question: BACKGROUND Since 2007, the National Living Donor Assistance Center has provided the most financial support to US living donors meeting specific income criteria by reimbursing travel, meal and lodging expenses. In 2019, the National Kidney Registry (NKR) started providing lost wages, travel and lodging reimbursement via their Donor Shield program. Donor Shield is automatically provided to donors who participate in kidney paired donation through the NKR or who donate at a Donor Shield Direct center, without any income restrictions. METHODS The support donors across the US received from the Donor Shield program between January 2019 and February 2020 was studied. RESULTS During the study period, 326 (25.9%) of the 1,260 donors covered by Donor Shield, from 46 programs received reimbursements amounting to a total of $647,384.45, with $472,389.97 (73.0%) covering lost wages. Median reimbursement per donor was $1,813.80 (range: $44.0 - $ 7,165.63). 81% of 108 reimbursed donors who were surveyed reported that the lack of these reimbursements would have posed a financial hardship, and 4% said they would have been unable to donate without this support. CONCLUSIONS Expansion of lost wages reimbursement programs to all donors in the US would be an important step towards achieving financial neutrality for this unique population, and could also help meet the growing demand for transplantable organs by increasing living donation rates.