What do you do with the Sims with the same name?

I don’t use mods or CC. And if that happens I just leave it. It would be different if it was the first and last name the same.

I leave names alone unless, for some reason, I change their gender. More than one sim with the same first name doesn't bother me. Even if they had the same first and last I wouldn't change it unless they were very close in appearance.

Once I had a Brownie troop with four girls named Sarah Elizabeth in real life. It happens. I just leave them alone.

I leave them alone. It's not like names are unique irl either. I personally know 3 people with the name Aki. They all went to same school with me and it wasn't even that big of a school lol.

First names can stay, having only sims with unique first names would be unrealistic.

When I have several sims with the same surname that's realistic too, but in this case I sometimes feel the need to make one of those take the partner's name upon marriage. What can mess with my usual rule of sims taking the surname of the partner that's higher in the pecking order (played sims > townies and "upper class" sims > "nobodys").

I always change them. The only time Sims are allowed to have the same name is when I have two Sims based on celebrities or book/tv/movie characters who happen to have the same name. Even then, I try to change them sometimes, like calling one "Doug" and one "Douglas," or whatever.