Death Stranding is an action game set in an open world, and includes asynchronous online functions. Kojima refers to Death Stranding as the first "strand game", an original genre characterized by the game's incorporation of social elements. Kojima compared this genre to how his earlier game Metal Gear—now considered a stealth game—was called an action game during its release because the stealth genre had not been established.

The player controls Sam Bridges, a porter for a company known as BRIDGES. The player is tasked with delivering supply cargo to various isolated cities known as KNOTs, as well as isolated researchers and survivalists, while also connecting them to a communications system known as the Chiral Network. The player is evaluated by the company and recipients based on their performance (including via "likes" similar to social networks), including whether the cargo was delivered, and if it is intact, among other factors. These merits are, in turn, used to level up the player's statistics, such as stability and weight capacity, and increase their standing with individual locations and characters (which can improve rewards). How cargo is packed by the player, and the overall weight being carried, affect Sam's ability to navigate through the environments.

This is the Director's Cut version released for Playstation 5.