Objective: We performed a retrospective observational cohort study including a matched control group. We included 1,285 living kidney transplant donors from seven tertiary hospitals and a matched control group consisting of the same number of health screening examinees with similar baseline clinical and socioeconomic status from 2003 to 2016. Changes in employment status and household income were identified from the linked claims database, which includes employment and economic status information. The outcomes were compared between the donor and matched control groups on an annual basis using multivariable logistic regression analyses adjusted for various clinicodemographic characteristics. Methods: The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of the sample was male. The living donors were at higher risk of being unemployed or struggling to maintain employment during the first two years after donation [e.g., first-year loss of employment, odds ratio (OR) 2.27 (1.55–3.33)]; however, this situation did not persist, compared with the matched control group. The donors also showed significantly lower odds for improvement in economic grades [OR 0.57 (0.47–0.71)] or higher odds for deterioration in financial status [OR 1.54 (1.23–1.93)] than the control group in the first year and succeeding time periods. Results: Live kidney donors may suffer from poor employment or low economic status even after their altruistic donation. Whether an advanced reimbursement program can reduce these disincentives should be further evaluated. Conclusions: Objective: Although studies have reported kidney donation’s adverse health outcomes, its socioeconomic impact on living donors requires further study. Methods: We performed a retrospective observational cohort study including a matched control group. We included 1,285 living kidney transplant donors from seven tertiary hospitals and a matched control group consisting of the same number of health screening examinees with similar baseline clinical and socioeconomic status from 2003 to 2016. Changes in employment status and household income were identified from the linked claims database, which includes employment and economic status information. The outcomes were compared between the donor and matched control groups on an annual basis using multivariable logistic regression analyses adjusted for various clinicodemographic characteristics. Results: The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of the sample was male. The living donors were at higher risk of being unemployed or struggling to maintain employment during the first two years after donation [e.g., first-year loss of employment, odds ratio (OR) 2.27 (1.55–3.33)]; however, this situation did not persist, compared with the matched control group. The donors also showed significantly lower odds for improvement in economic grades [OR 0.57 (0.47–0.71)] or higher odds for deterioration in financial status [OR 1.54 (1.23–1.93)] than the control group in the first year and succeeding time periods. Conclusions: Live kidney donors may suffer from poor employment or low economic status even after their altruistic donation. Whether an advanced reimbursement program can reduce these disincentives should be further evaluated.