We are working to have a metadata sharing package for the concepts in a custom installation, however we have found that 3 similar concepts exist which are similar: For example Malaria there is 123 (PIH), CEIL (116128) and AMPATH (906) which all have the SAME-AS mapping.
At least in the CIEL dictionary, multiple SAME-AS concepts should be retired in favor of the CIEL version. In this case, 123 and 906 are retired and the 116128 concept has reference maps to both of the older concepts. I had thought that if you include the CIEL concept in an MDS package and you already have an existing concept (123 or 906) in your concept dictionary that you will be prompted to update the existing concept rather than create a new one. That was the purpose of adding the reference maps to existing concept IDs.