvious-I-feel-stupid, the guys at Gnome Stew have written an article about using alternatives to outright death when the dice fall where they may.
Warhammer Fantasy Roleplay is famous for it’s maiming, and I know this from experience. It’s quite a lot of fun to see what sort of horrible disfigurement is going to befall a character. After a game-ending total party kill (TPK) recently in our D&D 4th edition sandbox campaign, this idea strikes me as all the more attractive. It would take some tweaking to apply it to 4th edition in particular due to it’s death save mechanic, and the players would obviously have to agree to the concept, but I think it could add some interesting gritty flavour (if that’s what you’re going for) and extend the life of the campaign in the even that horrible things happen to the group.
Check it out at Gnome Stew.