Death Stranding is an action game set in an open world environment, which also includes multiplayer functions. Kojima compared the genre to how his earlier game Metal Gear - now considered as a stealth game - was called an action game during its release because the stealth genre was not considered to exist at the time.

According to Kojima, one of the key aspects of the announcement trailer was the idea of a connection between life and death. He explained one of the main themes through a short story by KÅ?bÅ? Abe; The first tool created by humans was a stick, meant as protection by putting a distance between oneself and "bad things", and that the second was a rope, used to secure things one finds important. Kojima compared the main "tools" in action games - punching, shooting and kicking - to sticks, and that in Death Stranding, he wants people to communicate through the game equivalent of ropes. While the title refers to the phenomenon of cetacean stranding, "strand" is an alternative meaning for shore, and also stands for strings and connections.

When the main character, named Sam, dies, the player is sent to another world, referred to as an upside-down world submerged in water. Kojima suggests that when the player returns to the world of the living, anything they did or any damage that an explosion or the likes causes when the player dies remains persistent in the world and does not go away. Another element talked about is the existence of a type of rain, called "Timefall", with the ability to age or deteriorate whatever it hits. Another gameplay element talked about is the player's ability to interact with the environment and wander outside of the character's body, as well as recovering items when they die.