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Approvals 

1. Content Issue Summary 

As part of QI addressing the many issues in the 77465005 |Transplantation (procedure)| hierarchy. 

2. Analysis of Issue 

 Issues in 77465005 |Transplantation (procedure)| hierarchy.

1. Conflation of graft and transplant. 

129406001 |Transplantation - action (qualifier value)| is not a subtype of 129407005 |Grafting - action (qualifier value)| but 410820007 |Surgical transplantation - action (qualifier value)| is a subtype of Grafting - action.

Many grafting procedure concepts currently modeled with 129406001 |Transplantation - action (qualifier value)| should be remodeled with 129407005 |Grafting - action (qualifier value)|. For example, 6231003 |Grafting of palate (procedure)|.

Example  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259388/ uses graft and transplant interchangeably.

There is some grafting Editorial Guidance: Grafting

Flap procedures Editorial Guidance: Flap procedures

2. 129406001 |Transplantation - action (qualifier value)| is only a subtype of 129336009 |Implantation - action (qualifier value)| whereas 410820007 |Surgical transplantation - action (qualifier value)| is a subtype of 129406001 |Transplantation - action (qualifier value)| and 129407005 |Grafting - action (qualifier value)|

3. The definition of 'transplant' is challenging. It cannot be limited to a 'whole organ' as includes tissue transplantation and part-organ: for example,  174693008 |Transplantation of tail of pancreas (procedure)|.

 Many definitions include the idea of being transferred: A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/transplantation

Definition above including transfer misses 174808005 |Xenotransplant of heart (procedure)| and transplant of artificial material.

4. Inconsistency in use of 405813007 |Procedure site - Direct (attribute)| v 405814001 |Procedure site - Indirect (attribute)| - many (most) issues in hierarchy being created by this inconsistency.

5. No model available  - no guidance regarding use of  << 24486003 |Structure of transplant (body structure)| and << 261571005 |Tissue graft - material (substance)|

3. Additional issues identified  

Analysis by Yongsheng Gao - 

The model pattern hierarchy and report of transplantation procedures:

Open

• The M2 node of pattern T-P1-R1-R(Procedure site + Method) is only applicable to one concept, 119943006 |Endocrine gland transplantation (procedure)|. M12 is the subnode of M2, which has the pattern T-P1-R1-R(Procedure site - Direct + Method) and is applied to 223 concepts.  The question is, why is M2 node concept 119943006 |Endocrine gland transplantation (procedure)| modelled by “procedure site”?

• The M8 node of pattern T-P1-R1-R(Procedure site - Indirect + Method) is only applied to two concepts. The M13 is a subnode of the M8, which is applied to two concepts, with an additional role group for “procedure site - Direct” and “method”.  When should “procedure site - Indirect” be applied in the transplantation concept model? 

• Some concepts are modelled by more than three or more role groups. Should they be quickly reviewed if the additional role groups are intended?

• There are a few model patterns that are only applied to a single concept. Are they modelled correctly? 
  
  

4. Solution 

• Proposal to make 410820007 |Surgical transplantation - action (qualifier value)| a subtype of both 129338005 |Surgical implantation - action (qualifier value)| and 129406001 |Transplantation - action (qualifier value)| to separate grafting and transplantation. Remodel grafting to make a sibling of 410820007 |Surgical transplantation - action (qualifier value)| 

• We are moving away from 405814001 |Procedure site - Indirect (attribute)| in the graft procedures and flap procedures. Propose 405813007 |Procedure site - Direct (attribute)|

• Draft Model proposal: Options

1.  Consider adding new subtypes to  24486003 |Structure of transplant (body structure)|   but would need a 'transplant ' structure for all the various tissue types transplanted? Instead prefer guidance being published to state that << 24486003 |Structure of transplant (body structure)| should be reserved for disorders including sequelae when the transplant has been assimilated into the body or for procedures that take place on the transplanted organ or tissue that is already in situ in the body e.g. 440512006 |Biopsy of transplanted kidney using ultrasound guidance (procedure)|

For transplant procedures the guidance should state the target of405813007 |Procedure site - Direct (attribute)| is where on the body the transplant is being located /replacing.

or

2.  Substances could be expanded under 261571005 |Tissue graft - material (substance)| and used as a target for 363701004 |Direct substance (attribute)| in the model.

• Model pattern report above re existing content:

Task:
Analyse the model patterns by:

Combinations of attributes
Hierarchical relationships between patterns
Number of role groups greater than 3
One model pattern is only applied to one concept

The affected concepts are 

The template for modeling these concepts is located here: 

5. Construction 

6. Transition phase 

7. Glossary of Terms