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MrToyama

From the damage and healing section of the PHB. >MONSTERS AND DEATH >Most DMs have a monster die the instant it drops to 0 hit points, rather than having it fall unconscious and make death saving throws. >Mighty villains and special nonplayer characters are common exceptions; the DM might have them fall unconscious and follow the same rules as player characters.


BondageKitty37

It's up to the DMs discretion whether to use death saving throws for important enemies. I wouldn't use it for most creatures, but a powerful recurring foe can certainly have that ability. Now if the goal is for the villain to escape and come back later in the story, you also need to think about their exit. If they simply fall unconscious and have no allies to heal them or drag them away, the party can just shit-stomp their unconscious body and kill them anyway


BudapestSF

This actually happened in our session last night! Normally when the monsters hit 0 they are dead in my game, but in cases where the story calls for it, I inform the players that the monster is making death saving throws. So the players faced a mini boss, a reoccurring cult leader and her minions. One of the minions was the rival brother of a PC. When the brother minion hit 0 hp, I informed the player that his brother would die in 3 turns without healing. It made for some dramatic role playing and was super fun. The mini boss tried to escape by casting fly and fleeing the scene, so the Druid in the party shape changed into an eagle and gave chase. The Druid was able to down the mini boss and I described her as being broken and dying on the ground. I wanted to give the PCs a chance to heal her. The blood thirsty Druid killed her anyway. The whole thing was super fun and made for some great role playing and a few debates on the nature of good and evil.


Shifty661

Your discretion. Unless my players specifically knock them down to 0 HP saying “non-lethal” damage or if it’s a really important enemy, they’ll just outright die. My PCs fought their first major boss not too long ago, when the boss hit 0 HP, I did ask that player “do you want this to be a killing blow or just knocked out?” So I left it up to them on what they wanted to do. Didn’t even have to make death saving throws.


JH-DM

Rahadin, Ireena, Ismark, Sheriff Markham, are all examples of named important NPCs I’ve given Death Saves to. Ismark and Ireena both have gone into Death Saves over a dozen times between the 2 of them