The point of a duel is not to find a winner.
The point is, it PROVES there was an insult and incident because both participants agree to fight over it. It draws a line in the sand and says, "You must apologize or cross it". The winner isn't "right" and the loser "wrong" (though at some times and places people said God guided the hand of the right) - it's merely a situation that can only be settled with blood.
It's not about killing your opponent, it's about clearing the air. It's about SHOWING up to the duel so your honor is intact. It's about how you behave when fighting the duel.
As such, the only adjustment I think is needed is players attitudes about being in one. Duels to surrender were put there precisely so you don't have to lose your character, and yet most players still won't use them.
Put more role play before and after and I think everything is fine.
(I cannot think of dueling without remembering a short story (by Maupussant?) about a man who had to fight a duel the next morning. He was a good shot, had reasonable expectations of winning, and yet became so worried that during the duel he might show some Human Emotion and let his hand tremble that he preferred to blow his brains out the night before rather than risk dishonoring himself by winning but giving any sort of visible sign of fear. Granted, this was 19th Century France with pistols, but you get the idea. )
