Dr. Donald Balfour arrived at Mayo Clinic in July 1907, the beginning of four decades of accomplishment in surgery and medical education. He became a junior surgeon in 1909 and was appointed head of a Mayo section of surgery in 1912. Dr. Balfour achieved international recognition, especially for upper gastrointestinal procedures, and authored the classical surgical text, The Stomach and the Duodenum. He also designed a widely used surgical table and a self-retaining abdominal retractor.

Dr. Balfour suffered from the debilitating effects of tuberculosis, which necessitated periods of rest and recovery. In 1933, he was forced to devote his remaining energy to medical education. Initially associate director of Mayo Graduate School of Medicine (1935), he subsequently served as the second director of Mayo's pioneering graduate medical education program, from 1937 to 1947.

He was prominent in the development of Mayo institutions. Besides serving as an incorporator and member of the founding boards, he chaired the Mayo Board of Governors from 1933 to 1936. Before his death in 1963, he received many honors and was known for his kindness, courtesy and honesty.