Fellows: Career Profile

Dr. Donald Hricik - Transplant Nephrologist

Dr. Donald Hricik

I trained in the late 1970s and early 1980s – just after Medicare initiated coverage for dialysis and just before the introduction of cyclosporine, which revolutionized the field of transplantation. It was an exciting time when it became clear that we could prolong the lives of patients with ESRD and when career tracks in nephrology became diverse. I chose a clinically oriented career and, in my first faculty position at Case Western Reserve, actually had dual appointments in the Division of Nephrology and the Division of General Internal Medicine. My interest in clinical research began in earnest only when cyclosporine ignited the boom in solid organ transplantation, opening the door to tremendous opportunities for tracking the outcomes of transplant recipients, including complications of immunosuppression. It was only then – several years after fellowship training – that I chose to focus my career path on kidney transplantation. The vast majority of transplant nephrologists have worked and continue to work in academic settings – that’s where most of the programs operate. A career in transplant nephrology – whether purely clinical or research-based – implies an interdisciplinary approach, relying particularly on close relationships with academically oriented transplant surgeons. It is a unique interaction that is one of the favorite aspects of my job. My research career began with participation in industry-sponsored trials in kidney transplantation, but ultimately included investigator-initiated studies performed in collaboration with my colleagues in surgery and nephrology.

Currently, I am a Professor of Medicine and have been Chief of the Division of Nephrology since 1994. I was one of the first transplant nephrologists to become a division chief at a major US medical center, but several others have subsequently followed this career path – indicating that the field of transplant nephrology is one viable path towards leadership positions in academic medical centers. The field of kidney transplantation has matured and the training environment has changed since I was junior faculty member in the 1980s. In those days, someone with a few years of experience and interest in the field could walk into a medical directorship with relative ease. There were no accredited fellowships and documented experience was the only criteria for becoming a medical director recognized by the United Network for Organ Sharing (UNOS). Moreover, in my early career, I relied on self-training for designing studies and performing statistical analyses, and for writing grants and papers. Today, those seeking training in transplant nephrology would be wise to consider formal fellowship training in an accredited program. These training programs are important in allowing transplant fellows to identify research mentors early in their career. If I could do it again, I would have pursued some formal training in epidemiology and biostatistics. Although I chose a clinically oriented career, basic research in transplant immunobiology is another important route towards a successful career in the field. Importantly, the NIH has been increasingly dedicated to funding both basic and clinical research in transplantation, with patient-based research most often funded through consortiumbased funding mechanisms. Thus, networking with peers at other institutions is another key component to participating both in industry-sponsored multicenter trials and in NIH-sponsored clinical research in kidney transplantation.