Over the past 30 years, licensure and certification requirements for cardiovascular perfusionists have varied considerably in the United States. In addition to intraoperative perfusion for cardiac surgery, the role of cardiovascular perfusion has recently expanded to include extracorporeal membrane oxygenation and the management of organ recovery systems used for transplantation. Efforts by organizations such as the American Society of ExtraCorporeal Technology and the American Board of Cardiovascular Perfusion have led to the recognition of perfusion as a distinct allied health profession in many states. However, in other states, perfusionists remain less regulated, potentially compromising patient safety . This work will review the current perfusion licensure landscape in the United States and suggest strategies to regulate an increasingly complex and technological profession . We describe successful experiences from licensed and unlicensed states and highlight national variations in adoption. These examples emphasize the importance of ongoing legislative and regulatory focus on perfusion and the potential positive impact of active perfusion licensure. As the role of the certified clinical perfusionist evolves, innovative technologies and techniques such as extracorporeal membrane oxygenation, ex situ organ perfusion, in vivo lung perfusion, and normothermic regional perfusion continue to expand the scope of perfusion practice. One strategy to improve the quality of perfusion services nationwide is the broad adoption and implementation of compact perfusion licensure, an agreement between states allowing licensed professionals to practice in multiple states while maintaining a single license. Such a compact would pave the way for a more consistent and safer practice across states, underscoring the necessity of a multidisciplinary approach between perfusionists, anesthesiologists, and surgeons in improving patient safety.