diff --git a/tests/tx/designations.test.js b/tests/tx/designations.test.js
index d8861b51..c459a354 100644
--- a/tests/tx/designations.test.js
+++ b/tests/tx/designations.test.js
@@ -165,6 +165,7 @@ describe('Designations', () => {
 
     test('should respect quality values', () => {
       const langList = Languages.fromAcceptLanguage('fr;q=0.1,en;q=0.9');
+      designations.designations[0].status = 'active';
       const preferred = designations.preferredDesignation(langList);
 
       // Should prefer English due to higher quality
@@ -289,6 +290,8 @@ describe('Designations', () => {
 
     test('should prefer base over display for exact match', () => {
       const langList = Languages.fromAcceptLanguage('en-US');
+      designations.designations[0].status = 'active';
+      designations.designations[2].status = 'active';
       const preferred = designations.preferredDesignation(langList);
 
       expect(preferred.display).toBe('Base US English');
@@ -297,6 +300,7 @@ describe('Designations', () => {
 
     test('should fall back to language-region match', () => {
       const langList = Languages.fromAcceptLanguage('en-AU'); // Australian English not in designations
+      designations.designations[0].status = 'active';
       const preferred = designations.preferredDesignation(langList);
 
       // Should fall back to base English
diff --git a/tx/library/designations.js b/tx/library/designations.js
index ccdc1e56..8d4bbb41 100644
--- a/tx/library/designations.js
+++ b/tx/library/designations.js
@@ -610,35 +610,42 @@ class Designations {
 
       const matchTypes = [LangMatchType.FULL, LangMatchType.LANG_REGION, LangMatchType.LANG];
 
-      for (const matchType of matchTypes) {
-        for (const cd of this.designations) {
-          if (this._langMatches(lang, cd.language, matchType) && this.isDisplay(cd)) {
-            if (supplements && cd.source) {
-              supplements.add(cd.source);
+      for (const activeOnly of [true, false]) {
+        for (const matchType of matchTypes) {
+          for (const cd of this.designations) {
+            if (this._langMatches(lang, cd.language, matchType) && this.isDisplay(cd) && (!activeOnly || cd.isActive())) {
+              if (supplements && cd.source) {
+                supplements.add(cd.source);
+              }
+              return cd;
             }
-            return cd;
           }
-        }
-        for (const cd of this.designations) {
-          if (this._langMatches(lang, cd.language, matchType) && this._isPreferred(cd)) {
-            if (supplements && cd.source) {
-              supplements.add(cd.source);
+          for (const cd of this.designations) {
+            if (this._langMatches(lang, cd.language, matchType) && this._isPreferred(cd)&& (!activeOnly || cd.isActive())) {
+              if (supplements && cd.source) {
+                supplements.add(cd.source);
+              }
+              return cd;
             }
-            return cd;
           }
-        }
-        for (const cd of this.designations) {
-          if (this._langMatches(lang, cd.language, matchType)) {
-            if (supplements && cd.source) {
-              supplements.add(cd.source);
+          for (const cd of this.designations) {
+            if (this._langMatches(lang, cd.language, matchType) && (!activeOnly || cd.isActive())) {
+              if (supplements && cd.source) {
+                supplements.add(cd.source);
+              }
+              return cd;
             }
-            return cd;
           }
         }
       }
     }
     for (const cd of this.designations) {
-      if (!cd.language && this.isDisplay(cd)) {
+      if (!cd.language && this.isDisplay(cd) && cd.isActive()) {
+        if (supplements && cd.source) {
+          supplements.add(cd.source);
+        }
+        return cd;
+      } if (!cd.language && this.isDisplay(cd)) {
         if (supplements && cd.source) {
           supplements.add(cd.source);
         }
diff --git a/tx/workers/lookup.js b/tx/workers/lookup.js
index 6d52a4d6..6766a0ed 100644
--- a/tx/workers/lookup.js
+++ b/tx/workers/lookup.js
@@ -374,6 +374,12 @@ class LookupWorker extends TerminologyWorker {
             });
           }
 
+          if (designation.status && designation.status !== 'active') {
+            designationParts.push({
+              name: 'status',
+              valueCode: designation.status
+            });
+          }
           designationParts.push({
             name: 'value',
             valueString: designation.value
diff --git a/tx/workers/validate.js b/tx/workers/validate.js
index 40c5210e..8391df0e 100644
--- a/tx/workers/validate.js
+++ b/tx/workers/validate.js
@@ -1350,14 +1350,18 @@ class ValueSetChecker {
       if (vstatus.value && vstatus.value !== 'inactive') {
         result.addParamCode('status', vstatus.value);
       }
+      let mpath = inactive.path;
+      if (!mpath) {
+        mpath = 'code';
+      }
       if (!['inactive', 'DISCOURAGED'].includes(vstatus.value)) {
         let m = this.worker.i18n.translate('INACTIVE_CONCEPT_FOUND', this.params.HTTPLanguages, ['inactive', tcode]);
         msg(m);
-        op.addIssue(new Issue('warning', 'business-rule', inactive.path, 'INACTIVE_CONCEPT_FOUND', m, 'code-comment'));
+        op.addIssue(new Issue('warning', 'business-rule', mpath, 'INACTIVE_CONCEPT_FOUND', m, 'code-comment'));
       }
       let m = this.worker.i18n.translate('INACTIVE_CONCEPT_FOUND', this.params.HTTPLanguages, [vstatus.value, tcode]);
       msg(m);
-      op.addIssue(new Issue('warning', 'business-rule', inactive.path, 'INACTIVE_CONCEPT_FOUND', m, 'code-comment'));
+      op.addIssue(new Issue('warning', 'business-rule', mpath, 'INACTIVE_CONCEPT_FOUND', m, 'code-comment'));
     } else if (vstatus.value && vstatus.value.toLowerCase() === 'deprecated') {
       result.addParamCode('status', 'deprecated');
       let m = this.worker.i18n.translate('DEPRECATED_CONCEPT_FOUND', this.params.HTTPLanguages, [vstatus.value, tcode]);